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Lymphland International Lymphedema Online
| http://www.pressofatlanticcity.com/news/press/cape_may/article_2e3b1d5a-b160-11de-8214- 001cc4c002e0.html Cancer survivors enjoy nature, maybe some fish Print this Article Share this ArticleStoryDiscussionBy COURTNEY McCANN Staff Writer, 609-272- 7219 | Posted: Monday, October 5, 2009 | 0 comments Font Size:Default font sizeLarger font size. Sherry Sharisalerno, of North Wildwood, fly-fishes Sunday under the tutelage of instructor Ed Cabral, of Vernon, Sussex County, during Casting for Recovery at Outdoor World Lake and Shore campground in Dennis Township. DENNIS TOWNSHIP - Pamela Lawler stood hip-deep in lake water with waders and a fishing vest covering her clothes and a fly-fishing pole in hand. Next to her, seasoned fisherman Richard "Reggie" Regensburg, 71, pointed here and there to sunfish and bass swimming by. "There's a fish right here tapping on my boot," Lawler, 50, said excitedly as she cast her line again. Every so often, a shriek rang out across the water as one of the other 13 women stationed around the lake at the Outdoor World Lake and Shore campground reeled in a fish. As the women stood in the water enjoying the challenge of fishing and the peace of a perfect Indian summer morning, cancer likely was the furthest thing from their minds. But it was the one thing that tied them all together. The women were enjoying a three-day fly-fishing retreat as part of Casting for Recovery, a national nonprofit program that promotes fly-fishing as therapy for breast cancer survivors. Click here to see a photo gallery of the outing Dennis Township breast cancer survivors Jacqueline Bradley and Gerri Rescigno attended a retreat in northern New Jersey six years ago and were inspired to start a program in southern New Jersey. "Being out on the water was so peaceful," Bradley said. "You realize how important it is to take time for yourself. The laundry can wait. My husband can make himself a sandwich if he needs to." The retreat, funded by grants and donations, cost about $14,000, Bradley said, adding that more than 30 women applied for the 14 spots available. The women arrived at Outdoor World on Friday evening and spent most of Saturday learning how to cast. They fished for two hours on Sunday with the help of "water guides" from the South Jersey Coastal Fly Anglers club out of Ocean City. The fishermen signed on after club president John Loeper, whose wife is a breast cancer survivor, learned about Casting for Recovery at a fly-fishing show in Somerset. To prepare for the event, the anglers spent every Thursday night for weeks tying flies and putting together a fishing kit for each women. "We also spent three weeks out here testing the lake," Loeper said. "Catching a fish isn't the biggest part of this, but it's the icing on the cake." Lawler was diagnosed with breast cancer in December 2007. She had a mastectomy and underwent chemotherapy, and continued teaching history at Absegami High School in Galloway Township throughout her treatment. "My boss loves fishing, and he read about this program and told me I should try it," Lawler said. "I was like 'What?' I hadn't been fishing since I was a young girl." Lawler applied for the retreat in 2008 but had to wait until this year to be accepted. Upon arrival she was paired with Regensburg, a Palermo fisherman, teacher and archeologist. "I'm a history teacher, and he's an archaeologist," Lawler said. "They couldn't have paired us better." Lawler caught five fish Sunday, but bystanders couldn't tell who was more enthusiastic, the trainee or the teacher. "I love teaching women how to fly-fish," Regensburg said. "Because they don't 'muscle it,'" when they cast. Most of the women signed on for the weekend retreat to get away from home, work and doctor's offices. But they got some physical benefits in the bargain. The motions of casting in fly fishing help prevent lymphedema - swelling related to the lymphatic system - and strengthen shoulder muscles, which is good for women who have had mastectomies, said Doris Moore, a member of the retreat's support staff and a nurse with South Jersey Healthcare-Elmer Hospital in Salem County. "It's exercise, but it's pleasant, not forced," said Moore, herself a cancer survivor and former Casting for Recovery participant. "It's not like physical therapy. Here you can also have the joy of casting and maybe even catching a fish." A short distance from the water's edge, Ann Granata, of Egg Harbor Township, and angler Dave Dewees, of Cherry Hill, Camden County, walked along a dirt road towards Dewees' "secret fishing spot." Granata, 47, had salt-water fished before, but fly-fishing was something new for her. "You have to retrain yourself to do this," Granata said. "And you need patience." Granata has been cancer-free for about a year and a half. She suffered a setback in April when she developed an infection, went into sceptic shock and was in a coma for 18 days. Granata was originally on standby for the Casting for Recovery retreat, but made the list at the last minute when someone backed out. "There was a reason I was supposed to be here," said Granata. E-mail Courtney McCann: CMcCann@pressofac.com ===== Life-changing event Self-employed, single mother still recovering from effects of breast cancer By Monica Green October is Breast Cancer Awareness Month, and the Times-Review will feature breast cancer survivors each Monday of the month. When Leigh Anne Honaker found a lump in her breast, she immediately went to the doctor. “I did yearly mammograms,” the Cleburne woman said, “but I found the lump on my own.” She was 44 at the time, and her life changed forever in that moment. “My kids did not take it that well,” she said. “It was a real struggle.” Honaker has two children and is raising a great-niece. She also has a daughter-in-law and three grandchildren. She faced the battle as a self-employed, single mother. “I had to quit work because it ended up I had chemo brain real bad, and I couldn’t work if I wanted to because I couldn’t get my thoughts straight,” she said. “I’m a hairdresser. Working wasn’t much of an option.” Without work, money for treatments was hard to come up with. “Well I was one of the ones that did not have insurance so that was kind of a struggle but by the grace of God I was blessed with Dr. Trey Webb, Dr. Kent Hughes and Dr. Pot Luri,” she said. “Between those three I was able to have my biopsy and my mastectomy. “I will have to say Walls Regional Hospital too. Without them I couldn’t have done it either. They all pulled together and helped me get my biopsy and mastectomy at no charge or very minimal.” Luri led Honaker to a Medicaid program called Breast and Cervical Cancer Prevention. “I tell everyone about this program,” she said. “It has taken me through the rest of my journey for health insurance reasons.” Honaker went through two chemotherapy treatments. “The first one was the normal chemo, and the second one was the last resort, no other option chemo,” she said. After chemotherapy, she spent seven weeks in radiation, finishing in October 2008. “I tried to go back to work that October,” she said. “Just physically it was a very slow start. Mentally it was a very slow start. I got up doing pretty good, but with the economy I couldn’t afford to pay a lease so I had to quit.” She plans to begin working again soon. “My best friend is opening a salon and helping me get back on my feet, which is a godsend,” she said. “We’ re hoping to open Tuesday.” The salon, LaBelle Áme, is located at 212 S. Main St. Now 46, Honaker is gradually easing back into her routines. “It’s not back to normal,” she said. “I’m just a year out of radiation, so I got a little ways to go. I would say I’m about 75 percent back — mindwise too.” “I got lymphedema in my arm. That will keep me from being able to be 100 percent in my profession.” Honaker said the hardest part is when the treatments are over. “When it’s over, everyone thinks it’s over, when it’s not really for us,” she said. “You have all the testing to make sure it’s not back. It’s not ever over.” Another hard part is the body recovering, she said. “That physically has been the hardest for me,” she said. “When you’re self employed, and you have no spouse, and you’re the only income, and you have to bounce back — you can’t do it without friends.” Friends and support groups helped her through the struggle. “I joined the American Cancer Society support groups,” she said. “They were wonderful in helping out. We did Relay For Life, and we all had our own shirts. There were probably 30 or 40 of us.” She said she has also met many people since who have had it. “I was going through it with two people I know, and they both passed away. That was difficult,” she said. “When Stephanie [Huffman] passed I was freaking out, thinking ‘Am I going to be that person?’?” She advocates for breast cancer awareness with people she meets and through work. “You never know what people are going through until you’ve been through it yourself. It’s been a huge impact,” she said. “Mainly while I was sick and bald-headed, I was able to really advocate because people would approach me about it. I was able to share a lot of information, especially about the health care program. “I advocate a lot through my work and talking about it. Two customers have ended up going and getting mammograms and found out they have lumps. With the mastectomy and reconstruction, people always want to talk about that. I’m hoping with this new business we’re opening we can really push for breast cancer awareness. “People have got to be aware and get early diagnosis and do something about it. That’s what I’ve learned, never wait.” http://www.cleburnetimesreview.com/johnsoncounty/local_story_278154933.html?keyword=topstory -------- http://www.mansfieldnewsjournal.com/article/20091005/LIFESTYLE/910050303 Lymphedema patients find hope in local clinic By JAMI KINTON • News Journal • October 5, 2009 Print this pageE-mail this articleShare Del.icio.usFacebookDiggRedditNewsvineBuzz up!TwitterMANSFIELD -- There's no cure for her swollen legs and arms, but Tara Finnell said MedCentral/Mansfield Hospital provides a program to make life more manageable. "I just want people to know this is not a condition people just have to live with," said the lymphedema clinic occupational therapist. Finnell said in lymphedema, swelling occurs when the lymphatic system is damaged, which can be caused by radiation, significant trauma, obesity, infections, wounds or surgery. It can also be hereditary. "Doctors have just become aware of clinics like ours within the last couple years," Finnell said. "Before, they were just telling people that swelling was something they could do nothing for." Vickie Smith, 57, has been coming to the clinic weekly since May. The Mansfield woman, who struggles with swelling in her legs, said her doctor prescribed water pills to manage the problem. That approach, however, didn't seem to help. "It was really taking a toll on my life," Smith said. "After a while, I couldn't fit into my clothes. I couldn't get into a car. My friend was having to pick up my legs and put them in the car because they were so heavy." After a visit to The Ohio State University Medical Clinic, where she was diagnosed with lymphedema, Smith began therapy with Finnell. Monday was a typical visit. "Today, I'm going to unbandage her legs and then clean and lotion them," Finnell said. "Then I rewrap them. Vickie knows how to massage her skin. In the beginning, we just work a lot with educating the patient on what they need to be doing at home." Finnell said lymphedema can progress if not treated. "For example, if you don't treat a swollen arm, it can start to develop hard places from the proteins in fluid not moving," she said. "Your range of motion is decreased and can affect everything from bathing to dressing. I go over exercises with the patients to help them move the excessive fluid." Finnell said the frequency of visits to her office depends on the severity of the swelling. "At first, Vickie was coming to see me three times a week. Now she comes twice a week," Finnell said. She said swelling can occur anywhere to anyone of any age. "If you don't do anything, the problem will not get better, and you always risk the possibility of the swelling getting worse." Finnell said there is still no cure. "The fluid can be reduced, but you'll have lymphedema for life," she said. "You might break your wrist and it causes a flare up." Smith said since she has been seeing Finnell, she has lost 48 1/2 inches in her left leg and about 40 inches in her right. Last Monday was the first day since she started treatment that she was able to attend therapy with no assistance from a walker. "I had no hope before, but now I finally feel happy again," she said. "I've got a life now." jkinton@nncogannett.com 419-521-7220 ----- http://www.philstar.com/Article.aspx?articleId=511418&publicationSubCategoryId=80 What every Filipina should know about breast cancer AN APPLE A DAY By Tyrone M. Reyes, M.D. (The Philippine Star) Updated October 06, 2009 12:00 AM | Zoom Breast cancer is the most common cancer specific to women in the Philippines. In fact, the Philippines tops the list in Asia for the most number of breast cancer in women. According to the Philippine Cancer Society, an estimated 14,000 new breast cancer cases are diagnosed each year and nearly 6,300 deaths are expected from the disease annually. That is why it is imperative that Filipino women (and men, too) should possess adequate knowledge about this dreaded disease. This two-part series, written in support of the celebration of Breast Cancer Awareness Month this October, is meant to help in disseminating the latest facts and most recent advances about breast cancer. This week’s column will discuss the basics of the disease, and next week’s article will deal with advances in prevention, diagnosis, and treatment. BASICS Breasts are primarily composed of fatty and connective tissue called stroma. The muscles covering your ribs lie underneath the breast and the breast is suspended from the chest wall by ligaments. Within each breast is a network of 15 to 20 lobules. Each small lobule has a bulb. These bulbs produce milk. Thin tubes, or ducts, connect the lobes to the nipple (see illustration). There are two main kinds of breast cancer. They are: • Ductal, meaning it starts in the tubes, or milk ducts. • Lobular, meaning it starts in the milk-producing glands. There’s an early form of cancer called in situ. These cancers aren’t yet invasive and are contained in the milk ducts. However, if left alone, in situ cancers can develop into invasive cancers, which have the capability of spreading outside the breast. With noninvasive cancer (stage 0) and early-stage (stage I and II) invasive varieties, the cancer is confined to just the breast. A surgical option for early-stage breast cancer is a lumpectomy, followed by radiation treatment. TYPES OF BREAST CANCER Breast cancer is categorized by the appearance of the cancer cells and their cellular origin. The most common types of breast cancer are: • Invasive ductal carcinoma (IDC). This type starts in a duct and then invades connective or fatty tissue that surrounds the duct. It can travel to the lymph nodes or enter the blood stream and spread to other parts of the body. It is the most common type of breast cancer, making up 75 percent of all invasive cancers. • Invasive lobular carcinoma (ILC). This type starts in a milk-producing gland (lobule), and then invades the surrounding connective or fatty tissue. Like ductal carcinoma, it can spread to other parts of the body. It accounts for 15 percent of invasive breast cancers. This tumor may be more difficult to diagnose, as it can first show up as breast thickening rather than a firm mass. • Other invasive ductal-type cancers. These less-common invasive cancers include medullary, mucinous, tubular, and papillary. Combined, these account for about 10 percent of invasive cancers. • Ductal carcinoma in situ (DCIS). This non-invasive cancer is made up of abnormal cells in ducts that haven’ t spread to the connective or fatty tissue. It’s the most common noninvasive cancer. Unchecked, it could turn into invasive cancer. • Paget’s disease. This cancer is associated with nipple changes such as eczema, itching, and thickening of the dark circle of skin (areola) around the nipple, and can be invasive or noninvasive. About 50 percent of those with the disease have an associated cancerous lump. Paget’s disease accounts for less than five percent of all breast cancers. • Inflammatory breast cancer. This is an aggressive cancer in which the affected breast looks inflamed, red, and feels warm. The skin can have the appearance of an orange peel, with an engorged look. It is often mistaken initially for a breast infection (mastitis). It tends to occur more often in younger women. It accounts for about two percent of all cancers. STAGING YOUR CANCER Tumor size, lymph node involvement, and whether the cancer has spread to other parts of your body will determine the stage of your cancer. A key part of staging breast cancer is to determine whether an invasive tumor has spread to regional lymph nodes. To accomplish this, a test called sentinel node biopsy has become the gold standard. The sentinel nodes are the lymph nodes in the underarm area that are usually the ones closest to the area of the breast involved in the cancer. Using the result of the sentinel node biopsy, doctors can determine whether additional lymph nodes need to be removed. A surgeon may use any of several methods to locate the sentinel nodes. These include injecting a blue dye into the area of the breast where the tumor has been identified, the use of a radioactive tracer injected into the breast, or both. Once identified, the surgeon removes the sentinel nodes and a pathologist examines them for cancer cells. If no cancer is seen, then no further lymph nodes need to be removed. If the sentinel node does contain cancer, the surgeon will remove additional lymph nodes from the armpit (axillary lymph node dissection) to determine how many lymph nodes are involved as well as to remove the cancer in the area. Properly done, a sentinel node biopsy can accurately identify the lymph node involvement of the cancer 97 percent of the time. Sentinel node biopsy has spared many women from axillary node dissection and its complications, such as arm swelling (lymphedema). Additional information important to determine treatment includes identifying the cancer’s: • Grade. This is determined with tissue taken at the time of the core biopsy or surgical biopsy. The grade is based on how aggressive individual cancer cells appear under a microscope. There are different systems to grade cells, but a higher number typically means a more aggressive cancer. • Stage. This refers to the cancer’s size and whether it has spread (metastasized) to lymph nodes or other parts of the body (see illustration). To further determine the stage, a history, physical exam, blood tests, and chest X-ray may be done. In select cases, other imaging techniques, such as a bone scan, computerized tomography (CT) imaging or positron emission tomography (PET) scans, may be obtained. The various stages are: • Stage 0: The cancer is contained within the duct — ductal carcinoma in situ (DCIS). • Stage I: The invasive cancer is two cm. or less and is only on the breast. • Stage II: The invasive cancer is greater than two but less than five cm. or has spread to the lymph nodes. • Stage III: Advanced cancer that’s 5 cm. or more in size and has spread to lymph nodes or has involved the lymph channels and skin of the breast (inflammatory breast changes). It hasn’t spread beyond to the distant organs of the body. • Stage IV: Advanced cancer that has spread to other parts of the body such as lungs, liver, bones or brain. THE ROLE OF ESTROGEN AND GENETICS Estrogen is the primary female hormone, and research indicates it may play a key role in the development of breast cancer. It’s known to stimulate the growth of cancer cells in hormone receptor positive tumors. Researchers have also found that the more years a body is exposed to estrogen, the greater the risk of developing breast cancer. A woman’s genetic makeup can also play a role in developing breast cancer. Mutations or changes in the breast cancer gene (BRCA1, BRCA 2) increase the risk of developing both breast and ovarian cancers. However, such mutations account for only five to 10 percent of all breast cancers. Male breast cancers are rare, representing less than one percent of overall cases of breast cancer. Men can develop breast cancer at any age, but it’s generally diagnosed between ages 60 and 70. Men can develop breast cancer types similar to those of women. Risk factors include exposure to radiation, having a disease related to high levels of estrogen (such as in certain liver diseases), or a family history of breast cancer, particularly with BRCA 2 gene mutation. --------- How we're winning the war on breast cancerStory Highlights More than 190,000 will get a breast cancer this year, but many will live cancer free Mastectomy, removal of the breast, isn't nearly as devastating as it used to be New techniques targeting tumors with much more precision updated 11:44 a.m. EDT, Fri October 9, 2009Next Article in Health By Susan Brink (Health.com) -- I was 18 when I first felt a lump in my breast. Of course, I was convinced that I was going to die. This was three decades ago -- back when we knew far less about breast cancer. A general surgeon removed the lump, which, thank goodness, wasn't malignant. Prevention, detection and treatment have all improved over the years in the battle against breast cancer. But before I was even a fully developed woman, I was rendered lopsided and scarred. My surgeon had wielded his scalpel with outsized caution, cutting out a quarter of my breast just to test a pea-size growth. He gave little thought to how his young patient would feel about a healthy breast, surgically deformed. Fortunately, far fewer women have to put up with such blunt "solutions" these days. Although more than 190,000 people will get a breast cancer diagnosis this year, many of them will go on to live wonderfully cancer-free lives because of enormous improvements in how we detect, treat, even prevent this disease. Here's how we're actually winning the war on breast cancer. We know more than ever Once identified only by how far the disease had advanced -- such as stage 0 or stage IV -- scientists now know that breast cancer is actually many diseases and that each tumor has a unique genetic fingerprint. There are luminal A and B, HER2 type, and triple negative, among others. That means physicians can more effectively target treatment with therapies that have the best chance of working. Treatment gets personal Researchers now know that women whose cancer is diagnosed in the early stages of estrogen-receptor- positive cancer respond well to hormonal therapies including tamoxifen and aromatase inhibitors, which starve breast cancer cells of the hormones they need to grow. And, since 2004, the Oncotype DX test that helps identify the best treatment has been available to women who get this type of cancer -- which is about 75 percent of breast cancer patients. Don't Miss Animation confronts Gaza breast cancer taboo Male breast cancer patients blame water at Marine base "In the past, we were giving chemotherapy to women who would have done just as well on hormonal therapy," says Dr. Susan Love, president of the Dr. Susan Love Research Foundation and clinical professor of surgery at the University of California, Los Angeles. "Now, with this test, we can tell if a woman doesn't need it. That's great." This means you might be spared chemo's nausea, exhaustion, and hair loss. About 100,000 women have gotten the test. Patients should ask their doc whether it's right for them. RealSimple. com: Portraits in breast cancer Surgery is less traumatic We can only wish for the day when mastectomy -- removal of the breast -- becomes unnecessary. But the procedure isn't nearly as devastating as it used to be. Total skin-sparing mastectomy, in which the surgeon cores out the breast tissue while saving the skin envelope, can work for many women who don't have a tumor under the nipple or close to the skin. "For people who have a good result, it can be hard to tell they've even had a mastectomy," says Dr. Laura Esserman, director of the Carol Franc Buck Breast Care Center at University of California, San Francisco. While several centers offer this procedure, "I would suspect that less than 10 percent of women are offered this option," she says, so women should ask for it. Even if the total skin-sparing surgery isn't right for you, there's little chance that you'd need a radical mastectomy to remove the breast, the underlying chest muscles, and all underarm lymph nodes. Depending on the tumor, a common option is lumpectomy, in which the tumor and a margin of surrounding tissue are removed, combined with radiation therapy. The choice of more than 60 percent of women (if they are given the option), lumpectomy plus radiation has proven as effective as mastectomy for overall survival. Radiation is much safer If a woman needs radiation, new techniques target tumors with much more precision -- and the benefits are huge. In some cases, the standard six weeks of treatment can now be reduced to as little as one week, cutting down on the fatigue many patients feel. Better planning and targeting also decrease the chances that radiation will lead to heart damage, and irradiating only part of the breast leaves open the possibility that the treatment can be used again if the disease returns. Health.com: Can Twitter and Facebook help fight breast cancer? Reconstruction looks great There's a new specialty emerging that combines breast cancer surgery with plastic and reconstructive surgery. Called oncoplastic surgery, "it lets us look at a woman in a holistic way," says Dr. Gail Lebovic, president of the American Society of Breast Disease. Lebovic is one of a handful of oncoplastic leaders across the country, each one busy training other surgeons who plan for a good cosmetic outcome even before the initial cut to eliminate cancer cells. A woman with large breasts, for example, might have a lumpectomy, healthy tissue pulled together to minimize distortion, and an equal breast reduction on the other breast. "When you're able to offer reconstructive techniques at the same time, breast cancer surgery is not as horrible a thought," Lebovic says. She urges patients to discuss cosmetic results before surgery. Health.com: Sheryl Crow talks about life after breast cancer There are fewer complications For years doctors doing surgery on women with breast cancer would remove most of their lymph nodes in the area of a tumor. The painful cost? A high risk of lymphedema, or extreme swelling and pain in the arm. That's what happened to a friend of mine: Her arm swelled, months of therapy ensued, and she had to hold the arm high in the air for as many hours as she could stand. That happens less these days because surgeons often remove just the "sentinel" lymph node -- the first lymph node likely to be reached by spreading cancer cells. If that node shows no signs of cancer in a biopsy, additional lymph nodes can be left alone. "The likelihood of getting lymphedema after sentinel-node biopsy is less than 5 percent," says Dr. Monica Morrow, chief of the breast service at Memorial Sloan-Kettering Cancer Center in New York City. And if a woman has had a lot of lymph nodes removed and is in danger of developing inflammation, new research suggests that past advice to avoid weight-bearing exercise may be misguided. In a study of 141 breast cancer survivors with lymphedema, those who took weight-lifting classes saw less worsening of their condition and fewer symptoms, compared with the women who did not lift weights. Meanwhile, another new study suggests that actually finding microscopic tumor cells in lymph nodes near the tumor may help determine which patients need the most aggressive treatment. You can reduce risk! Health Library MayoClinic.com: Mastectomy -- surgery to treat or prevent breast cancer MayoClinic.com: Prophylactic mastectomy -- breast cancer prevention for high-risk women Although scientists say that the evidence linking good nutrition -- lots of fruits, vegetables, and grains -- to a lower risk of breast cancer isn't totally convincing, they know that some habits really do help. There's a clear link between even moderate drinking and a slightly increased risk of breast cancer, so cutting down is worthwhile. Controlling your weight appears to be superhelpful, too: Significant weight gain in adulthood, between the ages of 20 and 50, may double the risk of breast cancer. And studies show that moderate to vigorous exercise, like fast walking or swimming, can lower your risk by 30 percent. Health.com: Knowing your mother's health history can lower your risks Research is ramping up A new study launched this year may generate vast amounts of crucial information for decades to come. The Love/Avon Army of Women project has enrolled more than 300,000 women and hopes to recruit a million of all ages and every ethnicity, some who have breast cancer and some who don't. With those kinds of numbers, researchers can begin to identify risk factors that might change the breast cancer prevention landscape forever. "We'll be asking questions about oral contraceptives, fertility drugs, hair dye, deodorant -- everything," Love says. The effort will span decades. And, just as the Framingham Heart Study identified common heart disease risks like high cholesterol, smoking, and obesity, this study could ultimately point out what really causes breast cancer and how to prevent it http://www.cnn.com/2009/HEALTH/10/09/war.breast.cancer/ -------------------------------- http://www.morrisdailyherald.com/articles/2009/10/09/18735924/index.xml Wes Williams, director of physical therapy at Vital Care Physical Therapy, works with patient Phillip Ortiz. Vital Care is celebrating National Physical Therapy Month this October (Photo courtesy of Vital Care Physical Therapy) ShareVital Care Physical Therapy is celebrating National Physical Therapy Month. National Physical Therapy Month, sponsored by the American Physical Therapy Association (APTA), is a nationwide observance held each October. This year’s theme, “Move Forward: Physical Therapy Brings Motion to Life,” reflects the physical therapist brand, “Physical therapists help you restore and improve motion to achieve long-term quality of life.” “Freedom of motion is vital to our lives,” said Wes Williams, PT, MBA, director of physical therapy at Vital Care Physical Therapy and Sports Rehabilitation. “Motion is anti-aging and something we tend to take for granted until we lose it.“Physical therapists are experts in the way the body moves. We can help improve people’s quality of life by helping them move freely, so they can do the things they want to do without the pain and discomfort.” When APTA went out to conduct consumer research to learn about attitudes and perceptions related to physical therapists, consumers made it clear that they were more likely to choose a physical therapist if they knew they could significantly improve mobility to perform daily activities. Consumers would also likely choose a physical therapist if it would provide an alternative to painful and expensive surgery, as well as manage or eliminate pain without medication. Physical therapists are highly-educated, licensed health care professionals who can help patients reduce pain and improve or restore mobility — in many cases without expensive surgery or the side effects of prescription medications. Vital Care Physical Therapy and Sports Rehabilitation provide specialized treatment to patients with orthopedic, sports, recreational and work injuries. Vital Care also has specialized programs for hand therapy, lymphedema, vestibular/balance issues, women’s health and work hardening. Vital Care Physical Therapy has locations in Morris, Ottawa, Joliet and Bolingbrook. To learn more about conditions in which physical therapists can treat, or to learn about programs offered at Vital Care, visit the Web site www.vitalcarept.com. ------------------------------ October is National Physical Therapy Month October 10, 2009 Sanford Hospital Luverne Physical Therapy Staff: L to R: Brooke Vanden Hoek, PT; Kyle Hailey, PTA; Jennifer Hoefert, DPT; Jobi Colwell, PT; Kathleen Loosbrock, PTA; Pat Smedsrud, PT; Holly Sehr, DPT; Brynn Ladd, PT; and Tracy Kramer, PT In honor of National Physical Therapy Month, Sanford Hospital Luverne Physical Therapy Staff will offer free cane and walker checks on Tuesday, Oct. 13, 9:30 – 11:30 a. m., and Thursday, Oct. 29, 1:30 – 3:30 p.m. 47,000 senior citizens visit emergency rooms each year because of falls resulting from improper use or “fit” of their walking aids. An assessment by a physical therapist can help prevent fall-related injuries by making sure walking devices are appropriate and “fit” the user correctly. In honor of National Physical Therapy Month, Sanford Hospital Luverne Physical Therapy Staff will offer free cane and walker checks on Tuesday, Oct. 13, 9:30 – 11:30 a.m., and Thursday, Oct. 29, 1:30 – 3:30 p.m. Therapists will check the height and functionality of canes and/or walkers and provide education and tips to make sure they are the most beneficial and appropriate for the user. Refreshments will also be provided. More about physical therapists Physical therapists are highly-educated, licensed health care professionals. They are experts in examining and treating conditions involving the muscular, nervous, and skeletal systems that affect people’s abilities to move and function as well as they would like in their daily lives. Because people of all ages – from the newborn to the aged – have the need to move and function, physical therapists work with patients of all ages. Physical therapists examine each individual and develop a plan of care specifically for that person, using treatment techniques that promote the ability to move, reduce pain, restore function, and prevent disability. Physical therapists can also help prevent loss of mobility by developing fitness and wellness-oriented programs for healthier, more active lifestyles. Many people know physical therapists work to help patients suffering from orthopedic problems, like low back pain, knee surgeries, etc., to reduce pain and regain function. Others may be aware of treatments physical therapists provide to assist patients recovering from a surgery or stroke to regain the use of their limbs and walk again. Physical therapy may also improve the following conditions: Sprains/strains, Low back pain/Neck pain, Headaches/Tendonitis, Whiplash/Jaw joint dysfunction/Muscle bruises, Joint limitations, Muscle or tendon tears, Cartilage or meniscal injuries, Ligament injuries , Post-surgery rehabilitation, Arthritis/Joint replacements, Generalized weakness, Balance or walking conditions, Nervous system conditions, Developmental delays, Many other conditions Sanford Hospital Luverne Physical Therapists also offer aquatic therapy, wound care, workstation evaluations, pre/post-natal exercise programs, and lymphedema treatment. Most forms of physical therapy treatments are covered by insurance, but specific coverage details may vary with each plan. Sanford Hospital Luverne’s physical therapy staff includes seven physical therapists, two physical therapist assistants, and three rehabilitation aides. For more information, contact the Sanford Hospital Luverne Rehab Services Department at (507) 449-1229 http://www.noblescountyreview.net/default.asp?storyid=46050&secid=101 ------------------- PASS CHRISTIAN — The Pass Christian’s Boys’ & Girls’ Club Third Annual Pink Heart Fund’s Walk of Hope will be Nov. 7 at the club, 6303 W. Wittman Road. registration is 7 a.m. Walk is 8 a.m. Participants can decorate their child’s wagon or stroller. The event also includes face paintings, craziest team award, children’s live art auction and more. All proceeds will benefit the Pink Heart Funds, a nonprofit organization that provides free wigs for children and adults with hair loss due to disease or injury, andn free breast protesis and lymphedema sleeves. Pre-registration is $20, registration day of walk $25, PINK VIP is 50, and children age 10 -18 $10. Details: 452-9791 or www.pinkheartfunds.org. ------- Shortening a woman's ordeal Cancer trial uses 'chemo' at same time as narrowly focused radiation Rhonda Grenier and her husband, Kevin, at their White Plains home in Charles County. She participated in a trial using a shorter period of radiation therapy. (Baltimore Sun photo by Karl Merton Ferron / October 9, 2009) Hospitals and Clinics By Kelly Brewington | kelly.brewington@baltsun.com October 12, 2009 When Rhonda Bautista Grenier learned she had breast cancer at age 42, she not only faced a terrifying diagnosis, but the daunting logistics of treatment. How could she tackle a grueling schedule of chemotherapy and radiation, full of painful side effects and hours spent away from three demanding teenagers and a full- time job? Grenier learned of a new clinical trial at Johns Hopkins Kimmel Cancer Center that promised to shorten treatment from more than seven months to as a little as seven weeks for women like her who had been diagnosed with early-stage breast cancer. Instead of treating the cancer first with months of chemotherapy, then weeks more of radiation, patients received chemotherapy and radiation at the same time. The radiation treatments were significantly shortened by delivering higher doses to just a portion of the breast. Combining chemotherapy and radiation treatments was once unheard of in breast cancer treatment, because it posed a high risk of toxicity, resulting in painful, disfiguring burns. But with the experimental treatment at Hopkins showing promising results - fewer side effects, less toxicity and increased convenience for patients - a skeptical Grenier decided to go for it. "The C-word alone is devastating, then you have to decide how you're going to attack this thing," said Grenier, now 46. "The way I looked at it, this new trial was attacking the cancer from both angles at the same time. I was really scared, but it sounded logical to me." As new technologies enable specialists to detect breast cancer earlier, researchers are searching for ways to treat the disease faster, in shorter intervals and with greater precision. Hopkins' technique is the latest among many to attempt to shorten the duration of radiation, in particular. These methods target women with early- stage breast cancer whose tumors were first removed by lumpectomy. A clinical trial in Canada last year found that giving women just three weeks of radiation to their entire breast worked just as well as the standard five or more. Another huge national trial is under way testing whether giving high doses of radiation to just a portion of the breast is as effective as treating the entire breast. And still other researchers are experimenting with high-tech tools that administer radiation in specialized ways. One, known as MammoSite, is a small balloon connected to a tube that is placed in the breast for several days. Radiation is given through the tube and the balloon is removed a few days later when the treatment is completed. At University of Maryland Medical Center, researchers have received funding from the National Institutes of Health to develop a device that delivers high doses of radiation to small areas. Their hope is that one day women may never need to go under the knife to have their cancers treated - and cured. For many women, a cancer diagnosis comes at the most productive part of their lives as they juggle the demands of work and family life. It means getting time off work for treatments, finding a baby sitter and adding something scary and exhausting to their already chaotic schedules. "Coming in on a daily basis for radiation is tiresome. Shortening that treatment - that's something that makes a great deal of difference to them," said Dr. Eric Winer, director of the Breast Oncology Center at the Dana- Farber Cancer Institute in Boston. Shortening treatment is not just about improving quality of life; it has practical implications, he said. Some women don't show up for their treatments because it takes too long, or they have to travel too far or they can't get time off work. Shorter courses mean being able to deliver treatment to more people, he said. Reducing the course of radiation also means limiting radiation exposure to other areas of the body - such as the lungs, ribs and even the heart, said Dr. Richard Zellars, the assistant professor of radiation oncology at Hopkins who is heading the trial. Not everyone is convinced such techniques will be proven successful - and safe - in the long run. For now, experts aren't sure if treating just one portion of the breast with radiation will be as effective as treating the entire breast. It can take more than a decade for side effects to appear, said Dr. Nicole Simone, assistant clinical investigator for the radiation oncology branch of the National Cancer Institute. This could be especially true of the Hopkins trial, in which chemotherapy and radiation are combined, she said. "This could be phenomenal for the patients not to spend so much time trying to eradicate their disease, but I would worry with this particular trial, that there would be more long-term toxicity: increased skin pigmentation, blood vessels more apparent on the skin and lymphedema - swelling of the arm." Dr. William F. Regine, chief of radiation oncology at University of Maryland Medical Center, said combining chemotherapy with radiation could pose more risks than advantages. Other experiments are treating women with radiation for just one week. "I think adding chemo would make injury more severe," he said. "Some people would say, great, let's do it all at once - but we need to ask, was it really worth exposing them to this, when we can give just a week of radiation?" Zellars began his trial in 2004 and so far 30 women have participated. When he pitched the idea to Hopkins' Institutional Review Board - which must approve and monitor trials - one member was so aghast that she screamed at him, Zellars said. Prior studies had shown that combining radiation and chemotherapy caused burns as severe as third degree, and researchers quickly abandoned the idea. But those studies had treated the entire breast with radiation. If radiation beams were used to give a very targeted dose, the side effects would actually decrease, Zellars reasoned. So far, preliminary findings, published this summer in the Journal of Clinical Oncology, have indicated that to be true. Women actually showed fewer side effects than with standard treatment - 80 percent had skin redness from the radiation, but not severe burning as some had feared, and 20 percent had no visible burns. Other side effects include what is typical of cancer treatments - fatigue from radiation and nausea and vomiting from chemo. "They're doing fantastically well," he said of the study's participants. After receiving surgery to remove the breast tumor and surrounding tissue, women are given daily radiation for three weeks, instead of seven. Chemotherapy is given typically once every two weeks and starts at the same time as radiation, continuing for an extra four weeks after the radiation ends. ------ Living with lymphedema Dubai : When Raja A.F. was referred to Dr Mohan Rangaswamy, Specialist Plastic Surgeon, by a colleague at Welcare Hospital in Dubai in June this year, she had tried a variety of treatments in several hospitals, both within and outside the UAE. Sharmila Dhal, Senior Reporter Published: 00:00 October 15, 2009 The surgery lasted six hours by the end of which Raja’s weight came down from 180kg to 125kg.Image Credit: supplied photoA detailed investigation revealed that the cause for her lymphedema was a rare condition called lymphedema prcox where the lymph vessels have disappeared at puberty or at 20-30 years of age due to unknown reasons. Extreme challenge Dr Rangaswamy said the lymphedema had reached extreme proportions (Stage 4). He was convinced that Raja needed surgical debulking, a form of reconstructive plastic surgery. He had ample experience in treating lymphedema, gathered for the most part at the Lymphology Clinic of the premier All India Institute of Medical Sciences in Delhi where he worked for six years earlier. The first task at hand was to make the limb softer with a week of intensive pressure bandaging and pneumatic pump treatment to compress it and raise the pressure of the tissue fluid to push it inward into the veins. Six litres of excess lymph fluid and 5.5 litres of fat were then removed through liposuction, followed by removal of 4.6kg of excess skin and other tissues through the actual surgery called debulking. The entire process lasted six hours. By the end of it all, Raja's weight came down to 138kg from 180kg. Liposuction was done by two surgeons working simultaneously using blunt cannulae and suction pumps. To- and-fro movements made in the tissue planes selectively removed the fat, leading to further softening and reduction of the size of the limb. Debulking "The debulking was facilitated by combining it with liposuction, so the patient did not lose much blood. Otherwise, these tissues bleed a lot," said Dr Rangaswamy. "As it was difficult to hold the tissues up for surgery, we had to devise special instruments," said Dr Rangaswmy who used a myomectomy screw, which is normally used to hold the uterus during fibroid removal. A patient hoist, which is used to lift heavy patients, was employed to raise the limb as it was very heavy. A large foam incline plane was designed by a local company to enable the limb to be elevated above heart level. He said the debulking had made Raja's leg suitable for life-long management. But the excess protein-rich fluid would have to be forcibly returned to the blood circulation every day. For this, she will have to use compression bandages, custom-made stockings and pneumatic pumps on a regular basis. What is lymphedema? When blood is pumped by the heart, it reaches the tissues through the arterial system which ends in filters called capillaries. Here, the nutrition and oxygen-rich fluid is filtered out at one end to carry the ingredients to cells and tissues. The filtered fluid then returns to the capillaries at the other end which form veins and bring the blood back to the heart. About one-two per cent of protein-rich fluid (lymph) that has leaked out of the capillaries stays back in the tissues. It returns to the veins through fine vessels called lymphatics, but if they are blocked, it accumulates in the tissue spaces leading to a swelling called lymphedema. The skin becomes rough and thick with mushroom-like nodules and cracks resulting in an elephant-like leg. What are its causes? The commonest global cause is filariasis or a parasitic disease spread by mosquitoes. Upper limbs may also swell following surgery or radiation treatment for breast cancer. But a rare cause is a condition called lymphedema prcox - the lymph vessels disappear at puberty or at 20-30 years of age due to unknown reasons. What are its symptoms? Victims usually suffer from heavy weight, unsightly appearance and interference with daily activity. They suffer from painful infections, or lymphangitis, in the swollen limb leading to fever. Can it be cured? Lymphedema can be controlled but not cured. http://gulfnews.com/news/gulf/uae/health/living-with-lymphedema-1.514598 ----------------------------- Two time cancer survivor helps other women at In the Pink boutique Jeri Millard's In the Pink boutique is a place for women to shop and heal. By Maggie FitzroyStory updated at 10:20 AM on Wednesday, Oct. 14, 2009EMAILPRINTBLOG THISCOMMENTBuzz up! Photos Photo 1 of 3 MAGGIE FITZROY/Staff As her son Barron, 2, watches, breast cancer patient Ashley Harris of Ponte Vedra Beach tries on a custom- made compression sleeve for lymphedema with the help of Jeri Millard (right), owner of In the Pink, a Boutique for Women Living with Cancer, in Jacksonville Beach.Photo 2 of 3 MAGGIE FITZROY/Staff Jeri Millard has survived breast cancer and cervical cancer. She had the dream of opening a boutique such as In the Pink, where women with cancer could shop and heal, cope and survive the effects of their cancer. Photo 3 of 3 MAGGIE FITZROY/Staff Looking in the mirror, breast cancer patient Anne West of Ponte Vedra Beach tries on a new wig at the In The Pink boutique. » Jacksonville woman struggles with a dear friend's death from breast cancer » Cancer essay: Allyson Beatty » Cancer essay: Judy Martin When Jeri Millard received chemotherapy for breast cancer years ago, her hair began to fall out in clumps, and she needed to have it shaved off. She went to a public beauty salon. But as the razor buzzed, people stared at her. She felt ill. And cried. "No one should have to experience this," she declared to herself. She decided a woman shouldn't have to drive around town to find a prosthetic bra after a mastectomy. She shouldn't have to search to find a swimsuit to fit her altered body, or skin care products to soothe skin damaged by radiation. She needed a one-stop place to shop or buy a wig - where everyone knew her needs, and her name. Millard, of Ponte Vedra Beach, realized her dream in July when she opened In the Pink, a Boutique for Women Living with Cancer. The non-profit 501(c)(3) shop and salon in Jacksonville Beach is dedicated to helping women heal, cope and survive the effects of all types of cancer, physically and emotionally. Most of the store's proceeds are returned to customer services and products such as free bras and wigs for those who qualify financially, Millard said. As women from around the Beaches, Jacksonville and beyond have discovered the boutique, business has boomed, Millard said. "People keep telling me it's unique." Debbie Diramio of Jacksonville Beach is a regular customer. One recent day, she came in with friend Laura Bishop to shop for a Save the Ta Ta's brand T-shirt. Millard greeted Diramio and helped her find her size. She knew Diramio's history, that she was a breast cancer survivor who'd had a mastectomy and reconstructive surgery. And that she was being treated again with chemotherapy and radiation because the cancer is back, in her bones. Diramio looked trim, fit and perky. Her brown hair, really a stylish new wig, framed her face. "This place has brought back beauty to her life," Bishop said. "And self-confidence." "It makes you feel normal," said Diramio, who's also purchased hats, scarves and other clothing there. "I don't feel normal," Diramio said. "But if I can look like myself, it makes me feel better." Millard, who has also survived cervical cancer, began looking for a place for her boutique about five years ago. She discovered a quaint beach bungalow on Third Street in Jacksonville Beach that seemed perfect, but at the time it was a children's shop. "Everything happens for a reason," she said, because a few months later, she ruptured a disc in her back, and was paralyzed from the waist down. After 31/2 years of rehabilitation, she was back on her feet, and once again began planning her shop. In March, as she was driving by 522 Third St. N., the beach bungalow, she noticed a "For Lease" sign. "I was so happy," she said. "I went home and told my husband, 'The house is ready. It's there.' " Built in 1929 by the Mickler family, early Beaches area settlers, the one-story cottage has eight sunny rooms that give it a cozy feel. Millard's husband, Marty, worked for several months to transform the interior into a women's boutique. Pink flowers adorn the front and back, where parking is available. The front room is a quiet reflection room; another room is the beauty salon, where hair stylist Janet Underwood sees customers. Women can be privately measured for post-surgical camisoles and prosthetic bras in a fitting room. Other rooms hold a variety of products, including Lindi Skin products, designed for cancer patients' skin, which Millard said can peel and become dry, raw or leathery from treatments. The house "has a great spirit," Millard said. Despite opening in the midst of a national recession, she said she has mixed feelings about her success. Medical insurance covers some products, but there seems to be such a need that women are coming from as far away as Georgia and South Carolina. "Business is great," she said. "But that's really sad, because that means a lot of people have cancer." After helping Diramio find a shirt, Millard turned to help breast cancer survivor Ashley Harris of Ponte Vedra Beach, who came in to pick up a custom-fitted compression sleeve she'd ordered for lymphedema swelling in her right arm. "I love it," Harris said of the shop. "I wish it had been open when I was first diagnosed in 2008." In the salon, breast cancer survivor Anne West of Ponte Vedra Beach tried on a new wig for which she'd been fitted. Underwood had shaved off West's hair two weeks before, and West received the wig for free, courtesy of In the Pink. She purchased another one, so she could have two. "It looks real, and it feels real too," West said as she looked in the mirror. "This place is amazing." Since she still faces months of chemotherapy, West discussed makeup needs with Underwood, who advised her how to deal with thinning eye brows, once that became a problem. West said she'd be back. "They keep coming in, all through treatment, and we see them through," Millard said. "They become like family to us. I like that, because we become part of their journey through cancer." Maggie FitzRoy can also be reached at (904) 249-4947, ext. 6320. -------------------------------------------------------------------------------- In the Pink fundraiser - A Cafe, Chocolate and Charity evening of gourmet coffee and desserts is slated for Wednesday, Oct. 21, at In the Pink, 522 Third St. N., Jacksonville Beach. The free event from 6:30 to 9:30 p.m. will include a raffle and live auction featuring a trip to Villa Cavita, a small coffee plantation in the mountains of Costa Rica. - For more information, visit jaxinthepink.com or call 372-0029. --------------------------------- Lifting in memory of a friend Andy Tucker raises money for memorial fund supporting fitness BY SCOTT PAGE Gulf Breeze News scott@gulfbreezenews.com Local fitness expert Andy Tucker strains to lift more than 400 pounds of dead weight multiple times at The Club. The Good Shepherd Lutheran School family is missing one of its most beloved members, Randy Halsall, who died Aug. 21 after a valiant battle against cancer and lymphedema. Halsall volunteered at the school for the last six years of his life. Though his life has ended, Halsall’s impact on the staff and students continues to be felt as a memorial fund in his name is being used to improve the quality of physical education at the school. “Randy wanted to give a living gift instead of a memorial to Good Shepherd,” said his widow, Leslie Halsall. Per his wishes, Halsall’s family and friends have organized the Randy Halsall Memorial Fund to benefit physical education at Good Shepherd. Good Shepherd, which began the Presidential Fitness Program last year, already has improved its physical education program and has big plans for the future. After his 15th lift, Tucker collapses to the floor in utter exhaustion. The 405 pounds is twice his body weight. “We have already put in a track and a long-jump pit,” said physical education teacher Dave Matthews. The school plans to use the rest of the funds to purchase soccer equipment, enhance the long-jump pit and construct pull-up bars, among other things. Halsall, a former professional football player, felt that physical education was important for building well- rounded, confident people. On Friday, Oct. 9, the fund received a $1,587 donation from Andy Tucker, owner of Acceleration Fitness and one of Halsall’s close friends. Tucker met with Leslie Halsall and several members of the Good Shepherd staff at The Club to present them with the donation. Tucker, in Halsall’s honor, campaigned and secured sponsors for a weightlifting fundraiser. He dead-lifted 405 pounds, twice his body weight, as many times as he could. With each consecutive rep, Tucker raised more money for the memorial fund. Photos by Joe Culpepper/GBN Tucker lies flat on his back trying to catch his breath moments after his lifts. He raised more than $1,500. “Weightlifting was Randy’s passion,” Tucker explained. “I thought this was the best, most fitting way to honor his life.” Tucker completed 15 reps that garnered over $1,500. He said he felt as though Randy’s spirit was there helping him continue beyond his expectations. “I was just hoping to get the weight up seven or eight times,” Tucker said. “Once I got to 10 and beyond, I felt like Randy was there helping me.” Halsall, who was born in Toronto, Canada, was an athlete throughout his life. He attended Wake Forest University, where as a freshman he was a part of the 1970 ACC Championship football team. Submitted photo Randy Halsall led Wake Forest to the 1970 ACC football championship. Following his college career, Halsall was selected by the Toronto Argonauts as the first overall pick in the 1974 Canadian Football League Draft. During his career in the CFL, Halsall even had the opportunity to play in the Grey Cup. He used his athletic talents to find success in life as a personal trainer and body builder after his playing days ended. Halsall lived in a way that he was always mindful of his own physical fitness; call it an old habit of a former football player. Leslie described The Club, where Randy worked out, as “his home away from home.” Only Halsall’s commitment to his family went beyond his commitment to fitness. In addition to his wife, Halsall leaves behind son Randall, and daughters Jennifer Wilson and Andie Boyd. Scott Page/Gulf Breeze News Andy Tucker (white shirt) presents a check to Good Shepherd Lutheran Church Pastor Rory Hermann. The two were joined at the presentation by Leslie Halsall (left), Good Shepherd physical education teacher Dave Matthews (rear) and principal Connie Omelian (right). “Randy’s commitment to his two daughters and his son was amazing. His motto in life was ‘Go heavy or go home,’ and he would always preach that to them,” Leslie said. “It wasn’t just about weightlifting. It’s about giving everything you have and doing everything to the best of your ability.” In 2006, Halsall was diagnosed with cancer and lymphedema, and that motto took center stage in his life. “The doctors only gave him six to 18 months to live,” Leslie said. “His attitude was basically to just not act like anything was wrong and continue living life. “He just simply said, ‘I’m going to win. I’m going to beat it.’” Halsall’s attitude and his continued commitment to physical fitness allowed him to extend his life well beyond the medical expectations. “The doctors noticed that working out helped him keep his strength up,” Leslie recalled. “They also said it even helped with the chemotherapy.” Halsall impacted and inspired all who were close to him; especially by the faith and determination he showed during his battle with his health. “He was a very spiritual man,” said Rory Hermann, Good Shepherd pastor. “I could see it when I first met him. He maintained his faith and spirit, even as his health went downhill quickly.” During his final years, Halsall remained committed to volunteering at Good Shepherd. “I only met him twice, but I could tell that it took a lot out of him to come out and help us with our Presidential Fitness Program,” Matthews said. “But he never let it show. He came out and motivated the kids, and always had a smile on his face.” Tucker recalled that Halsall’s commitment to the gym also never slacked. “During his fight, he was still in here working out with a smile,” Tucker said. “He never gave up. “He had an IV in his arm, but was still lifting. He’s really become an inspiration to me, in addition to being my friend.” http://www.gulfbreezenews.com/news/2009-10-15/Community/Lifting_in_memory_of_a_friend.html -------- Date: 14 October 2009 By Alison Goulding Thirteen brave, sassy and smart women became calendar girls last week to raise awareness about a brutal form of cancer that has touched them all. Will I see my children grow up?" When Sarah Wilkinson was diagnosed with cervical cancer six years ago, it was the only question for the consultant who broke the news. His answer was "yes", and Sarah, now in remission, wants other women to know that the disease can be beaten. The mum-of-two, now 37, was one of 15 women who got together at Bigface Studio, in Shiney Row, recently to model for a calendar which will be sold to raise money to fight cervical cancer. Sarah, who lives in Chester-le-Street, was 31 when doctors diagnosed her with a rare form of the cancer, a glandular tumour on her cervix. She said: "It was ironic because life had started to settle down for me. I was happy and it was my fifth wedding anniversary with my husband Mark. "But I was getting a lot of trouble with bleeding and I was really fed-up and went back to my GP. I told her I was very unhappy being told everything was fine because I didn't think it was, so she examined me and found a little lump. "Within a fortnight I was seeing a consultant and within three weeks I was having a radical hysterectomy." The blow of the diagnosis left Sarah angry and confused. She said: "After they first told me I had cancer I would walk around the supermarket and see other people and think "Why me? Why me?" "I'm a practising catholic but when I got cancer I turned my back on my beliefs for a while. "I was so angry with everyone and it took me a while before I could go back to church. "Now it's something that gives me comfort again." But even though she was facing the worst, Sarah made the decision to take on a lead role with cervical screening in her job as a practice nurse. She said: "It sounds strange but I wanted to bring it to the forefront because at that time not many people had heard of it or understood it. "Personally I was worried about telling people I had cervical cancer in case they thought it was dirty or related to sex somehow. I was scared people would think I'd slept around." Sadly, cancer was just the start of Sarah's health problems. Following her radical hysterectomy, she began to have bowel problems and was diagnosed with bowel cancer. Further tests showed she did not have bowel cancer but doctors had to remove her bowel as it had been damaged by her initial operation to treat the cervical cancer. She was then diagnosed with lymphedema, a condition which causes fluid to build up in different parts of the body and tissue to swell. Sarah said: "My foot just ballooned up a year ago. When I was diagnosed with cervical cancer the doctors did tests on my lymph nodes to see if it had spread, which damaged them, and means fluid can build up in my leg." With regular treatment for her lymphedema at St Oswald's Hospice, in Gosforth, Sarah continues to work part time as a nurse. And with the support of her mum, Susan Baker, husband Mark and daughters, Lily, eight, and six-year-old Eve, she has rebuilt her life. Sarah said: "It was my children who made me keep going. If it weren't for them I might have jumped off a bridge but I had to carry on for them. "I didn't tell them I had cancer though, I told them I had a poorly tummy. "Over two years I went into hospital eight times. It was all they knew. A parent whose daughter goes to Eve's school told me that Eve had told her daughter that she prayed for me every day. "I find it very difficult when people say I'm brave. I'm not brave at all. I did what I had to do but it was the surgeons who saved me. "Back then, every single day cancer was in my head, now it's not." http://www.sunderlandecho.com/daily/Calendar-girls.5730895.jp ----- £1 million New Funding for Lymphoedema Research at St George's Hospital, London By Dr Anthony Stanton & Professor Peter Mortimer Cancer Research UK have awarded Professor Peter Mortimer and colleagues almost £1m for a 5-year research project on breast cancer-related lymphoedema. This will be conducted at St George's Hospital, University of London (Prof Mortimer and Prof Rodney Levick), Guy's Hospital, London (Prof Arnie Purushotham), and Brighton & Sussex University Hospitals (Prof Mike Peters), and 6 additional researchers will be working at these sites. The award is for a study that will follow a group of over 200 patients recently diagnosed with breast cancer for 36 months. By the end of this time most cases of lymphoedema will be evident and we will be able to make comparisons between the lymphoedema and non-lymphoedema groups, and to look retrospectively at these groups at earlier time-points. We have long felt that real progress in the understanding of the mechanism of the swelling, and why lymphoedema develops in some women but not others, will only come from a prospective approach. Our belief is that some women are especially prone to developing lymphoedema, irrespective of the cancer treatment they receive. Something like 66-75% of breast cancer patients do not develop lymphoedema after axillary clearance surgery (the prevalence of lymphoedema is, perhaps, 25-33%) whereas 5% of patients receiving the sentinel node biopsy will develop lymphoedema, despite receiving such minimal surgery. Furthermore, we found recently in a study of women followed from 6 months until 30 months post- operatively (but not from before the surgery) that there were crucial differences between the eventual lymphoedema and non-lymphoedema groups. Significantly, these differences were present at 6 months - before the onset of the lymphoedema - and in both arms. The new research will examine the lymph drainage and the formation of tissue fluid in the forearm, the strength of the lymphatic pumping mechanism in the arm, and whether the presence of connections between the lymphatic and venous systems in the arm (lymphovenous communications) confer any protective effect. The award is recognition by Cancer Research UK, the UK's leading cancer research charity, that lymphoedema following breast cancer treatment remains a significant problem. We are hopeful that this study will help identify women at risk of lymphoedema so that better prevention programmes can be developed and a better understanding of how swelling develops in breast cancerrelated lymphoedema will provide insight on other forms of lymphoedema. Source:Autumn 2009 issue of LymphLine ------ The following are breast cancer awareness campaigns that are going on in our area: ¦ Tickled Pink is dedicating October to Breast Cancer Awareness by donating 10 percent of proceeds to Women Supporting Women. Customers who spend $500 or more during October will receive a Love Quotes pink pashmina. The store is at 1300 Third St. S., Naples. Information: (239) 435-0004. ¦ Tanger Style of Pink: Breast Cancer Awareness Campaign at Tanger Outlet Center, 20350 Summerlin Road, Fort Myers, through Oct. 20. Purchase a PinkSTYLE card for $1 and get 25 percent off purchases at participating stores at Tanger Outlet. All proceeds from the sale of the card benefit the Susan G. Komen for the Cure Southwest Florida affiliate. Information: www.tangeroutlet.com ¦ Brighton Collectibles is fighting breast cancer through October at its Coconut Point store with its "Power of Pink" jewelry collection. Brighton will donate $10 to support the Susan G. Komen for the Cure Southwest Florida ‘Project Hope’ initiative for women recently diagnosed with breast cancer. Information: www. brighton.com ¦ Saks Fifth Avenue stores are selling an exclusive Michael Kors "Key to the Cure" shirt ($40) while supplies last. Heidi Klum is the 2009 ambassador for Saks Fifth Avenue’s Key to the Cure. Shop at any Saks store Oct. 15 through 18 and 2 percent of sales will be donated to local and national women’s cancer charities. Saks Fifth Avenue stores are at Waterside Shops, 5395 U.S. 41 N., Naples, (239) 592-5900 and Bell Tower, 13499 U.S. 41, Fort Myers, (239) 489-0980. ¦ Marissa Collections at 1167 Third St. S., Naples, is selling the following during October to benefit the Susan G. Komen Foundation of Southwest Florida: A pink tinted, treatment lipstick by Smashbox Cosmetics for $18 with all the proceeds donated to the Komen Foundation and a pink Rumba Time watch for $20 with 50 percent of the proceeds donated to the Komen Foundation. Information: (239) 263-4333. ¦ Breast cancer survivors can take six one-hour sessions of gentle exercise for free on Tuesdays starting today through Nov. 10 in Fort Myers; on Wednesdays starting this Wednesday through Nov. 11 in Naples; and on Saturdays starting this Saturday through Nov. 14 in Cape Coral. This is funded by grants from the League Club of Naples and the Cape Coral Foundation and presented by Lymphedema Resources Inc. Information: (239) 989-1009 or lymphedemares@aol.com ¦ Ladies Night Out an evening of pampering from 5:30 to 8 p.m. Oct. 14 at Radiology Regional Center, 10201 Across Ave., Estero. Proceeds benefit the local Komen affiliate. ¦ Blue Sushi Goes Pink, Gulf Coast Town Center, Oct. 14, is an evening of blues featuring Mark Hummel & the Blues survivors. Benefits Komen affilate. Information: www.blusushi.com ¦ Wildflower and Blue Willi’s at the Village on Venetian Bay will be selling raffle tickets for select clothing and gift items to support the American Cancer Society’s fight against breast cancer from Oct. 15 through Oct. 18 at 4200 Gulf Shore Blvd. N., Naples. ¦ Be Fit for the Cure by Wacoal from 11 a.m. to 5 p.m. on Oct. 16 at Macy’s, Coastland Center, 1800 U. S. 41 N., Naples, (239) 434-1300 and 10 a.m. to 8 p.m. on Oct. 28 at Dillards, Coastland Center mall, 1798 U.S. 41 N., Naples, (239) 261-4100. Wacoal will donate $2 to the Susan G. Komen for the Cure for every women who participates in the complimentary fittings. ¦ Naples Grande Beach Resort is celebrating the one-year anniversary of Veuve Clicquot Happy Hour by giving a donation to the local Susan G. Komen for the Cure affiliate for every Veuve Clicquot Rose or Pink Ribbon martini ordered during October. Visit wearing pink or orange from 3 p.m. to midnight Oct. 16 at the resort’s Aura Bar at 475 Seagate Drive, Naples, and be eligible to win prizes and get giveaways. Information: (239) 594-6363. ¦ Strides Against Breast Cancer, a 5K walk, will be held at 8 a.m. Oct. 17 at the Village on Venetian Bay, 4200 Gulf Shore Blvd. N., Naples. Registration begins at 7 a.m. Information: 261-0337. ¦ 951 Aveda is sponsoring a cut-a-thon from 10 a.m. to 4 p.m. Oct. 17 at 15215 Collier Blvd., Naples with all proceeds benefiting the Breast Cancer Research Foundation. A haircut and shampoo, mini-facial or a 20- minute chair massage is available for $25. Information and appointments: (239) 354-4403. ¦ Bella U Salon and Blue Martini will co-host and co-sponsor a fashion show to raise money for the American Cancer Society’s fight against breast cancer. The show will feature clothing by Anne Fontaine of Waterside Shops at 9 p.m. Oct. 19 at Blue Martini, the Mercato, 9114 Strada Place, Naples. Admission is free, but donation of $5 and more will entitle donors to a pink martini and the first 50 people will receive a gift bag. Information: www.BellaUSalon.com or (239) 591-2583 . ¦ Susan G. Komen for the Cure Southwest Florida Pink Weekend, Oct. 24-25, outreach to churches and synagogues during Breast Cancer Awareness Month to share breast health and breast cancer information. Breast cancer survivors and women who have lost their lives to this disease are recognized and honored. Information: www.komenswfl.org ¦ Coconut Point Restaurant Week, Coconut Point, Estero, Oct. 26 through Nov. 1. Participating restaurants will offer a $25 prix fixe menu with 20 percent of all proceeds benefiting the Komen Southwest Florida affiliate. Information: komenswfl.org to view participating restaurants. ¦ The Susan G. Komen for the Cure Southwest Florida affiliate and the Collier County chapter of Hadassah are hosting an educational luncheon from 11 a.m. to 2 p.m. Nov. 13 at the Hyatt Regency Coconut Point Resort, Coconut Point, Estero. U.S. Rep. Debbie Wasserman Schultz will discuss her experience with breast cancer and her introduction of the Early Act for young women. $30. Information: (239) 498-0016. About Susan G. Komen for the Cure The Susan G. Komen for the Cure® and the Komen Southwest Florida affiliate started when Nancy G. Brinker promised her dying sister, Susan G. Komen, she would do everything in her power to end breast cancer. In 1982, that promise became the Susan G. Komen for the Cure and launched the global breast cancer movement. Information: www.komenswfl.org or (239) 498-0016. http://www.naplesnews.com/news/2009/oct/05/how-you-can-be-pink/ ----- http://www.mailtribune.com/apps/pbcs.dll/article?AID=/20091025/NEWS/910250331 Easing the pain of a post-cancer muscle ailmentLymphedema, a swelling in the arms that causes discomfort, can strike without the patient knowing Pim Solof, a physical therapist for Asante Health System, applies a gentle massage to Su Rolle of Medford, who developed lymphedema three years after a double mastectomy. The massage prevents fluid buildup in the arm. Mail Tribune / Jim Craven Jim CravenOctober 25, 2009 By Bill Kettler Mail Tribune Breast cancer can be life-changing in ways that some women might never imagine. Consider lymphedema — the painful swelling in the arms that many breast cancer survivors experience. The symptoms can be subtle at first, and may arise long after surgery, preventing many women from seeking care early on, when it would be most helpful. Su Rolle of Medford developed lymphedema three years after a double-mastectomy. "It starts feeling kind of tender and swollen and painful," Rolle said. "So many women are not aware of the symptoms. They don't know what's happening. Women's awareness of lymphedema is really, really low." Lymphedema occurs when lymph fluid accumulates in the tissues. Lymph, the clear fluid that helps the body fight infection, normally drains to specialized nodes, which act as filters. Women often lose some lymph nodes in the armpit during cancer surgery or radiation treatment to prevent the spread of their cancer. The extra fluid ("edema," in medical language) collects because the flow of lymph is interrupted. Lymphedema can occur in other parts of the body because of disorders in the lymph system, but it's most commonly associated with breast cancer surgery. Researchers estimate 10 to 25 percent of breast cancer patients will have some symptoms of lymphedema. Besides swelling, women also may experience difficulty moving the affected arm or weakness, stiffness or numbness. Seemingly innocent activities have been linked to the onset of lymphedema, and any unusual stress on the arm may aggravate it. Rolle traces her first episode to a tetanus shot in her arm three years after her mastectomy. Another episode occurred after she picked up a grandchild. There is no cure for lymphedema, but women can minimize the symptoms with regular exercise and with massage, said Pim Solof, a physical therapist for Rogue Valley Medical Center. Solof has special training for treating lymphedema and she shows women how they can self-massage to prevent fluid from accumulating in the arm. "It's a shallow massage," she said. "It's almost like stroking a cat." Solof said it's important for women who have symptoms of lymphedema to seek treatment because it doesn't go away. In severe cases, the skin may split, and fluid can leak to the surface. "If you don't do anything it'll just get worse and worse," Solof said. "The arm gets heavy and hard to use." Tight-fitting compression sleeves can be helpful, she said. "The compression sleeve works to reduce fluid in the arm," she explained. Compression garments sold for sports aren't adequate for lymphedema purposes, she said, because they're not tight enough. The sleeves can be purchased at specialty stores such as Comfort Zone Boutique for about $100, Solof said. Rolle said she always wears a compression sleeve whenever she intends to pick up one of her grandchildren. Regular exercise can help prevent low-grade lymphedema from becoming more serious. Women who have been physically inactive can start at a low level of activity and gradually increase their exercise. There's no set point where everyone starts, Solof said. "It all depends on where you are (physically)," she said. Rolle said one of the most discouraging facets of lymphedema is the way it affects women's quality of life. "For women with chronic lymphedema, their lifestyle just changes," she said. "They're not so active, and they kind of withdraw." Reach reporter Bill Kettler at 776-4492 ---- Race for the Cure a Success Thousands turn out in Fresno to support a cure for breast cancer Tools1 CommentEmail this articlePrint this articleYouNews™Digg this!Save to DeliciousPost to FacebookShare on TwitterClose By KSEE News Story Published: Oct 25, 2009 at 12:42 AM EDT (Story Updated: Oct 25, 2009 at 12:42 AM EDT ) Susan G. Komen Race for the Cure Turned Fresno State Campus Pink. More than 6,600 runners and walkers joined together to raise awareness and funds for breast cancer. Multimedia Watch The Video Saturday's race raised more than $372,500, with pledges still coming in, that the Central Valley Affiliate will award to community programs that promote breast health education and treatment in the Central Valley, as well as breast cancer research, “Even though our community has been hit hard by the economy, the thousands of people who joined the race today demonstrated that our community is passionate about finding the cure for breast cancer and supporting their loved ones who have faced this illness,” said Sharon Johnson, executive director of the Central Valley Affiliate of Komen for the Cure. In addition to raising funds, participants celebrated with approximately 500 breast cancer survivors dressed in pink shirts and honored those who have lost their battle with the disease. The event also included performances by local musicians, a timed 5-kilometer run and noncompetitive walk around the campus and a children’s carnival area. New at the 2009 Komen Race for the Cure, attendees not only fought breast cancer, but also hunger and filled bins around the race site with canned goods to benefit the Poverello House. The Fresno State Athletic Department served as the 2009 Honorary Race Chair in recognition of their continued support of breast cancer awareness through programs such as their annual Pink Zone women’s basketball game and Volleyball Breast Cancer Awareness Night. Sue Behme, head coach for Fresno State’s women’s lacrosse team, represented the department and shared her personal inspiration to promote breast cancer awareness with Race participants, “We all know someone who has been touched by cancer who inspires us to fight this disease. Early detection is the key and it begins with education and knowledge,” said Behme. “Every woman should know their risk, listen to their body and have annual exams with their physician because that is the best defense against breast cancer.” A minimum of 25% of the event proceeds support national ground breaking breast cancer research and up to 75% of the funds raised at the event remain in Fresno County to support local breast health education, breast cancer screening and treatment programs. Local grant recipients in 2009 include Association for Community Enhancement, Centro La Familia, Community Lymphedema Clinic, Deaf and Hard of Hearing Service Center, Fresno Health Consumer Center, Hinds Hospice, Islamic Cultural Center of Fresno, Khmer Society of Fresno, and West Fresno Health Care Coalition. For more information go to www.komencentralvalley. ------- Lymphedema a treatable sideline of obesity By: Clint Cooper (Contact) ARTICLE TOOLS E-mail story Rhonda Haley - Download MP3 - Chances are, if a patient sees Rhonda Haley, the patient's obesity already has turned into lymphedema. There's no cure for lymphedema, but the BenchMark Physical Therapy specialist said treatment plans can make life with swollen tissues from a faulty lymph system more livable. "There's no special diet plan for lymphedema," said Ms. Haley, a certified lymphedema specialist. "It's just important (for the patient) to live a healthy lifestyle." The majority of patients she sees are overweight, she said. Obesity often leads to chronic venous insufficiency (when the veins have trouble sending blood from the legs back to the heart), which can develop into lymphedema, she said. Weight loss can improve lymphedema, Ms. Haley said, because it allows patients to be more mobile and better able to take care of themselves. Often, she said, abdominal fat restricts blood flow below the waist and keeps the lymph system from working properly. While the legs are the primary site for lymphedema, the arms are often affected and, more rarely, the trunk, face and genitals, she said. To treat the condition, certified lymphedema specialists work with patients and then help them prepare to manage it themselves. BenchMark's four-step program involves skin care, manual lymph drainage (a kind of light massage), compression therapy (the application of bandages to force lymphatic fluid up from the feet) and exercise (to get the legs moving and the muscles pumping), according to Ms. Haley. Treatment plans typically call for therapy five days a week for two weeks and then three times a week for the next two to three weeks, she said. After the initial treatment phase, the patient generally has a follow-up visit every six months. Part of the intensive phase of treatment is to teach the patient how to do maintenance therapy, Ms. Haley said. That includes instruction on how to bandage their legs, how to use compression stockings, how to perform manual lymph drainage and how to do home exercises. George Nye, 81, of Ringgold, Ga., had his legs measured earlier this week prior to the beginning of treatment. His primary care doctor had recommended the treatment after he gained 35 pounds since two heart failures several years ago. "My feet have been swelling for more than a year," he said. Mr. Nye's heart doctor said the swelling is not related to his heart, so the retiree said it probably is linked to his diabetes. He will start treatment when Ms. Haley returns from vacation. "It takes a special physical therapist to handle this kind of thing," he said. Although obesity is a primary cause of lymphedema, secondary causes may include trauma and surgery, Ms. Haley said. Heart, knee and breast surgeries all have been known to bring on lymphedema, she said. In fact, according to a 2006 American Society of Breast Disease study, obesity appeared to increase the risk of developing lymphedema after axillary lymph nodes are removed during breast cancer surgery. About 36 percent of obese patients developed the condition compared to about 16 percent of overweight patients, about 7 percent of normal weight patients and no underweight patients. Ooltewah-based BenchMark has treated lymphedema patients for about seven years, according to Priscilla Smith, executive administrator. Presently, eight clinics with a treatment program in East Tennessee and North Georgia average 130 patients and approximately 2,000 visits a month, she said. "There was a great need to develop a program to treat patients with the condition," she said, "because we noticed that many patients were looking for a program, and a comprehensive program like the one at BenchMark didn't exist at the time. Travel for patients with lymphedema is not easy, so it was important the program be available in as many clinics as possible to accommodate and add convenience for the patient." http://www.timesfreepress.com/news/2009/oct/15/lymphedema/ ----- Parents Stick to Promise October 15, 2009 - Frank Rosci, Jewish Exponent Feature Rachel Levin Troxell A father's promise to his dying daughter to keep the fledgling business she founded in 2007 up and running has been kept, turning what she began into a real success. The father is Howard Levin, who, with wife Judy, came out of retirement to devote mind, body and soul to keep alive daughter Rachel Levin Troxell's dream -- her company LympheDIVAs, the maker and marketer of a specific type of cancer-related apparel. Rachel, who was diagnosed with breast cancer in 2005, died on Jan. 22, 2008, at the age of 37, after a recurrence of the disease. And while she didn't live to see LympheDIVAs soar, her purpose, power and spirit live on. "Judy and I made a promise to Rachel. That's why we're here. This is her 'child,' and we continue to tell her story," explained Howard, a physician, who had retired in 2004, while, Judy, a social worker, had done so in 2005. Rachel had married between the time her breast cancer was detected and the time it returned. She and her husband, Jason, who has remained involved with the business, had no children. Rachel, as driving force, started LympheDIVAs with two other women, Robin Miller, a graphic designer, and Kristin Dudley, a fashion designer. Both are no longer with the company. Parents Howard and Judy Levin Rachel was a breast-cancer survivor, as was Miller. Both developed lymphedema, also known as lymphatic obstruction, a permanent condition of localized fluid retention and swelling just under the skin. The unsightly and embarrassing disorder is caused by a compromised lymphatic system, resulting in the disfiguring, and often debilitating, swelling of the arms and hands for women with breast cancer. When Rachel and Miller researched compression sleeves and gauntlets used to control the effects of lymphedema, the results yielded only the heavy, hot, bandage-like and bandage-colored products that seemed devoid of comfort, give and style. That represented little to no choice to women like Rachel -- a writer, filmmaker, teacher and tri-athlete -- so she and Miller decided to improve on what was available. Fashion Wins Out LympheDIVAs, explained the Levins, is dedicated to the creation of medically correct and fashionable compression sleeves and hand gauntlets for women with lymphedema. Following their search, Rachel and Miller met with Dudley for the first time to discuss their idea of more elegant and comfortable compression sleeves and gauntlets. That's when LympheDIVAs LLC took flight. Utilizing suggestions made by a medical advisory board, a research-and-development company and a number of lymphedema patients, LympheDIVAs was ready to begin selling its line of products in December 2007. The company continued to grow and expand until Rachel's death. Working with Invista -- today a division of Koch Enterprises, but before that the DuPont fiber division (LympheDIVAs' fabric supplier is Corolon Mills now) -- what the three founders introduced was a lightweight, breathable, wicking (material that carries away moisture, keeping arms and hands cooler), strong and stretch fabric that offered support and, most importantly, style for women going through the physical and emotional discomfort of their medical problems. "When competitors jumped in with similar solid colors, it didn't matter to Rachel because she said it was all good in terms of helping women," said her father. The products are made at the aforementioned Corolon Mills, outside of Greensboro, N.C. Owner Larry Reid was so impressed with Rachel, her story and her idea that he purchased an $80,000 Italian-made knitting machine on which to make the products, noted the Levins. Said Howard: "We really do believe in this product, and we want to help women as Rachel wanted to, so we're enjoying doing this for her. "In one way or another," added Judy, "we will work to see that Rachel's business continues -- and continues to help women." http://www.jewishexponent.com/article/19827/ ---- Prevention, Risk Reduction, And Treatment Of Lymphedema ScienceDaily (Oct. 15, 2009) — As breast cancer awareness month is observed during October, the American Physical Therapy Association (APTA) is hoping to shine a spotlight on lymphedema, a chronic, debilitating and often irreversible side effect of cancer treatment. -------------------------------------------------------------------------------- Breast cancer-related lymphedema, which can cause significant swelling of the upper and lower extremities due to the build-up of excess lymph fluid, is mostly caused by damage to the body's lymphatic system during treatment for cancer and can include limited movement, joint pain, and difficulty performing activities. Physical therapists, who are experts in restoring motion and mobility in people's lives, play an important role not only in treating the effects of lymphedema but also in reducing the risk of occurrence. A study published in the journal Cancer (April 25, 2008) showed that pre-operative assessments of patients with breast cancer by physical therapists allow for earlier diagnosis and treatment of lymphedema. This includes programs that use infra-red technology to measure limb volume and regular post-operative follow- up to detect lymphedema. The study further demonstrated that when lymphedema was detected early, the patient's condition was managed with a more conservative approach that included a light-grade compression sleeve and hand gauntlet that effectively decreased early swelling and possibly prevented the progression of lymphedema. Fitted by a physical therapist, these were prescribed for daily wear. "Lymphedema is normally treated with more aggressive and often costly and time-consuming techniques, such as complete decongestive therapy," explained APTA Board member and spokesperson, and the study's lead author, Nicole Stout, PT, MPT, CLT-LANA. Complete decongestive therapy requires the patient to attend daily therapy sessions for weeks and wear bulky compression bandages. "This study clearly demonstrates the fact that lymphedema can be managed with a more conservative treatment option when diagnosed in its earliest stages, which is good news for patients with breast cancer," Stout said. "Based on these findings, we encourage patients with breast cancer to seek referral for physical therapy services before, during and after breast cancer treatment because arm problems can occur at any time during the course of care and the best outcomes are reached when they can be detected early, or even prevented. "We hope physicians, surgeons, oncologists, and other physical therapists will make early intervention and conservative treatment of lymphedema the standard of care in breast cancer treatment," Stout concluded. APTA Board member Babette Sanders, PT, MS, knows firsthand the benefits of using physical therapy for prevention and maintenance of keeping lymphedema at bay. "Swelling occurred immediately in my upper arm and trunk after my mastectomy," she said. "By quickly incorporating physical therapy as part of my overall management of the condition, I was able to get rid of the swelling and have since kept it away. I am able to remain lymphedema free with monthly preventative treatment. It makes a tremendous difference in the quality of my daily living and my ability to move and function." Stout recommends patients with breast cancer be aware of their risk factors and indicators of the onset of lymphedema: Risk Factors •Being overweight or gaining weight during or after cancer treatment •Having lymph nodes removed •Having radiation therapy •Having an infection or blood clot in the limb affected by cancer treatment Warning Signs •Aching or heaviness in the limb that was affected by cancer treatment •A feeling of fullness or tightness in the limb affected by cancer treatment •Visible swelling that affects the limb affected by cancer treatment Some risk factors, such as the necessary treatment for cancer, cannot be avoided. However, there are many things you can do to help reduce the risk of lymphedema, such as: •Maintain a healthy body weight •Follow proper skin care and hygiene practices •Avoid infections from cuts, burns, or skin wounds •Exercise sensibly and avoid unnecessary strain to the limb According to APTA, breast cancer patients who seek the services of a physical therapist can reduce their risk of lymphedema, as it can be prevented or more effectively managed if caught in its earliest stages and treated by a physical therapist. APTA is launching this effort as it kicks off National Physical Therapy Month in October to educate the public about the important role physical therapists and physical therapist assistants play in health care. -------------------------------------------------------------------------------- Adapted from materials provided by American Physical Therapy Association. http://www.sciencedaily.com/releases/2009/10/091015171455.htm ======== Physical therapists play integral role in prevention, risk reduction, and treatment of lymphedema ALEXANDRIA, VA -- As breast cancer awareness month is observed during October, the American Physical Therapy Association (APTA) is hoping to shine a spotlight on lymphedema, a chronic, debilitating and often irreversible side effect of cancer treatment. According to APTA, breast cancer patients who seek the services of a physical therapist can reduce their risk of lymphedema, as it can be prevented or more effectively managed if caught in its earliest stages and treated by a physical therapist. APTA is launching this effort as it kicks off National Physical Therapy Month in October to educate the public about the important role physical therapists and physical therapist assistants play in health care. Breast cancer-related lymphedema, which can cause significant swelling of the upper and lower extremities due to the build-up of excess lymph fluid, is mostly caused by damage to the body's lymphatic system during treatment for cancer and can include limited movement, joint pain, and difficulty performing activities. Physical therapists, who are experts in restoring motion and mobility in people's lives, play an important role not only in treating the effects of lymphedema but also in reducing the risk of occurrence. A study published in the journal Cancer (April 25, 2008) showed that pre-operative assessments of patients with breast cancer by physical therapists allow for earlier diagnosis and treatment of lymphedema. This includes programs that use infra-red technology to measure limb volume and regular post-operative follow- up to detect lymphedema. The study further demonstrated that when lymphedema was detected early, the patient's condition was managed with a more conservative approach that included a light-grade compression sleeve and hand gauntlet that effectively decreased early swelling and possibly prevented the progression of lymphedema. Fitted by a physical therapist, these were prescribed for daily wear. "Lymphedema is normally treated with more aggressive and often costly and time-consuming techniques, such as complete decongestive therapy," explained APTA Board member and spokesperson, and the study's lead author, Nicole Stout, PT, MPT, CLT-LANA. Complete decongestive therapy requires the patient to attend daily therapy sessions for weeks and wear bulky compression bandages. "This study clearly demonstrates the fact that lymphedema can be managed with a more conservative treatment option when diagnosed in its earliest stages, which is good news for patients with breast cancer," Stout said. "Based on these findings, we encourage patients with breast cancer to seek referral for physical therapy services before, during and after breast cancer treatment because arm problems can occur at any time during the course of care and the best outcomes are reached when they can be detected early, or even prevented. "We hope physicians, surgeons, oncologists, and other physical therapists will make early intervention and conservative treatment of lymphedema the standard of care in breast cancer treatment," Stout concluded. APTA Board member Babette Sanders, PT, MS, knows firsthand the benefits of using physical therapy for prevention and maintenance of keeping lymphedema at bay. "Swelling occurred immediately in my upper arm and trunk after my mastectomy," she said. "By quickly incorporating physical therapy as part of my overall management of the condition, I was able to get rid of the swelling and have since kept it away. I am able to remain lymphedema free with monthly preventative treatment. It makes a tremendous difference in the quality of my daily living and my ability to move and function." Stout recommends patients with breast cancer be aware of their risk factors and indicators of the onset of lymphedema: Risk Factors ¦Being overweight or gaining weight during or after cancer treatment ¦Having lymph nodes removed ¦Having radiation therapy ¦Having an infection or blood clot in the limb affected by cancer treatment Warning Signs ¦Aching or heaviness in the limb that was affected by cancer treatment ¦A feeling of fullness or tightness in the limb affected by cancer treatment ¦Visible swelling that affects the limb affected by cancer treatment Some risk factors, such as the necessary treatment for cancer, cannot be avoided. However, there are many things you can do to help reduce the risk of lymphedema, such as: ¦Maintain a healthy body weight ¦Follow proper skin care and hygiene practices ¦Avoid infections from cuts, burns, or skin wounds ¦Exercise sensibly and avoid unnecessary strain to the limb A physical therapist will create an exercise program tailored to your individual needs and monitor its effect on your limb. http://www.scienceblog.com/cms/physical-therapists-play-integral-role-prevention-risk-reduction-and- treatment-lymphedema-26286.html ---- Businesses provide variety of options for cancer patients BY ELIZABETH BASSETT October 19, 2009 Supporting women is big business. Ambling through a department store or a Target will reveal racks and racks of undergarments for women, and there’s enough variety to boggle the mind. When Linda Hentz first started offering specialized bras for women who had undergone surgery for breast cancer at D&J Medical Supplies, she only stocked two types of bras. Today, she has whole catalogs devoted to bras, camisoles, bathing suits and other garments, and she started a new company—Ladies Choice, which is adjacent to her other store—to sell apparel and prosthetics to women who’ve had breast cancer. “When they get a good fit, when they get a bra on and get their clothes on, a lot of them will cry,” Hentz said. Hentz is one of many people in Tarrant County who guide women in the baffling post-surgical world of breast cancer. The general public may be inundated with pink products in October, with this month marking the 25th National Breast Cancer Awareness Month. But health professionals, patients and those who work in support services are exposed to another breast cancer-centered industry during the entire calendar year. Women wear special camisoles and bras while they are healing from surgery to treat breast cancer, and depending on what kind of reconstruction a woman can get, she may use special products for the rest of her life. More than 200,000 women get mastectomies annually, and while 35 percent seek reconstruction, most need a breast care professional for post-mastectomy products, said Rhonda Turner, with the National Association for the Advancement of Orthotics and Prosthetics and founder of the American Association of Breast Care Professionals, in an April 2009 essay for the industry magazine The O&P Edge. “Independent businesses — mostly woman-owned — comprise more than 75 percent of the post- mastectomy industry, and the professionals behind these entrepreneurial ventures provide a medical service not available anywhere else,” she said in the essay. Numbers about the industry are difficult to find, but for individual women with health insurance, most of the costs are covered. “About 99 percent of the insurances cover it, as well as Medicare,” said Mary Mysko, health initiative community manager with the American Cancer Society. Medicare and most insurance plans will cover the cost of a woman getting mastectomy bras — most remarkably similar to a normal bra, except with an extra pocket to slip a prosthetic into — and a prosthetic, Mysko said, and for women who are uninsured, various organizations will donate the apparel. The American Cancer Society also manages a program called Reach to Recovery, which matches a breast cancer survivor with a newly diagnosed woman. The survivor will give the new patient educational information, as well as a heart-shaped pillow to use while healing after surgery and a leisure bra, or a soft bra with a foam insert for the woman to wear before getting fitted for a more permanent prosthetic. Sherree Bennett is a volunteer in the Reach to Recovery program as well as the breast health nurse navigator at the Paul and Judy Andrews Women’s Hospital at Baylor All Saints Medical Center at Fort Worth. When she meets with newly-diagnosed women — and she meets with every one that comes through her hospital — she gives them educational literature, the post-op bra and emotional support, which is equally needed. Because she works at a health care institution, she also can keep a stock of the bras on hand, instead of having a woman mail in for it. “I’m able to sort of save the woman a step,” she said. “We can sort of kill three birds with one stone by doing it here.” When women go home from surgery, they wear a camisole, which a woman can pull up over her legs (because lifting the arms to pull on a garment can be painful). The camisole has pockets and fasteners to hold drains in place, and when a woman is ready she graduates to the leisure bra. About four to six weeks after surgery, when a doctor gives the go-ahead, the woman can get a prescription for her mastectomy bras and prosthetic. Tricia Phillips is a patient navigator employed by the American Cancer Society but who works at the JPS Center for Cancer Care, which is across Hemphill Street from D&J and Ladies Choice. Because she works for the American Cancer Society, she can find programs who can give supplies even to those who may not be able to afford them. “It’s a needy population, so they typically do not have the resources, insurance or coverage, to purchase those things,” she said. When women are ready for a fitting, they are sent to a mastectomy supply store like Ladies Choice, where they work with a certified mastectomy fitter like Hentz to find a well-fitting bra and a prosthetic that either replicates the whole breast or a portion of the breast that may have been removed during a lumpectomy. It’s not uncommon to see an immediate change in a woman’s mood once she has on her new undergarment, Hentz said, and Phillips said they sometimes come in to show her their new look. Not only can a well-fitting bra help a woman’s self-image, but a good one can lend itself toward better healing, said Linda Stowell, a physical therapist and certified lymphedema therapist at the Frances and Frank Turrella Lymphedema Center at Baylor All Saints. The bras can offer slight compression, which helps to move lymph, or bodily fluid associated with a lymph node. A breast cancer surgery may include removing lymph nodes where the cancer has spread, and the removal can cause the fluid to back up and make the arm or trunk swell. Finding a good garment that will offer correct support for an altered body as well as a chance to regain a natural outward appearance is not easy if you don’t go to the right place, Stowell said. “If you go to Macy’s or Dillard’s, they don’t have those kinds of bras,” she said. There are additional support garments, like compression sleeves, that can help with lymphedema. “If they need them and can’t afford them, there’s support available for that as well,” said Kim Conley, medical bill advocate for Moncrief Cancer Resources. Those garments may not be directly tied to the breast, but they may be necessary as a result of the breast cancer treatment. Hentz, who is holding an open house for local medical professionals at Ladies Choice on Oct. 27, said the public is more comfortable discussing breast cancer and so she hopes more women realize they may be able to get new bras or prosthetics through their health insurance. Once her new company is up and running full- time, she expects to have contracts with health insurance companies to help women get their supplies faster. Ladies Choice also will offer goods like wigs, head scarves and skin products for women treated for all kinds of cancer, Hentz said. While she hasn’t run across another business in Tarrant County that will have the same focus Ladies Choice will, she said it would be just fine by her if a cure for breast cancer was found and put her out of business permanently. She lost her mother to breast cancer. “Unfortunately, there’s enough business for more,” she said. “It’s not going to put me out of business if someone else opens.” http://www.fwbusinesspress.com/display.php?id=11188 ---- Publish Date: 10/6/2009 A lifelong challenge Massage is best therapy for breast cancer survivors with lymphedema By Pam Mellskog 2009 Longmont Times-Call LONGMONT — Despite the relatively common occurrence of lymphedema — the swelling of a limb — in breast cancer survivors with major lymph node removal, misperceptions still cloud the condition’s treatment. “A lot of people think it can be tapped, like maple syrup,” said Jodi Winicour, a certified lymphedema therapist and physical therapist at Longmont United Hospital. Instead, she uses manual — light, rhythmic massage — to gently flush the retained fluid from the swollen arm to a healthier section of the lymph system for re-circulation in the body. This specialized massage technique for lymphedema patients debuted about 20 years ago. LUH’s Health Center of Integrated Therapies introduced it in 2001. Though not often painful or life threatening in breast cancer survivors, lymphedema can cause discomfort and a disrupted sense of normalcy, according to patients. “I was trying on a short-sleeved shirt, and I looked at myself, and I thought, ‘When did my arm get so fat?’” said Jo Geiger, 68. The retired registered nurse and massage therapist was diagnosed with breast cancer in her right breast in 1990, the left breast in 1992 and had both removed. Like so many other survivors, her doctor removed the cluster of about 25 Jelly Belly-sized lymph nodes in her armpit areas to determine if the cancer had spread beyond her breast. Doctors screen cells from the lymph system to gauge the cancer’s reach because this system works like a sieve to catch cancer cells along with bacteria, viruses and other waste products, according the Mayo Clinic Web site. “I think of lymph nodes as those security guards that drive around in gated community neighborhoods to identify intruders and then call the police — the immune system,” Winicour said. The lymphatic system carries off undesirables through the lymph vessels, which lead to lymph nodes. Lymphocytes — infection-fighting cells that live in the lymph nodes — filter these wastes and ultimately flush them from the body. Lymphedema occurs when, in the case of some biopsied breast cancer survivors, the flushing system gets damaged and clogged. About half of those who undergo this type of invasive biopsy never develop telltale lymphedema-related swelling, according to the National Lymphedema Network. NLN reports that even fewer, between 4 percent and 10 percent, suffer the condition if they qualified for sentinel node biopsy. Doctors began using SNB in 1991 to harvest far fewer nodes and reduce the kind of collateral damage that causes lymphedema. ------------------------- New Discovery Brings Hope to Treatment of Lymphatic Diseases - http://www.brightsurf. com/news/headlines/47789/New_Discovery_Brings_Hope_to_Treatment_of_Lymphatic_Diseases.html New Discovery Brings Hope to Treatment of Lymphatic Diseases August 11, 2009 Researchers in the laboratory of Dr. Jayakrishna Ambati at the University of Kentucky have discovered the first naturally occurring molecule that selectively blocks lymphatic vessel growth.. In an article in the Aug. 9, 2009 online edition of Nature Medicine, they report the identification of a new molecule known as soluble VEGFR-2 that blocks lymphangiogenesis - the growth of lymphatics - but not blood vessel growth. The twin circulatory systems of mammals - blood and lymphatic - are intricately intertwined, both anatomically and functionally. Until now it has been difficult to selectively target one without affecting the other. The lymphatic vessel network is essential for transporting fluids, molecules, and immune cells. It is crucial for wound healing and immune defense. Disturbances in the lymphatics are involved in diseases as varied as lymphedema, transplant rejection, and tumor metastasis, which collectively affect hundreds of millions of people worldwide. Study links arm/hand swelling to number of lymph nodes removed during breast cancer surgery - http://www. brightsurf. com/news/headlines/44815/Study_links_armhand_swelling_to_number_of_lymph_nodes_removed_during_ breast_cancer_surgery.html Study links arm/hand swelling to number of lymph nodes removed during breast cancer surgery April 24, 2009 In older breast cancer survivors, the number of lymph nodes removed during surgery and the presence of cancer in the lymph nodes were the two factors most directly linked to the development of lymphedema, swelling of the arm and hand, according to a study from the Medical College of Wisconsin's Center for Patient Care and Outcomes Research in Milwaukee, Wisconsin. "Lymphedema causes physical discomfort and disability, as well as a cosmetic deformity which can lead to anxiety, depression and emotional distress that can affect a woman's activities of daily living and quality of life," says lead author Tina Yen, M.D., M.S., a Medical College of Wisconsin surgical oncologist who practices at Froedtert Hospital, a major hospital affiliate. "For these reasons, lymphedema is probably the most feared complication among breast cancer survivors. A better understanding of its risk factors is needed to help improve outcomes." MU Study Identifies Patient Strategies for Managing Symptoms of Lymphedema - http://www.brightsurf. com/news/headlines/41217/MU_Study_Identifies_Patient_Strategies_for_Managing_Symptoms_of_Lymph edema.html MU Study Identifies Patient Strategies for Managing Symptoms of Lymphedema October 30, 2008 An estimated 2 million women in the United States are at risk of developing lymphedema, a condition that involves the chronic and abnormal swelling of the arm, chest, neck and/or back, as a complication of breast cancer treatment. While physicians will recommend proven techniques to manage the swelling, a University of Missouri researcher has found that patients often won't follow the recommendations, or they will use alternative treatments and not discuss them with their doctors. "Lymphedema has a profound impact on health and well-being, but often goes undiagnosed and untreated by physicians and patients," said Jane Armer, professor in the Sinclair School of Nursing and director of nursing research at the Ellis Fischel Cancer Center. "Understanding the ways that people self-manage the chronic symptoms of lymphedema is essential to facilitate an improvement in the use of treatments and the quality of life of these people." Study suggests some breast cancer patients facing radiation after a mastectomy may be over-treated - http: //www.brightsurf. com/news/headlines/40348/Study_suggests_some_breast_cancer_patients_facing_radiation_after_a_mastec tomy_may_be_over-treated.html Study suggests some breast cancer patients facing radiation after a mastectomy may be over-treated September 22, 2008 BOSTON -- A new study suggests standard radiation therapy for some breast cancer patients may not be medically required and may, therefore, be causing unnecessary serious side effects such as lymphedema and pulmonary problems. The research conducted at Fox Chase Cancer Center involved women who got a mastectomy, but whose lymph nodes were negative. "When a woman has a tumor greater than 5 centimeters and negative lymph nodes, a mastectomy followed by radiation is recommended," said Penny Anderson, M.D., attending physician in the radiation oncology department at Fox Chase. "We typically irradiate the chest wall because it's been shown to improve survival. Out of an abundance of caution, many radiation oncologists also treat the surrounding lymph nodes, but there is little evidence that this improves outcome." M. D. Anderson nurse addresses lymphedema in breast cancer patients and survivors - http://www. brightsurf. com/news/headlines/37874/M_D_Anderson_nurse_addresses_lymphedema_in_breast_cancer_patients_an d_survivors.html M. D. Anderson nurse addresses lymphedema in breast cancer patients and survivors May 19, 2008 Nurse-administered prevention and management strategies can decrease incidence of lymphedema and improve quality of life in patients PHILADELPHIA - A poster session presented today by The University of Texas M. D. Anderson Cancer Center at the Oncology Nurses Society 33rd Annual Congress, found that early nursing intervention and implementation of effective strategies can lead to a decrease in the incidence of lymphedema, better management of chronic lymphedema and improved quality of life in breast cancer patients. Preoperative assessment of cancer patients enables early diagnosis, treatment of lymphedema - http://www. brightsurf. com/news/headlines/37512/Preoperative_assessment_of_cancer_patients_enables_early_diagnosis_treatme nt_of_lymphedema.html Preoperative assessment of cancer patients enables early diagnosis, treatment of lymphedema April 30, 2008 The preoperative assessment of breast cancer patients for subclinical lymphedema enables clinicians to establish a baseline, which serves to enable the early diagnosis and successful treatment of the debilitating condition, according to data from a five-year study published this week in the online edition of the journal Cancer (http://www3.interscience.wiley.com/cgi-bin/abstract/118821880/ABSTRACT). In a study conducted by the National Institutes of Health (NIH) and the National Naval Medical Center, in collaboration with faculty and students from the University of Michigan-Flint and George Mason University, researchers measured the upper limb volume of 196 newly diagnosed breast cancer patients from 2001 to 2006 to establish a baseline prior to surgery. At designated postoperative intervals, the researchers took repeated measurements as part of a "surveillance" model to monitor for possible impairments related to breast cancer treatment--such as lymphedema--as opposed to treating therapy-related problems after they occur. Using the surveillance approach, the investigators demonstrated that a short trial of compression garments effectively treated subclinical lymphedema when it was detected early. Forty-three, or 22 percent, of the 196 breast cancer patients in the study developed subclinical lymphedema, as defined by a change in limb volume of >75cc; and all subjects showed a significant mean volume reduction to very near their pre- surgical "normal" state. All subjects were able to maintain this level for an average of 4.8 months, and none of the patients demonstrated progression of the condition in the follow-up period. Venous origin of the mammalian lymphatic vasculature - http://www.brightsurf. com/news/headlines/33261/Venous_origin_of_the_mammalian_lymphatic_vasculature.html Venous origin of the mammalian lymphatic vasculature October 01, 2007 In the October 1 issue of G&D, Dr.. Guillermo Oliver (St. Jude Children's Research Hospital) and colleagues present new evidence to resolve a century-old debate over the origin of the mammalian lymphatic vasculature. Understanding the development of the lymphatic vasculature is integral to understanding its function in both health (mediating immunity and maintaining tissue fluid levels) and disease (lymphedema and spreading tumor metastasis). The adult mammalian lymphatic vasculature is derived from a few embryonic lymph sacs. The debate has surrounded the cellular origin of the lymphatic vasculature: Does it arise from venous endothelial cells or does it arise in the mesenchyme and then establish venous connection later on in development" Exercise and yoga improves quality of life in women with early-stage breast cancer - http://www..brightsurf. com/news/headlines/32646/Exercise_and_yoga_improves_quality_of_life_in_women_with_early- stage_breast_cancer.html Exercise and yoga improves quality of life in women with early-stage breast cancer September 05, 2007 Studies support use during and after treatment Alexandria, VA-Two studies report that exercise and yoga can help maintain and in some cases improve quality of life in women with early-stage breast cancer. The first study found that resistance and aerobic exercise improved physical fitness, self-esteem and body composition, and that resistance exercise improved chemotherapy completion rates. The second study demonstrated that yoga was particularly beneficial for women who were not receiving chemotherapy during the study period. Both studies will be published online September 4 in the Journal of Clinical Oncology (JCO). Lymphedema risk greatly increased with boost of radiation to axillary nodes - http://www.brightsurf. com/news/headlines/27424/Lymphedema_risk_greatly_increased_with_boost_of_radiation_to_axillary_nod es.html Lymphedema risk greatly increased with boost of radiation to axillary nodes November 09, 2006 The significant risk of developing lymphedema may outweigh the benefit of receiving an extra boost of radiation to lymph nodes possibly involved in early-stage breast cancer. That is the conclusion of a study presented today at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Philadelphia. Lymphedema is an uncomfortable swelling of a limb caused by a build-up of lymphatic fluid. This occurs when the lymph vessels are damaged and/or nodes are removed. The disruption of lymphatic flow prevents the proper drainage, causing a back-up of fluid. About 15-20% of women with breast cancer who have lymph nodes removed during surgery will develop lymphedema. Can bench pressing reduce or prevent lymphedema symptoms in breast-cancer survivors? - http://www. brightsurf. com/news/headlines/21599/Can_bench_pressing_reduce_or_prevent_lymphedema_symptoms_in_breast- cancer_survivors.html Can bench pressing reduce or prevent lymphedema symptoms in breast-cancer survivors? October 26, 2005 PENN researchers propose strength-training is contrary to current lymphedema treatment guidelines (Philadelphia, PA) - In a novel research study to begin this week at the Abramson Cancer Center of the University of Pennsylvania, Kathryn Schmitz, PhD, MPH, Assistant Professor in Epidemiology, will help to determine the extent to which a slowly progressive program of strength-training exercises is safe for breast cancer survivors with and without symptoms of lymphedema. Lymphedema, which is characterized by a painful swelling of an affected arm and resulting loss of arm function, is one of the most common and feared side effects of breast-cancer treatments that involve lymph-node removal and/or radiation therapy. These are all the articles that we in the front page of the Related Lymphedema Current Events and Lymphedema News Articles, but there is a link at the bottom of these 9 that says: More Lymphedema Current Events and Lymphedema News Articles - do you want me to do those also? If so just let me know. Obesity Increases Lymphedema Risk for Breast Cancer Survivors - December 19, 2008 COLUMBIA, Mo. - Throughout the world, 10 million breast cancer survivors have a lifetime risk for developing lymphedema, a chronic condition that involves swelling of the limbs and impacts physical and psychosocial health. Second only to the recurrence of cancer, it is the most dreaded effect of breast cancer treatment. In a new study, University of Missouri researchers found that the risk of developing lymphedema is 40 percent to 60 percent higher in women with body mass index (BMI) classified as overweight or obese compared to normal weight women. The researchers recommend increased health education for breast cancer survivors. "Breast cancer survivors with high BMIs will benefit from education focused on maintaining optimal BMI and lymphedema risk reduction practices," said Jane Armer, professor in the Sinclair School of Nursing and director of nursing research at the Ellis Fischel Cancer Center. "Overweight women have the greatest risk of developing lymphedema and should be monitored closely for changes in symptoms and limb volume, especially those who have cancer treatment to the dominant side or experience post-operation swelling." Study links arm/hand swelling to number of lymph nodes removed during breast cancer surgery - April 24, 2009 In older breast cancer survivors, the number of lymph nodes removed during surgery and the presence of cancer in the lymph nodes were the two factors most directly linked to the development of lymphedema, swelling of the arm and hand, according to a study from the Medical College of Wisconsin's Center for Patient Care and Outcomes Research in Milwaukee, Wisconsin. "Lymphedema causes physical discomfort and disability, as well as a cosmetic deformity which can lead to anxiety, depression and emotional distress that can affect a woman's activities of daily living and quality of life," says lead author Tina Yen, M.D., M.S., a Medical College of Wisconsin surgical oncologist who practices at Froedtert Hospital, a major hospital affiliate. "For these reasons, lymphedema is probably the most feared complication among breast cancer survivors. A better understanding of its risk factors is needed to help improve outcomes." Breakthrough in understanding of hereditary disease of lymphatic vessels - August 19, 2004 (Helsinki, August 22nd) -- A study from the Ludwig Institute for Cancer Research (LICR) Affiliate Center at the University of Helsinki in Finland has shed light on the development of lymphatic vasculature and valves, and may help to develop better treatments for lymphedema. The disease, which results from damaged or absent lymphatic vessels, may be inherited or may be a side- effect of the surgical removal of tumors. Lymphatic vessels normally remove fluid and proteins escaping from blood capillaries into surrounding tissues, and lymphedema is characterized by the disabling swelling of legs, and sometimes arms, that results when the lymphatic vessels are unable to clear the lymph from the tissues. The current study, which was published today in Nature Medicine, has uncovered a fundamental mechanism of the formation of lymphatic vessels M. D. Anderson nurse addresses lymphedema in breast cancer patients and survivors - May 19, 2008 Nurse-administered prevention and management strategies can decrease incidence of lymphedema and improve quality of life in patients PHILADELPHIA - A poster session presented today by The University of Texas M. D. Anderson Cancer Center at the Oncology Nurses Society 33rd Annual Congress, found that early nursing intervention and implementation of effective strategies can lead to a decrease in the incidence of lymphedema, better management of chronic lymphedema and improved quality of life in breast cancer patients Lymphedema risk greatly increased with boost of radiation to axillary nodes - November 09, 2006 The significant risk of developing lymphedema may outweigh the benefit of receiving an extra boost of radiation to lymph nodes possibly involved in early-stage breast cancer. That is the conclusion of a study presented today at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Philadelphia. Lymphedema is an uncomfortable swelling of a limb caused by a build-up of lymphatic fluid. This occurs when the lymph vessels are damaged and/or nodes are removed. The disruption of lymphatic flow prevents the proper drainage, causing a back-up of fluid. About 15-20% of women with breast cancer who have lymph nodes removed during surgery will develop lymphedema Preoperative assessment of cancer patients enables early diagnosis, treatment of lymphedema - April 30, 2008 The preoperative assessment of breast cancer patients for subclinical lymphedema enables clinicians to establish a baseline, which serves to enable the early diagnosis and successful treatment of the debilitating condition, according to data from a five-year study published this week in the online edition of the journal Cancer (http://www3.interscience.wiley.com/cgi-bin/abstract/118821880/ABSTRACT). In a study conducted by the National Institutes of Health (NIH) and the National Naval Medical Center, in collaboration with faculty and students from the University of Michigan-Flint and George Mason University, researchers measured the upper limb volume of 196 newly diagnosed breast cancer patients from 2001 to 2006 to establish a baseline prior to surgery. At designated postoperative intervals, the researchers took repeated measurements as part of a "surveillance" model to monitor for possible impairments related to breast cancer treatment--such as lymphedema--as opposed to treating therapy-related problems after they occur. Using the surveillance approach, the investigators demonstrated that a short trial of compression garments effectively treated subclinical lymphedema when it was detected early. Forty-three, or 22 percent, of the 196 breast cancer patients in the study developed subclinical lymphedema, as defined by a change in limb volume of >75cc; and all subjects showed a significant mean volume reduction to very near their pre-surgical "normal" state. All subjects were able to maintain this level for an average of 4.8 months, and none of the patients demonstrated progression of the condition in the follow-up period MU Study Identifies Patient Strategies for Managing Symptoms of Lymphedema - October 30, 2008 An estimated 2 million women in the United States are at risk of developing lymphedema, a condition that involves the chronic and abnormal swelling of the arm, chest, neck and/or back, as a complication of breast cancer treatment. While physicians will recommend proven techniques to manage the swelling, a University of Missouri researcher has found that patients often won't follow the recommendations, or they will use alternative treatments and not discuss them with their doctors. "Lymphedema has a profound impact on health and well-being, but often goes undiagnosed and untreated by physicians and patients," said Jane Armer, professor in the Sinclair School of Nursing and director of nursing research at the Ellis Fischel Cancer Center. "Understanding the ways that people self-manage the chronic symptoms of lymphedema is essential to facilitate an improvement in the use of treatments and the quality of life of these people." Study suggests some breast cancer patients facing radiation after a mastectomy may be over-treated - September 22, 2008 BOSTON -- A new study suggests standard radiation therapy for some breast cancer patients may not be medically required and may, therefore, be causing unnecessary serious side effects such as lymphedema and pulmonary problems. The research conducted at Fox Chase Cancer Center involved women who got a mastectomy, but whose lymph nodes were negative. "When a woman has a tumor greater than 5 centimeters and negative lymph nodes, a mastectomy followed by radiation is recommended," said Penny Anderson, M.D., attending physician in the radiation oncology department at Fox Chase. "We typically irradiate the chest wall because it's been shown to improve survival. Out of an abundance of caution, many radiation oncologists also treat the surrounding lymph nodes, but there is little evidence that this improves outcome." --------------- 02 October 2009 - Fighting Spread Of Mosquito-Borne Diseases Using Parasite Bacteria Infecting mosquitoes with a bacterial parasite could help prevent the spread of lymphatic filariasis, one of the major neglected tropical diseases of the developing world, according to research published in the journal Science. Lymphatic filariasis affects more than 120 million people worldwide - over 40 million of these are seriously incapacitated and disfigured by the disease. It is caused by infection with the parasitic filarial nematode, a threadlike worm that is spread by mosquitoes and occupies the lymphatic system. In chronic cases, infection leads to a condition known as elephantiasis, which can cause severe swelling in the legs, male scrotum and female breasts. Previous research has shown that infecting a mosquito with a strain of the bacterial parasite Wolbachia known as wMelPop - nicknamed 'popcorn' - can halve its lifespan. Mosquito-borne parasites such as the filarial nematode or the malaria parasite require an incubation period between ingestion and transmission, so only older mosquitoes can be infective. Skewing the mosquito population towards younger individuals reduces the number of infectious insects. Now, researchers funded primarily by the Wellcome Trust have shown that as well as reducing the mosquito's lifespan, wMelPop directly inhibits transmission of the filarial nematode by encouraging the mosquito's immune system to attack the worm. They found that significantly reduced numbers of filarial nematodes developed in mosquitoes infected with wMelPop - in some cases, less than 15% of the number in mosquitoes which were not carrying wMelPop. "Wolbachia infection appears to significantly increase the activity of around two hundred mosquito genes, many of which are involved in the immune response," says Dr Steven Sinkins, a Wellcome Trust Senior Research Fellow at the University of Oxford. "This then primes the mosquito's immune system to fight infection by the filarial nematodes, preventing the worm from developing to a stage where transmission to humans is possible." Wolbachia infections - including wMelPop - have also been shown to protect against certain viruses. Today's research suggests that this effect could also be a result of the boost to the mosquito's immune system. Dr Sinkins and colleagues are currently looking at whether infecting other species of mosquito, such as Anopheles gambiae - the mosquito responsible for the majority of malaria infections - with wMelPop will have a similar effect and help inhibit malaria transmission as well as filariasis transmission. Another potential target is the Aedes polynesiensis mosquito, which spreads lymphatic filariasis in the islands of Polynesia, where decades of mass drug administration have failed to eradicate the filarial parasites from the human population. "The Wolbachia 'popcorn' strain is a naturally-occurring organism found in a particular species of fruit fly which, if successfully introduced into mosquito populations, could potentially help us fight a number of the world's most serious diseases," says Dr Sinkins. Wolbachia have been shown in previous studies to be capable of spreading rapidly through insect populations. When a male carrying Wolbachia mates with a female that does not, the resulting eggs fail to develop. However, a female that is infected with Wolbachia can breed successfully with any male, and thus produces more offspring on average than Wolbachia-uninfected females. Source: Craig Brierley Wellcome Trust 29 September 2009 - News From The American Journal Of Pathology, October 2009 B-Cell Lymphoma Protected by SPAK Silencing A group led by Dr. Michael Teitell at UCLA has demonstrated that misregulation of the protein SPAK may contribute to B-cell lymphoma development. Their report can be found in the October 2009 issue of the American Journal of Pathology. B-cell lymphomas are the most frequent human immune system cancers. Epigenetic changes, such as DNA hypermethylation, may promote B-cell transformation by silencing tumor suppressor genes. Expression levels SPAK, a protein that regulates cellular stress responses, are reduced during cancer progression. Using a mouse model of B-cell malignancies and human B-cell lymphoma tissue samples, Balatoni et al report that SPAK expression is inhibited in B-cell tumors due in part to hypermethylation. Decreased SPAK expression protected B cells from environmental stressors that would induce cell death in non-cancerous cells. This SPAK-silenced protection may therefore be responsible for survival and metastatic progression in DNA-damaged B cells. Dr. Teitell and colleagues suggest "that SPAK silencing in B-cell lymphomas promotes cancer progression by crippling genotoxic stress signaling to impair caspase activation. These results likely generalize to breast, prostate, and possibly other cancers beyond B lymphoma and uncover a novel role for SPAK in controlling the DNA damage response, highlighting a protective cell death mechanism that is disabled during the progression of cancer. SPAK expression or repression may also help indicate those patient tumors that should or should not receive genotoxic therapies as the development of personalized medicine pushes ahead." Balatoni CE, Dawson DW, Suh J, Sherman MH, Sanders G, Hong JS, Frank MJ, Malone CS, Said JW, Teitell MA: Epigenetic Silencing of Stk39 in B-Cell Lymphoma Inhibits Apoptosis from Genotoxic Stress. Am J Pathol 2009, 175: 1653-1661 Immune Cells Key to Abdominal Drainage Gou Young Koh and colleagues at the Korea Advanced Institute of Science and Technology in Daejeon, Korea have discovered that macrophages, a type of immune cell, impair fluid drainage during peritoneal inflammation. They present these findings in the October 2009 issue of the American Journal of Pathology. Lymphatic vessels in the diaphragm are responsible for draining excess peritoneal fluid, which lubricates most of the organs in the abdomen. During peritoneal inflammation, however, these vessels have altered structure and function. To characterize changes in lymphatic vessels during peritoneal inflammation, Kim et al injected the inflammatory molecule LPS into mice to induce peritonitis. LPS injection induced changes in lymphatic vessel structure and function that were reversible upon discontinuation of LPS-induced inflammation. Macrophage migration to these sites of lymphangiogenesis contributed to lymphatic remodeling, and both macrophage attachment to the lymphatic vessels and inflammatory fibrosis resulted in impaired peritoneal fluid drainage. These data highlight the key role of macrophages in inflammation-induced lymphangiogenesis and lymphatic vessel dysfunction in the diaphragm. This study by Kim et al "reveal[s] that CD11b+ macrophages play an important role in intraperitoneal LPS- induced aberrant lymphangiogenesis and lymphatic dysfunction in the diaphragm." They suggest that "it is possible that human patients with Gram-negative bacterial peritonitis may also have dysfunctional lymphangiogenesis and lymphatic remodeling in the diaphragm." Kim KE, Koh Y-J, Jeon B-H, Jang C, Han J, Kataru RP, Schwendener RA, Kim J-M, Koh GY: Role of CD11b+ Macrophages in Intraperitoneal Lipopolysaccharide-induced Aberrant Lymphangiogenesis and Lymphatic Function in the Diaphragm. Am J Pathol 2009, 175: 1733-1745 Dissecting Out Metastasis Researchers led by Drs. Elena Deryugina and James Quigley of The Scripts Research Institute in La Jolla, CA have found that urokine plasminogen activator (uPA) may be instrumental in the early stages of metastasis. They report their data in the October 2009 issue of the American Journal of Pathology. Prostate cancer, which develops most frequently in men over fifty, is the most common type of cancer of men in the United States. Most prostate cancer-related deaths are due to advanced disease, which often results in metastatic spread to other organs. Tumor cell intravasation, the entry of aggressive cells into the blood vessels, is an early step in the complex metastatic process. To explore the mechanisms governing intravasation, Conn et al isolated high and low dissemination variants of a prostate carcinoma cell line. The cell line more prone to dissemination had increased angiogenic potential, and these cells were more migratory and invasive. Highly metastatic cells also produced more of the serine protease uPA. By inhibiting uPA activation, invasion, angiogenesis, and intravasation were all blocked. Drs. Deryugina, Quigley, and colleagues conclude that "a comparative analysis of these congenic variants has indicated important functional roles for VEGF secretion and uPA activation in facilitating tumor cell intravasation and has indicated a potential direct link between tumor-induced angiogenesis and tumor cell intravasation." Conn EM, Botkjaer KA, Kupriyanova TA, Andreasen PA, Deryugina EI, Quigley JP: Comparative Analysis of Metastasis Variants Derived from Human Prostate Carcinoma Cells: Roles in Intravasation of VEGF-Mediated Angiogenesis and uPA-Mediated Invasion. Am J Pathol 2009, 175: 1638-1652 DAF Protects against Atherosclerosis Dr. Dorian Haskard and colleagues at the Imperial College, London, UK have discovered that decay accelerating factor (DAF) protects against atherosclerosis. These results are presented in the October 2009 issue of the American Journal of Pathology. Atherosclerosis describes any hardening and loss of elasticity of the arteries due to a build-up of fatty material such as cholesterol. Activation of the complement system, which consists of a cascade of small proteins that can result in cell lysis or trigger inflammation, plays a regulatory role in atherosclerotic lesion development. However, whereas proximal members of the complement pathway have a protective role, distal components are atherogenic. DAF regulates complement activation at the C3 (proximal) level, but its role in atherosclerotic lesion development remains unclear. Leung et al hypothesized that DAF plays a protective role in atherosclerosis. Using a DAF-deficient mouse model of atherosclerosis, they found that DAF-deficient animals had increased levels of the distal complement components C5b-9 in aortic lesions. Lesions in DAF-deficient mice had accelerated development and increased size and complexity compared with normal animals. DAF, therefore, plays an essential regulatory role in limiting complement activation on the arterial wall and is protective against atherosclerosis. This study by Leung et al "underlines the importance of DAF in shielding the arterial wall from the atherogenic effects of complement." Leung VWY, Yun S, Botto M, Mason JC, Malik TH, Song W, Paixao-Cavalcante D, Pickering MC, Boyle JJ, Haskard DO: Decay-Accelerating Factor suppresses Complement C3 activation and retards Atherosclerosis in Low Density Lipoprotein Receptor Deficient Mice. Am J Pathol 2009, 175: 1757-1767 Matripase Critical for Epithelial Function A group led by Dr. Thomas Bugge of the National Institutes of Health in Bethesda, MD reports that the serum protease matripase is required for global homeostasis of diverse epithelial tissues. This study can be found in the October 2009 issue of the American Journal of Pathology. Epithelial cells line the surfaces of cavities and structures throughout the body. These cells have multiple general and organ-specific functions, including maintaining ion gradients, transporting molecules, secreting hormones and growth factors, and excluding pathogens. The serum protease matripase plays a critical role in the function of epithelial cells in the skin; however, matripase is broadly expressed in different types of epithelial tissues. To explore the role of matripase on other epithelial tissues, List et al generated matripase-deficient mice. The loss of matripase was associated with severe organ dysfunction in multiple tissues; these epithelial tissues lost key epithelial functions. The data by Dr. Bugge and colleagues "all strongly argue for a primary role of matriptase in tissue homeostasis, rather than a role in the restoration of homeostasis after chance injury to epithelial tissues. … This study has revealed an essential role of matriptase in the maintenance of global epithelial homeostasis in the mouse and has provided an important animal model for the further exploration of matriptase function in multiple physiological and pathological processes." List K, Kosa P, Szabo R, Bey AL, Wang CB, Molinolo A, Bugge TH: Epithelial integrity is maintained by a matriptase-dependent proteolytic pathway. Am J Pathol 2009, 175: 1453-1463 Source: Angela Colmone American Journal of Pathology 28 September 2009 - A Novel Concept Of Growing Cells On Lymph Nodes: Pitt Researchers Receive $5 Million From NIH For Regenerative Medicine Regenerative medicine researchers at the University of Pittsburgh received two grants totaling more than $5 million from the National Institutes of Health (NIH) to explore new methods for cultivating replacement cells from existing tissues and organs. A $2.9 million, five-year Transformative R01 (T-R01) grant presented to Eric Lagasse, a professor of pathology in Pitt's School of Medicine and a researcher in Pitt and UPMC's jointly operated McGowan Institute for Regenerative Medicine, will support the development of a novel concept: using the body's many lymph nodes as sites for growing replacement cells for other tissues and organs, in essence using them as bioreactors to grow cells within the living body. Ipsita Banerjee, a professor of chemical and petroleum engineering in Pitt's Swanson School of Engineering and a McGowan faculty member, received a $2.2 million, five-year New Innovator award to unravel how embryonic stem cells develop into mature cells and possible techniques for influencing their growth to suit specific organs. The grants were presented as part of the 2009 NIH Director's High-Risk Research Awards, a cluster of five-year grants presented to researchers exploring ideas with the potential to advance their fields and medical treatment. On Sept. 24, the NIH announced 115 awards totaling $348 million, including 42 T-R01 Awards, 18 Pioneer Awards, and 55 New Innovator Awards for early-stage investigators. This marks the inaugural year for the T-R01 grants - which support innovative and high-risk projects that could profoundly impact biomedical research and medical treatment - and also is a record year for the number of New Innovator and Pioneer Awards bestowed. Fellow New Innovator and T-R01 recipients include researchers from the Cleveland Clinic, Columbia University, Duke University, Harvard University, Johns Hopkins University School of Medicine, Massachusetts General Hospital, the Massachusetts Institute of Technology, Mount Sinai School of Medicine, Stanford University, and the University of Pennsylvania. Lagasse's work focuses on lymph nodes, which are important in responses to bacterial and viral infection and are found throughout the body. Even spread out, the total mass of the nodes makes them a feasible place to grow liver cells, for example, which must also be available in abundance and with ample blood flow to provide life-sustaining hepatic function, Lagasse said. His team will explore growing liver and other tissues in such "ectopic" sites, meaning outside of where it would normally reside. The same principle of using lymph nodes as a site for ectopic cell factories might work for replacing pancreas cells that make insulin for patients with diabetes or immune system T-cells for patients who have AIDS and other diseases of immunologic- impairment. "Our regenerative medicine approach for healing damaged tissues and organs might not have moved forward without this new grant concept," Lagasse noted. "This funding supports assessment and rapid translation from the bench to the bedside of nontraditional treatments." Banerjee will investigate the process through which embryonic stem cells become mature, organ-specific cells and how scientists can control that development. Using a bottom-up approach, Banerjee will cultivate stem cells into pancreatic cells, noting molecular-level information that could be integrated into dictating cell development, such as the influence of environmental factors and gene and protein networks. "I want to take a completely different approach to addressing the complex process of cell development, which will potentially advance our understanding of regenerative medicine and stem cell bioengineering as a whole," Banerjee said. Two Pitt researchers have received NIH Director's awards in the past. In 2007, Eva Szigethy, of the Children's Hospital of Pittsburgh of UPMC and an assistant professor of psychiatry and pediatrics at Pitt, received a New Innovators grant to use inflammatory bowel disease as a model for investigating the interactions between the brain, gut, and immune system in determining how adolescents cope with chronic illness. The following year, Barry London, a Pitt professor of medicine, was presented with a Pioneer Award to develop new techniques to image electrical activity of the heart and identify those at risk of sudden cardiac death. Source: Morgan Kelly University of Pittsburgh --------- Genital Lymphoedema By Melanie Lewis MCSP SRP, Macmillan Lymphoedema Clinical Specialist Service Co-ordinator Lymphoedema of the genital region is relatively uncommon, but is extremely uncomfortable and distressing for the patients who suffer with this condition. It can affect both men and women alike, but is seen more frequently in males due to the anatomical differences between the genders and effects of gravity. Around ten percent of people who develop leg oedema will have associated genital swelling, but some patients can have genital oedema alone. In some circumstances, genital oedema can occur acutely due to trauma or cellulitis and may be able to resolve completely by itself. Far more usual however, is the chronic genital oedema, which is unfortunately irreversible, but can be controlled and reduced through appropriate lymphoedema management. The main cause of genital oedema is either due to primary or secondary lymphoedema. Primary lymphoedema affecting only the genitals is rare. It can be noticed from birth or during the teens, and as the affected individual grows, the involved lymphatic system becomes ever more under pressure to drain the tissue fluid and the swelling becomes far more obvious. The main reasons for primary genital lymphoedema are that the lymph vessels are absent or reduced in number or simply don't work as well as they should i.e. functional failure. It has also been thought that primary lymphoedema patients who are obese, have an increased risk of genital swelling due to greater pressure on the groin from the enlarged abdomen. Secondary lymphoedema more commonly affects the genital region than primary lymphoedema. In Africa, India and other tropical countries, genital swelling is frequently seen due to infectious diseases like filariasis. This can lead to gross elephantiasis of the penis and scrotum. In the Western world, the majority of genital oedemas are from trauma or surgery to remove gynaecological, urological, abdominal or prostatic cancers. It has been reported that up to 70% of patients treated for carcinoma to the vulva will have lower body swelling. Radiotherapy to the lymph nodes in the groin or abdominal region can also cause genital lymphoedema. The incidence also increases if there has been surgery and radiotherapy plus episodes of cellulitis. Clinical Features Swelling - Various parts of the genital anatomy can become swollen. In males, both the penis and scrotum, or each, can swell independently. Very few patients just have penile oedema, but it does happen, as can be seen from the case study. Sometimes, the scrotum becomes so swollen, that the patient has difficulty in walking. As the swelling increases, it can involve the area above the base of the penis (called the pubic area), thus causing the penis to retract into the scrotum. This clearly causes problems for micturition (urination)and sexual activity. In females, the inner and outer lips of the vagina (labia) can become so swollen that they extend out of the vagina by up to 6 inches; again this creates problems for sexual activity and urination. In both genders, the pubic area on the lower abdomen alone can become oedematous, with associated skin changes and fibrosis. Genital swelling can occur due to other causes. Palliative patients who have renal, cardiac or hypoproteinaemia (high output failure due to low protein) and patients who have had venous problems, could develop genital oedema. A clear diagnosis and medical investigations are needed, prior to lymphoedema management. Pain is a problem for some patients, who describe a dragging, heavy, bursting sensation or an ache around the genital region. This is usually eased when the area is decongested or lifted by a jock straplike support or cycling shorts. Skin changes are readily seen in genital oedema. Thickening and dry, flaking skin (hyperkeratosis) or warty blisters (papillamatosis) do occur as the swelling progresses. Acute Inflammatory Episodes (cellulitis) are commonly seen in oedematous skin, which is the ideal medium for bacteria as it is generally warm, moist and has numerous crevices. The bacteria multiply in the protein rich oedema fluid, and infections can spread throughout the genital region, causing it to be red, hot, tender and swell even further. More often than not, an infection is seen as the precipitating factor in causing the swelling. Fungal Infections do occur, due to the area being moist, warm and having so many crevices. Sweating also can trigger fungal infections. Lymphorrhoea occurs when the tissue pressure increases and causes leakage of fluid from the thin layer of skin. Lymphorrhoea can continue for a few days or weeks and carries a high risk of developing infections. It can be very distressing for patients, as some have to wear incontinence/sanitary pads to absorb the copious fluid. Lymphoedema treatment is necessary to stop this leakage. Sexual Dysfunction happens as the oedema increases. In males, impotence or painful erections impede sexual intercourse. Females find that the presence of oedema dampens sexual activity, due to decreased libido and pain. Lymphoedema Treatment and Management The four cornerstones of lymphoedema care can be modified to treat genital oedema. Skin Care and meticulous hygiene of the genitals is imperative. Daily bathing with an antibacterial soap and drying the area afterwards is very important to reduce the likelihood of infections. Regular moisturising with an aqueous cream will deter any areas of dry, flaky skin and keep the area soft. As this area is prone to fungal infections and cellulitis, regular inspection will enable the patient to detect any early signs of inflammation. If an infection occurs, prompt anti- fungal or antibiotic treatment is required. If a patient suffers from recurring cellulitis episodes, then longterm prophylactic antibiotics may be required. Compression Garments or Multi- Layered Bandaging techniques are needed to give the genital area support and compression. The penis, scrotum and labia areas will continue to swell until a firm outer casing prevents them from doing so. This outer casing works by providing the muscles with a base to press against, thereby, reducing the swelling. The best form of compression garment comes in the form of custom-made tights or shorts. Spandex or padded cycling shorts and sports jock straps are also very useful to provide more comfort to the oedematous areas. Under garments must be firm and supportive, not loose. In some instances, two pairs, or an under garment plus swimming trunks, have been found to be effective. Foam inserts also can increase the amount of compression to the penis, scrotum or female genital area. Ladies may find that the addition of a sanitary towel underneath garments is also helpful. For male patients with significant penile and scrotum swelling, a regime of multi-layered bandaging may be appropriate. This will consist of washable or disposable bandages and padding/foam being applied to the scrotum and penis separately. Your lymphoedema specialist will need to have had additional training in managing lymphoedema of the genitals, as bandaging the genital area can be very awkward, particularly in getting the bandages to stay in place once the oedema has reduced. Occasionally, bandaging can cause an irritation at the base of the penis and the edge of the scrotal bandaging, thus care must be taken to ensure adequate padding is in place. Simple solutions that have helped, include creating a harness for the swollen scrotum, using a soft pliable material like splint foam or 'Velfoam' prior to padding and bandaging. The harness creates more uplift for the scrotum and patients find it more comfortable as the bandages don't tend to slip. The harness and the penile bandaging can be kept in place using Velcro strips, as it is much easier to apply and reapply and does, therefore, tend to stay in place better. The use of compression shorts, post bandaging, also draws the genitals close to the body and also keeps the bandages in place. All bandages can be easily removed for micturition or if soiled, and the patient taught how to apply/reapply them. The use of bandages can significantly reduce the oedema, which would be maintained by compression garments such as shorts or tights. Exercise in any form is important, as it keeps all the joints and muscles working adequately. If there are no areas of broken skin, then an excellent form of exercise is swimming or walking in the water. The genital area will have some support from the swimming attire and the pressure from the water assists too. Other forms of aerobic exercise that are also useful are cycling and walking, but it is important that compression garments and padding are worn when cycling. A specific form of exercise for female genital oedema is the pelvic floor exercise. Together with abdominal exercises and diaphragmatic breathing, pelvic floor exercises can help in reducing the oedema. Ask your lymphoedema specialist or physiotherapist for further advice. Lymph Drainage is an important part of lymphoedema management. Manual Lymphatic Drainage (MLD) and Simple Lymphatic Drainage (SLD) are massage techniques designed to move fluid away from the swollen genital region, to parts that are not affected, to drain freely. The massage itself is very light and is not painful. It is also very useful in softening hard, fibrosed tissue. MLD is a technique that is carried out by trained therapists. SLD is a simplified form of MLD and can be taught to the patient or carer to do themselves. Surgical Management In some cases where conservative treatment does not control the swelling, surgical intervention may be required. Surgery could involve reducing the scrotum, penis or labia with the aid of plastic surgery skin grafting. Case Study Mr A is a 68-year-old gentleman who has suffered with genital oedema since November 2001.Whilst on holiday in 2001, Mr A developed a painful spot on the right buttock possibly from an insect bite. Unfortunately, this blemish continued to increase in size and eventually became an abscess. He was operated on 3 times in a generalist hospital and due to infections and gangrenous tissue, some of his inguinal lymph nodes were removed. Mr A's genital swelling started soon after the surgery and was sited in the penis area alone. He unluckily had numerous cellulitis episodes, which in turn increased the penile swelling. The scrotum area was severely distorted due to the previous operations and in December 2002, Mr A underwent plastic surgery to graft and lower the testicle area, which although improved the cosmetic appearance of the testicles increased the penile swelling. Mr A was referred to the lymphoedema service and assessed in June 2003. On examination, the genital area was red, inflamed and had a discharge from the shaft of the penis, which was grossly oedematous. The lymphorrhoea had been present for the last 6 months and Mr A had to pad the area to stop it staining his under garments. Severe skin changes were apparent with brown discolouration patches, hyperkeratosis and fibrosis all over the penis. The pubic area was also swollen and fibrosed. Functionally, Mr A felt all forms of activity were limited, as well as travelling and socialising. He suffered an extreme amount of discomfort and pain, which hindered his mobility, and psychologically he felt that the oedema had greatly affected his quality of life and the way in which he viewed himself as a man. Treatment commenced immediately, with Mr A starting a 2-week course of antibiotics to manage the infection. Information regarding hygiene and daily moisturising with an aqueous cream was initiated to help the skin changes, and antibacterial talc was recommended to reduce friction in the groin region. A simple technique of bandaging was also taught to the patient to reduce penis size and stop the leaking fluid. MLD was started and SLD was taught, to improve the fibrosis and create collateral drainage. Mr A was reassessed four weeks later and was delighted with the results. His penile swelling had reduced significantly, making it look far more normal. The skin condition was greatly improved with all areas of hyperkeratosis and leaking diminished. His mobility was normal due to the pain being relieved and he informed me that he had booked a holiday. He is continuing with his lymphoedema regime, consisting of SLD, multi-layered bandaging and daily use of his compression padded cycling shorts, which will keep him in control of his genital oedema. For further information regarding genital oedema, ask your lymphoedema specialist or medical practitioner. Source: Autumn 2003 issue of LymphLine Other helpful links: http://www.lymphedema.com/scrotal.htm http://www.lymphedema.com/wcina.htm ---------- 07 October 2009 - Toronto Researchers Discover Novel Circulation In Human Eye, New Glaucoma Treatment Target Researchers at the University of Toronto, St. Michael's Hospital and Sunnybrook Health Sciences Centre have discovered a previously unidentified form of circulation within the human eye which may provide important new insights into glaucoma, a leading cause of blindness. For over a century, the eye has been considered to lack lymphatics, a circulation responsible for pumping fluid and waste out of tissues. The inability to clear that fluid from the eye is linked to glaucoma, a leading cause of irreversible blindness affecting over 66 million people worldwide. "We challenged this assumption about a lack of lymphatics and discovered specialized lymphatic channels in the human eye," said Prof. Yeni Yücel, a pathologist-scientist in U of T's Faculty of Medicine and St. Michael's Hospital, and lead author of the study which appears in the current issue of Experimental Eye Research. Glaucoma is a degenerative disease believed to be caused by the death of nerve cells at the back of the eye and in vision centers of the brain. It is often associated with elevated pressure in the eye. Current treatments for glaucoma rely on eye drops or surgery to lower eye pressure either by reducing fluid formation or improving fluid drainage from the eye. "Good vision depends on the stable flow of fluid into and out of the eye. Any disturbance of this delicate fluid balance can lead to high eye pressure and irreversible glaucoma damage," said study co-author Dr. Neeru Gupta, Director of the Glaucoma Unit and Nerve Protection Unit at St. Michael's Hospital and Professor of Ophthalmology at U of T. The lymphatic circulation, distinct from blood circulation, carries a colorless fluid called, lymph containing extra water, proteins and antigens through lymphatic vessels to lymph nodes and then to the blood stream. This circulation is critical for the drainage of the fluid from tissues, clearance of proteins and immune monitoring of the tissue. Using molecular tools and three-dimensional reconstruction, the team of researchers identified a rich network of lymphatic channels in the ciliary body of the human eye. These studies were confirmed by electron microscopy. The discovery of a lymphatic circulation in the eye overthrows the idea that the eye is an immune privileged site due to the lack of lymphatics and has major implications for understanding eye inflammations and eye tumor spread, among other eye disorders. "This 'uveolymphatic' circulation plays a role in the clearance of fluid from the eye, making it highly relevant to glaucoma. This discovery is exciting because it means we can focus on innovative treatment strategies for patients with glaucoma by specifically targeting this new circulation to lower eye pressure," said Dr. Gupta. According to the researchers, future studies will be directed at better understanding how to manipulate the lymphatic circulation in the eye. "It's clear that if we want to develop new strategies to prevent blindness, we need to challenge existing beliefs, and hopefully open the door to new treatments for eye disease," said Prof. Yücel, who also serves as Director of the Ophthalmic Pathology Laboratory in U of T's Department of Ophthalmology and research Scientist at the Keenan Research Center at Li Ka Shing Knowledge Institute, SMH. Glaucoma is expected to affect 80 million people worldwide by 2020. Although the disease can affect anybody, those with elevated eye pressure, the elderly, blacks and persons with a family member with glaucoma are at greatest risk. Other risk factors that may be associated with glaucoma include diabetes, high blood pressure and near-sightedness. This study was a collaboration between the University of Toronto and two fully-affiliated hospitals: St. Michael's Hospital and Sunnybrook Health Sciences Centre. Other co-authors include Miles G. Johnston, Professor Laboratory Medicine and Pathobiology and scientist at Neuroscience Program, Sunnybrook Hospital, Tina Ly, Manoj Patel, Ersin Gümüs, Stephan A. Fraenkl and Eva Horvath from SMH, and Brian Drake, Sara Moore, Dalia Tobbia, Dianne Armstrong from Sunnybrook Hospital Research Institute. This research was supported by this work was supported by the Canadian Institutes of Health Research (85053), Nicky And Thor Eaton Fund, The Dorothy Pitts Fund, and Henry Farrugia Fund. Source: April Kemick University of Toronto 06 October 2009 - Elevated Lymphotoxin Expression In Liver Leads To Chronic Hepatitis And Causes HCC A recent study maps the pathway that leads from infection with Hepatitis B and C virus (HBV and HCV) to chronic hepatitis and liver cancer and proposes a new therapeutic strategy for treating liver diseases with chronic inflammation. The research, published by Cell Press in the October issue of the journal Cancer Cell, describes a signaling pathway that can be beneficial during liver regeneration, but can lead to chronic hepatitis and severe liver damage when chronically activated. The research was performed in the Department of Pathology, Institutes of Clinical Pathology and Neuropathology at the University Hospital in Zurich. HBV and HCV cause chronic hepatitis and can lead to hepatocellular carcinoma (HCC), the most prevalent primary liver cancer in humans. "Although aberrant expression of cytotoxic cytokines is thought to be critically involved in hepatitis-induced liver cancer, the exact mechanisms driving this progression remain elusive," explains senior study author Dr. Mathias Heikenwalder. The cytokines lymphotoxin (LT) are mainly produced by white blood cells called lymphocytes and play an important role in organ development and control of the immune response. Previous work had shown that, when compared with normal livers, HCV-infected livers exhibit dramatically increased expression of LT. Dr. Heikenwalder's laboratory, in collaboration with the laboratory of Professor Adriano Aguzzi and colleagues investigated a possible causal relationship between aberrant sustained hepatic LT signaling, chronic hepatitis and the development of HCC. The researchers found that the LT receptor (LT-R) were upregulated in HBV- or HCV-induced hepatitis and HCC and identified both lymphocytes and liver cells called hepatocytes as the main expressing cells. Liver specific expression of LT? and LT? induced chronic liver inflammation and HCC in mice. It was the hepatocytes themselves which were the major LT-responsive liver cells and, importantly, when LT-R signaling was blocked in mice with chronic hepatitis, inflammation was partially attenuated and HCC was prevented. It appears as if LT-R signaling might be beneficial in some cases and detrimental in others. Previous work has shown that LT- signaling in liver cells supported liver regeneration. However, as is evidenced in this study, there is a causal link between chronic LT?R signaling and both chronic hepatitis and HCC development. Taken together, the findings indicate that sustained LT-R signaling in liver leads to chronic hepatitis-induced HCC. "Our results show that LT signaling is critically involved in the development of chronic hepatitis and subsequent HCC formation and imply that blocking LT-R signaling might become a beneficial therapeutic approach in the context of HBV- or HCV-induced chronic hepatitis and other liver diseases displaying sustained hepatic LT-R signaling," concludes Dr. Heikenwalder. The researchers include Johannes Haybaeck, University Hospital Zurich, Zurich, Switzerland; Nicolas Zeller, University Hospital Zurich, Zurich, Switzerland; Monika Julia Wolf, University Hospital Zurich, Zurich, Switzerland; Achim Weber, University Hospital Zurich, Zurich, Switzerland; Ulrich Wagner, University Zurich, Zurich, Switzerland; Michael Odo Kurrer, Cantonal Hospital Aarau, Aarau, Switzerland; Juliane Bremer, University Hospital Zurich, Zurich, Switzerland; Giandomenica Iezzi, Swiss Federal Institute of Technology (ETH), Zurich, Schlieren, Switzerland; Rolf Graf, University Hospital Zurich, Zurich, Switzerland; Pierre-Alain Clavien, University Hospital Zurich, Zurich, Switzerland; Robert Thimme, University of Freiburg, Freiburg, Germany; Hubert Blum, University of Freiburg, Freiburg, Germany; Sergei A. Nedospasov, Engelhardt Institute of Molecular Biology, Moscow, Russia, German Rheumatism Research Center, Berlin, Germany; Kurt Zatloukal, Institute of Pathology, Medical University of Graz, Graz, Austria; Muhammad Ramzan, INSERM and Universite´ Joseph Fourier-Grenoble, Grenoble, France; Sandra Ciesek, Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany; Thomas Pietschmann, Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany; Patrice N. Marche, INSERM and Universite´ Joseph Fourier-Grenoble, Grenoble, France; Michael Karin, University of California, San Diego and University of California, Los Angeles, CA; Manfred Kopf, Swiss Federal Institute of Technology (ETH), Zurich, Schlieren, Switzerland; Jeffrey L. Browning, Biogen Idec, Cambridge, MA; Adriano Aguzzi, University Hospital Zurich, Zurich, Switzerland; and Mathias Heikenwalder, University Hospital Zurich, Zurich, Switzerland. Source: Cathleen Genova Cell Press 02 October 2009 - Fighting Spread Of Mosquito-Borne Diseases Using Parasite Bacteria Infecting mosquitoes with a bacterial parasite could help prevent the spread of lymphatic filariasis, one of the major neglected tropical diseases of the developing world, according to research published in the journal Science. Lymphatic filariasis affects more than 120 million people worldwide - over 40 million of these are seriously incapacitated and disfigured by the disease. It is caused by infection with the parasitic filarial nematode, a threadlike worm that is spread by mosquitoes and occupies the lymphatic system. In chronic cases, infection leads to a condition known as elephantiasis, which can cause severe swelling in the legs, male scrotum and female breasts. Previous research has shown that infecting a mosquito with a strain of the bacterial parasite Wolbachia known as wMelPop - nicknamed 'popcorn' - can halve its lifespan. Mosquito-borne parasites such as the filarial nematode or the malaria parasite require an incubation period between ingestion and transmission, so only older mosquitoes can be infective. Skewing the mosquito population towards younger individuals reduces the number of infectious insects. Now, researchers funded primarily by the Wellcome Trust have shown that as well as reducing the mosquito's lifespan, wMelPop directly inhibits transmission of the filarial nematode by encouraging the mosquito's immune system to attack the worm. They found that significantly reduced numbers of filarial nematodes developed in mosquitoes infected with wMelPop - in some cases, less than 15% of the number in mosquitoes which were not carrying wMelPop. "Wolbachia infection appears to significantly increase the activity of around two hundred mosquito genes, many of which are involved in the immune response," says Dr Steven Sinkins, a Wellcome Trust Senior Research Fellow at the University of Oxford. "This then primes the mosquito's immune system to fight infection by the filarial nematodes, preventing the worm from developing to a stage where transmission to humans is possible." Wolbachia infections - including wMelPop - have also been shown to protect against certain viruses. Today's research suggests that this effect could also be a result of the boost to the mosquito's immune system. Dr Sinkins and colleagues are currently looking at whether infecting other species of mosquito, such as Anopheles gambiae - the mosquito responsible for the majority of malaria infections - with wMelPop will have a similar effect and help inhibit malaria transmission as well as filariasis transmission. Another potential target is the Aedes polynesiensis mosquito, which spreads lymphatic filariasis in the islands of Polynesia, where decades of mass drug administration have failed to eradicate the filarial parasites from the human population. "The Wolbachia 'popcorn' strain is a naturally-occurring organism found in a particular species of fruit fly which, if successfully introduced into mosquito populations, could potentially help us fight a number of the world's most serious diseases," says Dr Sinkins. Wolbachia have been shown in previous studies to be capable of spreading rapidly through insect populations. When a male carrying Wolbachia mates with a female that does not, the resulting eggs fail to develop. However, a female that is infected with Wolbachia can breed successfully with any male, and thus produces more offspring on average than Wolbachia-uninfected females. Source: Craig Brierley Wellcome Trust 29 September 2009 - News From The American Journal Of Pathology, October 2009 B-Cell Lymphoma Protected by SPAK Silencing A group led by Dr. Michael Teitell at UCLA has demonstrated that misregulation of the protein SPAK may contribute to B-cell lymphoma development. Their report can be found in the October 2009 issue of the American Journal of Pathology. B-cell lymphomas are the most frequent human immune system cancers. Epigenetic changes, such as DNA hypermethylation, may promote B-cell transformation by silencing tumor suppressor genes. Expression levels SPAK, a protein that regulates cellular stress responses, are reduced during cancer progression. Using a mouse model of B-cell malignancies and human B-cell lymphoma tissue samples, Balatoni et al report that SPAK expression is inhibited in B-cell tumors due in part to hypermethylation. Decreased SPAK expression protected B cells from environmental stressors that would induce cell death in non-cancerous cells. This SPAK-silenced protection may therefore be responsible for survival and metastatic progression in DNA-damaged B cells. Dr. Teitell and colleagues suggest "that SPAK silencing in B-cell lymphomas promotes cancer progression by crippling genotoxic stress signaling to impair caspase activation. These results likely generalize to breast, prostate, and possibly other cancers beyond B lymphoma and uncover a novel role for SPAK in controlling the DNA damage response, highlighting a protective cell death mechanism that is disabled during the progression of cancer. SPAK expression or repression may also help indicate those patient tumors that should or should not receive genotoxic therapies as the development of personalized medicine pushes ahead." Balatoni CE, Dawson DW, Suh J, Sherman MH, Sanders G, Hong JS, Frank MJ, Malone CS, Said JW, Teitell MA: Epigenetic Silencing of Stk39 in B-Cell Lymphoma Inhibits Apoptosis from Genotoxic Stress. Am J Pathol 2009, 175: 1653-1661 Immune Cells Key to Abdominal Drainage Gou Young Koh and colleagues at the Korea Advanced Institute of Science and Technology in Daejeon, Korea have discovered that macrophages, a type of immune cell, impair fluid drainage during peritoneal inflammation. They present these findings in the October 2009 issue of the American Journal of Pathology. Lymphatic vessels in the diaphragm are responsible for draining excess peritoneal fluid, which lubricates most of the organs in the abdomen. During peritoneal inflammation, however, these vessels have altered structure and function. To characterize changes in lymphatic vessels during peritoneal inflammation, Kim et al injected the inflammatory molecule LPS into mice to induce peritonitis. LPS injection induced changes in lymphatic vessel structure and function that were reversible upon discontinuation of LPS-induced inflammation. Macrophage migration to these sites of lymphangiogenesis contributed to lymphatic remodeling, and both macrophage attachment to the lymphatic vessels and inflammatory fibrosis resulted in impaired peritoneal fluid drainage.. These data highlight the key role of macrophages in inflammation-induced lymphangiogenesis and lymphatic vessel dysfunction in the diaphragm. This study by Kim et al "reveal[s] that CD11b+ macrophages play an important role in intraperitoneal LPS- induced aberrant lymphangiogenesis and lymphatic dysfunction in the diaphragm." They suggest that "it is possible that human patients with Gram-negative bacterial peritonitis may also have dysfunctional lymphangiogenesis and lymphatic remodeling in the diaphragm." Kim KE, Koh Y-J, Jeon B-H, Jang C, Han J, Kataru RP, Schwendener RA, Kim J-M, Koh GY: Role of CD11b+ Macrophages in Intraperitoneal Lipopolysaccharide-induced Aberrant Lymphangiogenesis and Lymphatic Function in the Diaphragm.. Am J Pathol 2009, 175: 1733-1745 Dissecting Out Metastasis Researchers led by Drs. Elena Deryugina and James Quigley of The Scripts Research Institute in La Jolla, CA have found that urokine plasminogen activator (uPA) may be instrumental in the early stages of metastasis. They report their data in the October 2009 issue of the American Journal of Pathology.. Prostate cancer, which develops most frequently in men over fifty, is the most common type of cancer of men in the United States. Most prostate cancer-related deaths are due to advanced disease, which often results in metastatic spread to other organs. Tumor cell intravasation, the entry of aggressive cells into the blood vessels, is an early step in the complex metastatic process. To explore the mechanisms governing intravasation, Conn et al isolated high and low dissemination variants of a prostate carcinoma cell line. The cell line more prone to dissemination had increased angiogenic potential, and these cells were more migratory and invasive. Highly metastatic cells also produced more of the serine protease uPA. By inhibiting uPA activation, invasion, angiogenesis, and intravasation were all blocked. Drs. Deryugina, Quigley, and colleagues conclude that "a comparative analysis of these congenic variants has indicated important functional roles for VEGF secretion and uPA activation in facilitating tumor cell intravasation and has indicated a potential direct link between tumor-induced angiogenesis and tumor cell intravasation." Conn EM, Botkjaer KA, Kupriyanova TA, Andreasen PA, Deryugina EI, Quigley JP: Comparative Analysis of Metastasis Variants Derived from Human Prostate Carcinoma Cells: Roles in Intravasation of VEGF-Mediated Angiogenesis and uPA-Mediated Invasion. Am J Pathol 2009, 175: 1638-1652 DAF Protects against Atherosclerosis Dr. Dorian Haskard and colleagues at the Imperial College, London, UK have discovered that decay accelerating factor (DAF) protects against atherosclerosis. These results are presented in the October 2009 issue of the American Journal of Pathology. Atherosclerosis describes any hardening and loss of elasticity of the arteries due to a build-up of fatty material such as cholesterol. Activation of the complement system, which consists of a cascade of small proteins that can result in cell lysis or trigger inflammation, plays a regulatory role in atherosclerotic lesion development. However, whereas proximal members of the complement pathway have a protective role, distal components are atherogenic. DAF regulates complement activation at the C3 (proximal) level, but its role in atherosclerotic lesion development remains unclear. Leung et al hypothesized that DAF plays a protective role in atherosclerosis. Using a DAF-deficient mouse model of atherosclerosis, they found that DAF-deficient animals had increased levels of the distal complement components C5b-9 in aortic lesions. Lesions in DAF-deficient mice had accelerated development and increased size and complexity compared with normal animals. DAF, therefore, plays an essential regulatory role in limiting complement activation on the arterial wall and is protective against atherosclerosis. This study by Leung et al "underlines the importance of DAF in shielding the arterial wall from the atherogenic effects of complement." Leung VWY, Yun S, Botto M, Mason JC, Malik TH, Song W, Paixao-Cavalcante D, Pickering MC, Boyle JJ, Haskard DO: Decay-Accelerating Factor suppresses Complement C3 activation and retards Atherosclerosis in Low Density Lipoprotein Receptor Deficient Mice. Am J Pathol 2009, 175: 1757-1767 Matripase Critical for Epithelial Function A group led by Dr. Thomas Bugge of the National Institutes of Health in Bethesda, MD reports that the serum protease matripase is required for global homeostasis of diverse epithelial tissues. This study can be found in the October 2009 issue of the American Journal of Pathology. Epithelial cells line the surfaces of cavities and structures throughout the body. These cells have multiple general and organ-specific functions, including maintaining ion gradients, transporting molecules, secreting hormones and growth factors, and excluding pathogens. The serum protease matripase plays a critical role in the function of epithelial cells in the skin; however, matripase is broadly expressed in different types of epithelial tissues. To explore the role of matripase on other epithelial tissues, List et al generated matripase-deficient mice. The loss of matripase was associated with severe organ dysfunction in multiple tissues; these epithelial tissues lost key epithelial functions. The data by Dr. Bugge and colleagues "all strongly argue for a primary role of matriptase in tissue homeostasis, rather than a role in the restoration of homeostasis after chance injury to epithelial tissues. … This study has revealed an essential role of matriptase in the maintenance of global epithelial homeostasis in the mouse and has provided an important animal model for the further exploration of matriptase function in multiple physiological and pathological processes." List K, Kosa P, Szabo R, Bey AL, Wang CB, Molinolo A, Bugge TH: Epithelial integrity is maintained by a matriptase-dependent proteolytic pathway. Am J Pathol 2009, 175: 1453-1463 Source: Angela Colmone American Journal of Pathology 28 September 2009 - A Novel Concept Of Growing Cells On Lymph Nodes: Pitt Researchers Receive $5 Million From NIH For Regenerative Medicine Regenerative medicine researchers at the University of Pittsburgh received two grants totaling more than $5 million from the National Institutes of Health (NIH) to explore new methods for cultivating replacement cells from existing tissues and organs. A $2.9 million, five-year Transformative R01 (T-R01) grant presented to Eric Lagasse, a professor of pathology in Pitt's School of Medicine and a researcher in Pitt and UPMC's jointly operated McGowan Institute for Regenerative Medicine, will support the development of a novel concept: using the body's many lymph nodes as sites for growing replacement cells for other tissues and organs, in essence using them as bioreactors to grow cells within the living body. Ipsita Banerjee, a professor of chemical and petroleum engineering in Pitt's Swanson School of Engineering and a McGowan faculty member, received a $2.2 million, five-year New Innovator award to unravel how embryonic stem cells develop into mature cells and possible techniques for influencing their growth to suit specific organs. The grants were presented as part of the 2009 NIH Director's High-Risk Research Awards, a cluster of five-year grants presented to researchers exploring ideas with the potential to advance their fields and medical treatment. On Sept. 24, the NIH announced 115 awards totaling $348 million, including 42 T-R01 Awards, 18 Pioneer Awards, and 55 New Innovator Awards for early-stage investigators. This marks the inaugural year for the T-R01 grants - which support innovative and high-risk projects that could profoundly impact biomedical research and medical treatment - and also is a record year for the number of New Innovator and Pioneer Awards bestowed. Fellow New Innovator and T-R01 recipients include researchers from the Cleveland Clinic, Columbia University, Duke University, Harvard University, Johns Hopkins University School of Medicine, Massachusetts General Hospital, the Massachusetts Institute of Technology, Mount Sinai School of Medicine, Stanford University, and the University of Pennsylvania. Lagasse's work focuses on lymph nodes, which are important in responses to bacterial and viral infection and are found throughout the body. Even spread out, the total mass of the nodes makes them a feasible place to grow liver cells, for example, which must also be available in abundance and with ample blood flow to provide life-sustaining hepatic function, Lagasse said. His team will explore growing liver and other tissues in such "ectopic" sites, meaning outside of where it would normally reside. The same principle of using lymph nodes as a site for ectopic cell factories might work for replacing pancreas cells that make insulin for patients with diabetes or immune system T-cells for patients who have AIDS and other diseases of immunologic- impairment. "Our regenerative medicine approach for healing damaged tissues and organs might not have moved forward without this new grant concept," Lagasse noted.. "This funding supports assessment and rapid translation from the bench to the bedside of nontraditional treatments." Banerjee will investigate the process through which embryonic stem cells become mature, organ-specific cells and how scientists can control that development. Using a bottom-up approach, Banerjee will cultivate stem cells into pancreatic cells, noting molecular-level information that could be integrated into dictating cell development, such as the influence of environmental factors and gene and protein networks. "I want to take a completely different approach to addressing the complex process of cell development, which will potentially advance our understanding of regenerative medicine and stem cell bioengineering as a whole," Banerjee said. Two Pitt researchers have received NIH Director's awards in the past. In 2007, Eva Szigethy, of the Children's Hospital of Pittsburgh of UPMC and an assistant professor of psychiatry and pediatrics at Pitt, received a New Innovators grant to use inflammatory bowel disease as a model for investigating the interactions between the brain, gut, and immune system in determining how adolescents cope with chronic illness. The following year, Barry London, a Pitt professor of medicine, was presented with a Pioneer Award to develop new techniques to image electrical activity of the heart and identify those at risk of sudden cardiac death. Source: Morgan Kelly University of Pittsburgh ------ 1. 07 October 2009 - Toronto Researchers Discover Novel Circulation In Human Eye, New Glaucoma Treatment Target Researchers at the University of Toronto, St. Michael's Hospital and Sunnybrook Health Sciences Centre have discovered a previously unidentified form of circulation within the human eye which may provide important new insights into glaucoma, a leading cause of blindness. For over a century, the eye has been considered to lack lymphatics, a circulation responsible for pumping fluid and waste out of tissues. The inability to clear that fluid from the eye is linked to glaucoma, a leading cause of irreversible blindness affecting over 66 million people worldwide. "We challenged this assumption about a lack of lymphatics and discovered specialized lymphatic channels in the human eye," said Prof. Yeni Yücel, a pathologist-scientist in U of T's Faculty of Medicine and St. Michael's Hospital, and lead author of the study which appears in the current issue of Experimental Eye Research. Glaucoma is a degenerative disease believed to be caused by the death of nerve cells at the back of the eye and in vision centers of the brain. It is often associated with elevated pressure in the eye. Current treatments for glaucoma rely on eye drops or surgery to lower eye pressure either by reducing fluid formation or improving fluid drainage from the eye. "Good vision depends on the stable flow of fluid into and out of the eye. Any disturbance of this delicate fluid balance can lead to high eye pressure and irreversible glaucoma damage," said study co-author Dr. Neeru Gupta, Director of the Glaucoma Unit and Nerve Protection Unit at St. Michael's Hospital and Professor of Ophthalmology at U of T. The lymphatic circulation, distinct from blood circulation, carries a colorless fluid called, lymph containing extra water, proteins and antigens through lymphatic vessels to lymph nodes and then to the blood stream. This circulation is critical for the drainage of the fluid from tissues, clearance of proteins and immune monitoring of the tissue. Using molecular tools and three-dimensional reconstruction, the team of researchers identified a rich network of lymphatic channels in the ciliary body of the human eye. These studies were confirmed by electron microscopy. The discovery of a lymphatic circulation in the eye overthrows the idea that the eye is an immune privileged site due to the lack of lymphatics and has major implications for understanding eye inflammations and eye tumor spread, among other eye disorders. "This 'uveolymphatic' circulation plays a role in the clearance of fluid from the eye, making it highly relevant to glaucoma. This discovery is exciting because it means we can focus on innovative treatment strategies for patients with glaucoma by specifically targeting this new circulation to lower eye pressure," said Dr. Gupta. According to the researchers, future studies will be directed at better understanding how to manipulate the lymphatic circulation in the eye. "It's clear that if we want to develop new strategies to prevent blindness, we need to challenge existing beliefs, and hopefully open the door to new treatments for eye disease," said Prof. Yücel, who also serves as Director of the Ophthalmic Pathology Laboratory in U of T's Department of Ophthalmology and research Scientist at the Keenan Research Center at Li Ka Shing Knowledge Institute, SMH. Glaucoma is expected to affect 80 million people worldwide by 2020. Although the disease can affect anybody, those with elevated eye pressure, the elderly, blacks and persons with a family member with glaucoma are at greatest risk. Other risk factors that may be associated with glaucoma include diabetes, high blood pressure and near-sightedness. This study was a collaboration between the University of Toronto and two fully-affiliated hospitals: St. Michael's Hospital and Sunnybrook Health Sciences Centre. Other co-authors include Miles G. Johnston, Professor Laboratory Medicine and Pathobiology and scientist at Neuroscience Program, Sunnybrook Hospital, Tina Ly, Manoj Patel, Ersin Gümüs, Stephan A. Fraenkl and Eva Horvath from SMH, and Brian Drake, Sara Moore, Dalia Tobbia, Dianne Armstrong from Sunnybrook Hospital Research Institute. This research was supported by this work was supported by the Canadian Institutes of Health Research (85053), Nicky And Thor Eaton Fund, The Dorothy Pitts Fund, and Henry Farrugia Fund. Source: April Kemick University of Toronto 2. 06 October 2009 - Elevated Lymphotoxin Expression In Liver Leads To Chronic Hepatitis And Causes HCC A recent study maps the pathway that leads from infection with Hepatitis B and C virus (HBV and HCV) to chronic hepatitis and liver cancer and proposes a new therapeutic strategy for treating liver diseases with chronic inflammation. The research, published by Cell Press in the October issue of the journal Cancer Cell, describes a signaling pathway that can be beneficial during liver regeneration, but can lead to chronic hepatitis and severe liver damage when chronically activated. The research was performed in the Department of Pathology, Institutes of Clinical Pathology and Neuropathology at the University Hospital in Zurich. HBV and HCV cause chronic hepatitis and can lead to hepatocellular carcinoma (HCC), the most prevalent primary liver cancer in humans. "Although aberrant expression of cytotoxic cytokines is thought to be critically involved in hepatitis-induced liver cancer, the exact mechanisms driving this progression remain elusive," explains senior study author Dr. Mathias Heikenwalder.. The cytokines lymphotoxin (LT) are mainly produced by white blood cells called lymphocytes and play an important role in organ development and control of the immune response. Previous work had shown that, when compared with normal livers, HCV-infected livers exhibit dramatically increased expression of LT. Dr. Heikenwalder's laboratory, in collaboration with the laboratory of Professor Adriano Aguzzi and colleagues investigated a possible causal relationship between aberrant sustained hepatic LT signaling, chronic hepatitis and the development of HCC. The researchers found that the LT receptor (LT-R) were upregulated in HBV- or HCV-induced hepatitis and HCC and identified both lymphocytes and liver cells called hepatocytes as the main expressing cells. Liver specific expression of LT? and LT? induced chronic liver inflammation and HCC in mice. It was the hepatocytes themselves which were the major LT-responsive liver cells and, importantly, when LT-R signaling was blocked in mice with chronic hepatitis, inflammation was partially attenuated and HCC was prevented. It appears as if LT-R signaling might be beneficial in some cases and detrimental in others. Previous work has shown that LT- signaling in liver cells supported liver regeneration. However, as is evidenced in this study, there is a causal link between chronic LT?R signaling and both chronic hepatitis and HCC development. Taken together, the findings indicate that sustained LT-R signaling in liver leads to chronic hepatitis-induced HCC. "Our results show that LT signaling is critically involved in the development of chronic hepatitis and subsequent HCC formation and imply that blocking LT-R signaling might become a beneficial therapeutic approach in the context of HBV- or HCV-induced chronic hepatitis and other liver diseases displaying sustained hepatic LT-R signaling," concludes Dr. Heikenwalder. The researchers include Johannes Haybaeck, University Hospital Zurich, Zurich, Switzerland; Nicolas Zeller, University Hospital Zurich, Zurich, Switzerland; Monika Julia Wolf, University Hospital Zurich, Zurich, Switzerland; Achim Weber, University Hospital Zurich, Zurich, Switzerland; Ulrich Wagner, University Zurich, Zurich, Switzerland; Michael Odo Kurrer, Cantonal Hospital Aarau, Aarau, Switzerland; Juliane Bremer, University Hospital Zurich, Zurich, Switzerland; Giandomenica Iezzi, Swiss Federal Institute of Technology (ETH), Zurich, Schlieren, Switzerland; Rolf Graf, University Hospital Zurich, Zurich, Switzerland; Pierre-Alain Clavien, University Hospital Zurich, Zurich, Switzerland; Robert Thimme, University of Freiburg, Freiburg, Germany; Hubert Blum, University of Freiburg, Freiburg, Germany; Sergei A. Nedospasov, Engelhardt Institute of Molecular Biology, Moscow, Russia, German Rheumatism Research Center, Berlin, Germany; Kurt Zatloukal, Institute of Pathology, Medical University of Graz, Graz, Austria; Muhammad Ramzan, INSERM and Universite´ Joseph Fourier-Grenoble, Grenoble, France; Sandra Ciesek, Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany; Thomas Pietschmann, Medical School Hannover (MHH) and the Helmholtz Centre for Infection Research (HZI), Hannover, Germany; Patrice N. Marche, INSERM and Universite´ Joseph Fourier-Grenoble, Grenoble, France; Michael Karin, University of California, San Diego and University of California, Los Angeles, CA; Manfred Kopf, Swiss Federal Institute of Technology (ETH), Zurich, Schlieren, Switzerland; Jeffrey L. Browning, Biogen Idec, Cambridge, MA; Adriano Aguzzi, University Hospital Zurich, Zurich, Switzerland; and Mathias Heikenwalder, University Hospital Zurich, Zurich, Switzerland. Source: Cathleen Genova Cell Press 3. 02 October 2009 - Fighting Spread Of Mosquito-Borne Diseases Using Parasite Bacteria Infecting mosquitoes with a bacterial parasite could help prevent the spread of lymphatic filariasis, one of the major neglected tropical diseases of the developing world, according to research published in the journal Science. Lymphatic filariasis affects more than 120 million people worldwide - over 40 million of these are seriously incapacitated and disfigured by the disease. It is caused by infection with the parasitic filarial nematode, a threadlike worm that is spread by mosquitoes and occupies the lymphatic system. In chronic cases, infection leads to a condition known as elephantiasis, which can cause severe swelling in the legs, male scrotum and female breasts. Previous research has shown that infecting a mosquito with a strain of the bacterial parasite Wolbachia known as wMelPop - nicknamed 'popcorn' - can halve its lifespan. Mosquito-borne parasites such as the filarial nematode or the malaria parasite require an incubation period between ingestion and transmission, so only older mosquitoes can be infective. Skewing the mosquito population towards younger individuals reduces the number of infectious insects. Now, researchers funded primarily by the Wellcome Trust have shown that as well as reducing the mosquito's lifespan, wMelPop directly inhibits transmission of the filarial nematode by encouraging the mosquito's immune system to attack the worm. They found that significantly reduced numbers of filarial nematodes developed in mosquitoes infected with wMelPop - in some cases, less than 15% of the number in mosquitoes which were not carrying wMelPop.. "Wolbachia infection appears to significantly increase the activity of around two hundred mosquito genes, many of which are involved in the immune response," says Dr Steven Sinkins, a Wellcome Trust Senior Research Fellow at the University of Oxford. "This then primes the mosquito's immune system to fight infection by the filarial nematodes, preventing the worm from developing to a stage where transmission to humans is possible." Wolbachia infections - including wMelPop - have also been shown to protect against certain viruses. Today's research suggests that this effect could also be a result of the boost to the mosquito's immune system. Dr Sinkins and colleagues are currently looking at whether infecting other species of mosquito, such as Anopheles gambiae - the mosquito responsible for the majority of malaria infections - with wMelPop will have a similar effect and help inhibit malaria transmission as well as filariasis transmission. Another potential target is the Aedes polynesiensis mosquito, which spreads lymphatic filariasis in the islands of Polynesia, where decades of mass drug administration have failed to eradicate the filarial parasites from the human population. "The Wolbachia 'popcorn' strain is a naturally-occurring organism found in a particular species of fruit fly which, if successfully introduced into mosquito populations, could potentially help us fight a number of the world's most serious diseases," says Dr Sinkins. Wolbachia have been shown in previous studies to be capable of spreading rapidly through insect populations. When a male carrying Wolbachia mates with a female that does not, the resulting eggs fail to develop. However, a female that is infected with Wolbachia can breed successfully with any male, and thus produces more offspring on average than Wolbachia-uninfected females. Source: Craig Brierley Wellcome Trust ----- Movin' On Movin' On, a one-hour class of gentle exercises and movement for breast cancer survivors, will be held Saturdays, now through Nov. 14. Presented by Lymphedema Resources Inc., the class is offered at no charge as it is funded by grants from The League Club of Naples and the Cape Coral Foundation. For information, call 898-1008. ----- Villager finds poetic inspiration in her own cancer battle By AZIA LI FORREST, DAILY SUN THE VILLAGES — Once it’s written down on paper, it’s real. That’s the philosophy Rose Haverlack uses while living as a survivor of breast cancer. “When you’re faced with breast cancer, and it could be life-threatening, everything changes — so I write about it,” the Village of Bonnybrook resident said. “That’s the way — for me — it can become real. Because I can take, (then) dismiss it or dream it and it’s gone. But on paper — this is the real thing.” As a 12th-grade English teacher in Pittsburgh, Pa., she was simply too busy for cancer. “The kids would say, ‘We only have 10 minutes left, let’s just relax’, she said. “I look at the clock and say, ‘We still have 10 minutes. We can do this and this and this.’ Kids have — in their heads at least — many tomorrows.” Fourteen years ago, when Haverlack received the diagnosis, she thought it must be wrong. She also gave blood every 59 days, and she was frightened because she had just given blood. “I had to set down the law,” she said. “I told the doctor, ‘Look, I don’t have time for this — school is starting.’ He told me I didn’t have an option, I was going in for surgery.” Haverlack was out of work for six months while undergoing chemotherapy and radiation treatments. She found the radiation especially grueling because she has sensitive skin. “I got burned to a crisp,” she said. “They had to stop the radiation for about three weeks because my skin was peeling off.” Haverlack had two lymph nodes removed. As a result, 13 years later, she developed lymphedema, a buildup of lymph fluid in the fatty tissues just under the skin that causes the skin to swell mildly or severely. “Many people get it immediately after surgery,” she said. “I was fortunate.” Now, Haverlack wears a compression sleeve — a lifetime commitment. “I was fine all these years.” she said. “I wore my breast cancer bracelet, then one morning when I woke up, I had this balloon hand and a fat arm. I thought maybe my bracelet had twisted. No, it just happened.” Still, she maintains a positive outlook on life. “You could waste your days — I don’t,” she said. “I use my days. It’s (breast cancer) the best thing that ever happened to me.” As a facilitator for the Tri-County Breast Cancer Support Group, Haverlack sometimes shares her story through poetry. She wrote “The Journey,” which uses a road as a metaphor for her experience, for the support group. In the poem, the road appears smooth, but a closer look shows it is made up of rocks and debris. After the dirt was dug up and chemicals were applied to it, the road is changed forever. But with sunlight (enlightenment), seeds (friendship) and water (tears), a flower (rose) still grows. Other writings by Haverlack include “Cancer — the Experience of a Lifetime,” “Touched by an Angel, a Butterfly” and “My Choice,” which explains why she sees having breast cancer as a gift, not a tragedy. “A support system is key,” she said, “because you think you’re all alone, and you’re not. Millions of people have this. There’s so much to be learned.” Haverlack’s goal is to help at least just one other person. “It’s like teaching,” she said, “You don’t know how many lives you’ve touched.” http://www.thevillagesdailysun.com/articles/2009/10/27/news/news02.txt ------ Weightlifting eases survivors’ swelling issues Wednesday, October 28, 2009 Last updated: Tuesday October 27, 2009, 4:05 PM BY MARY JO LAYTON The Record STAFF WRITER 0 Comments When Joan Petrelli, 64, had breast cancer eight years ago, surgeons removed 21 lymph nodes and three nerves under her left arm, leaving her with a painful swelling in the upper arm known as lymphedema. She was told not to lift weights or exercise the arm — a long-standing recommendation from doctors. But new research may force doctors to rethink what they tell their patients about exercise: A recent study showed that women who lift weights have far fewer lymphedema symptoms. The research, which appeared in an August issue of the New England Journal of Medicine, found that “slowly progressive” weightlifting increased strength without increasing arm swelling. In fact, the weightlifting can act like a pump to remove excess fluid from the arm, relieving swelling and easing symptoms, experts say. “They were always saying, ‘Don’t do the exercise,’Ÿ” said Carol Livingstone, health and fitness director at the Ridgewood YMCA, which runs a fitness program for cancer survivors. “Now the research validates what we’ve been doing.” Many breast cancer survivors develop lymphedema, an uncomfortable and sometimes painful swelling in the upper arm or hand that can be debilitating and disfiguring. The condition, which has no cure, occurs after removal of lymph nodes in the armpit to determine if cancer has spread. The more nodes removed, the greater the problem. “It feels great to lift weights and exercise, as long as I don’t overdo it,” said Petrelli, a Totowa resident who works at the Ridgewood Y and is a volunteer instructor for cancer survivors. In the study, led by Dr. Kathryn H. Schmitz, an exercise physiologist and assistant professor at the University of Pennsylvania, half of the 141 women were randomly assigned to the weightlifting group. These women joined a local fitness center, where trainers taught them useful exercises, supervised their progress, and monitored them for lymphedema flare-ups over the course of a year. The women assigned to the control group maintained their current level of exercise. Control patients needed significantly more treatments for lymphedema flare-ups than patients who lifted weights — 195 times versus 77 times. The researchers designed the workouts for community gyms, including YMCAs, so that many cancer survivors would have access to them. The Ridgewood YMCA follows the Living Strong, Living Well program created by Stanford University, where Livingstone trained. The 12-week small-group program — free to cancer survivors — teaches patients how to build muscle mass, increase flexibility and endurance and prevent or ease symptoms of lymphedema. Barbara Ferraro, an Oradell resident, completed the program after a mastectomy, chemotherapy and radiation. “I was like a piece of wood, so stiff,” Ferraro, 61, said in the weight room in September. She believes the workouts also prevented any swelling in her arm. When she first used the rotation wheel, “I would use my right hand, but the left one was going along for the ride,” she said. By the end of the program, her left side had strengthened significantly, she said. “When I went to my doctor for a checkup, the nurse noticed right away that I’ve been lifting weights,” she said. A friend she met in the program, Marsha Groner, a 67-year-old Hillsdale resident, built up to lifting 70 pounds of weights doing a lateral pull to strengthen chest muscles after surgery and radiation. “Don’t meet us in a dark alley,” she joked. The women say the information and support they’ve shared has motivated them on days when the grueling regimes of treatment normally would have kept them in bed. At a recent workout, Lisa Torsiello, a 42-year-old Glen Rock resident, lifted weights to prevent lymphedema after breast cancer surgery. There’s an added boost: Though she has only been enrolled in the program for two weeks, Torsiello already feels more energetic, which is vital because she’s halfway through her chemotherapy. “I need the energy. I have a 2-year-old,” Torsiello said. Karen Coles, a 46-year-old Fair Lawn resident, began the 12-week program just two weeks after her breast cancer surgery. The first day her doctor gave her permission to drive, Coles said, she headed for the gym. “If it weren’t for this program, I’d still be in bed,” she said. E-mail: layton@northjersey.com ----- http://www.northjersey.com/specialreports/Weightlifting_eases_survivors_swelling_issues.html ---- Duncan family is seeking money for special suits to ease swelling Health BY VALLERY BROWN Comments 0 Published: October 31, 2009 DUNCAN — Kayden Ward hasn’t lived long enough to know he’s different. He smiles, gurgles and flops around on his father’s knee like a normal 10-week-old boy. But he does all this while bound with tight bandages. Kayden Ward, 10 weeks old, sits on the lap of his grandmother, Melissa Howe. His mother, Brittney Rodriguez, left, massages her son once a day to help move fluids out of his body and control swelling. Kayden has a rare condition that causes him to swell and makes him highly susceptible to infection. He must remain tightly bandaged nearly 24 hours a day. PHOTO BY VALLERY BROWN, THE OKLAHOMAN MultimediaVideo view all videos Duncan family seeks help Oct 30A Duncan family is seeking help in providing a special... Photo view all photos Related contentLinksknow it: Giving and Volunteering More InfoRaising money for Kayden Kayden Ward’s family is taking donations for treatments at www.babykayden.org. They will also host a benefit for Kayden at the University of Science and Arts of Oklahoma ballroom on Dec. 13 in Chickasha. So far, the family has raised about $230 for buying compression clothing, and the Web site is getting about 250 visits per day. NewsOK Related ArticlesKayden has a disease called congenital vascular lymphedema. It causes portions of his body to swell beneath the skin with excess fluids. He must remain tightly wrapped for nearly 24 hours a day. His family is working to collect money for special clothing that will manage his condition. "He’s fought since he was born,” said Melissa Howe, Kayden’s grandmother. "He just needs help.” Kayden was born with lymphedema and was diagnosed several weeks after he was born because of unusual swelling on his hand, left foot and genital area. So far, he’s seen about 30 doctors. A daytime compression garment costs about $1,000. A suit for night wear costs between $1,000 and $1,500, said Carmen Wilcox, Kayden’s lymphedema therapist from Norman Regional Hospital. He’ll need new garments as he grows, she said. It’s an expense Kayden’s family has to pay for out of pocket because so far SoonerCare has not agreed to cover the garments. Howe said her family is doing everything to find a way to pay for the special clothing. "In the meantime, Kayden has to wait it out with the bandages,” Howe said. "We never thought we’d be in the situation of struggling to pay for something he needs.” Daily care Kayden’s mother, 18-year-old Brittney Rodriguez, is a college freshman. She takes classes online through Oklahoma State University. Neither she nor Kayden’s father, 19-year-old Clay Ward, can work because of the time and knowledge required to care for Kayden. Ward is responsible for changing his son’s bandages. Kayden requires rewrapping at least twice per day and every time his diaper is changed. Rodriguez massages her son at least once a day to keep the fluids moving in his system and to prevent swelling. Both parents drive with Kayden to his physical therapy appointments in Norman once a day, Rodriguez said. "It’s stressful, it takes some getting used to,” Rodriguez said. Wilcox said Kayden’s lymphedema is not curable, but it can be managed. The red-headed boy will never be able to play close-contact or high-intensity sports because of his condition. He will need to use compression garments or wrap himself for the rest of his life, she said. "Otherwise, he’ll be able to live normally,” she said. Wilcox said the compression clothing is important for Kayden’s treatment. Bandages weigh him down and restrict his movement. Last week, the bandages caused Kayden to overheat and have a small seizure, Howe said. Cuts, abrasions, sores and other skin problems can lead to infections that are potentially deadly for Kayden because his immune system can’t fight them off as well, Wilcox said. Uncontrolled swelling can cause dangerous infections, as well. "The garments allow him to go through normal development,” Wilcox said. She said the disease in children is rare, and Kayden is the only case she’s seen as an infant in her nearly 10 years of practice. Lymphedema can have genetic causes but also can be caused by injuries to the lymph nodes, cancer treatments and other problems. Wilcox said most of her patients’ insurance providers don’t cover the compression garments. "If they can’t change the bandages on their own, they have to have them,” she said. "You can’t be successful in treatment without the compression.” Read more: http://newsok.com/duncan-family-is-seeking-money-for-special-suits-to-ease- swelling/article/3413543#ixzz0VYiAPIGH http://newsok.com/duncan-family-is-seeking-money-for-special-suits-to-ease-swelling/article/3413543 ------- Updated NCCN Guidelines for Breast Cancer Discourages Prophylactic Mastectomy in Women Other Than Those at High Risk Wed Oct 28, 2009 10:12am EDT Email | Print | Share| Reprints | Single Page[-] Text [+] Featured Broker sponsored link Updated NCCN Guidelines for Breast Cancer Discourages Prophylactic Mastectomy in Women Other Than Those at High Risk The removal of a noncancerous breast (prophylactic mastectomy) is generally discouraged in women other than those at high risk as stated in the updated National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology(TM) for Breast Cancer. Other noteworthy updates to the NCCN Guidelines include a new regimen for adjuvant chemotherapy in invasive breast cancer and the option for women with clinically negative lymph nodes to avoid a full axillary lymph node dissection. FORT WASHINGTON, Pa., Oct. 28 /PRNewswire-USNewswire/ -- Despite a recent study finding that an increasing number of women who had cancer in one breast are opting to have the other breast removed, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology(TM) for Breast Cancer discourages prophylactic mastectomy in women except for those considered high risk. This recommendation is noted in the recently updated NCCN Guidelines for Breast Cancer along with a new regimen for adjuvant chemotherapy and recommendations for utilizing sentinel node mapping and excision in women with clinically negative lymph nodes. In the updated NCCN Guidelines, it states that prophylactic mastectomy (the removal of a noncancerous breast) contralateral to a known unilateral breast cancer is not recommended except as outlined in the NCCN Guidelines for Genetics/Familial High-Risk Assessment: Breast and Ovarian and the NCCN Guidelines for Breast Cancer Risk Reduction. When prophylactic mastectomy is being considered, the NCCN Guidelines note that the small benefits must be balanced with the risk of recurrent disease from the known breast cancer, the psychological and social issues associated with bilateral mastectomy, and the overall risks of contralateral mastectomy. The practice of removing noncancerous breasts to reduce the risk or prevent cancer has become increasingly common among women. A study recently published in the journal Cancer found that among women who had cancer in one breast, the number who opted to have the other breast removed, more than doubled from 1995 through 2005 in New York state. However, there is no data to demonstrate that having prophylactic mastectomy actually improves survival. The NCCN Guidelines Panel suggests that high-risk women considering a prophylactic mastectomy should be evaluated by a multi-disciplinary team and counseled on the risks of the procedure. Perhaps the most clinically important update to the NCCN Guideline is the removal of the recommendation for a full axillary lymph node dissection as an option for women with clinically negative lymph nodes. The updated NCCN Guidelines now recommend that women with stage one or two invasive breast cancer with clinically negative lymph nodes, undergo sentinel node mapping and excision provided they are being treated by a team of clinicians with experience in sentinel node biopsy. Sentinel node biopsy is a diagnostic procedure used to determine whether breast cancer has metastasized to axillary lymph nodes (e.g., lymph nodes under the arm). Sentinel node biopsy requires the removal of only a few lymph nodes compared to a full axillary lymph node dissection, and may decrease the risk of lymphedema and pain associated with surgery. Another important update to the NCCN Guidelines is the addition of a new regimen for adjuvant chemotherapy for invasive breast cancer. The NCCN Guidelines now include FEC [fluorouracil (Adrucil(R), Pfizer Inc.) / epirubicin (Ellence(R), Pfizer Inc.) / cyclophosphamide (Cytoxan(R), Bristol-Myers Squibb Company)] followed by weekly paclitaxel (Taxol(R), Bristol-Myers Squibb Company) as an option for adjuvant therapy, treatment given after surgery. Although the incidence of breast cancer has increased steadily in the United States over the past few decades, breast cancer mortality appears to be declining suggesting a benefit from early detection and more effective treatment. NCCN Clinical Practice Guidelines in Oncology(TM) are developed and updated through an evidence-based process with explicit review of the scientific evidence integrated with expert judgment by multidisciplinary panels of physicians from NCCN Member Institutions. The most recent version of this and all the NCCN Guidelines are available free of charge at NCCN.org. About the National Comprehensive Cancer Network The National Comprehensive Cancer Network (NCCN), a not-for-profit alliance of 21 of the world's leading cancer centers, is dedicated to improving the quality and effectiveness of care provided to patients with cancer. Through the leadership and expertise of clinical professionals at NCCN Member Institutions, NCCN develops resources that present valuable information to the numerous stakeholders in the health care delivery system. As the arbiter of high-quality cancer care, NCCN promotes the importance of continuous quality improvement and recognizes the significance of creating clinical practice guidelines appropriate for use by patients, clinicians, and other health care decision-makers. The primary goal of all NCCN initiatives is to improve the quality, effectiveness, and efficiency of oncology practice so patients can live better lives. The NCCN Member Institutions are: City of Hope Comprehensive Cancer Center, Los Angeles, CA; Dana-Farber/Brigham and Women's Cancer Center | Massachusetts General Hospital Cancer Center, Boston, MA; Duke Comprehensive Cancer Center, Durham, NC; Fox Chase Cancer Center, Philadelphia, PA; Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT; Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance, Seattle, WA; The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Memorial Sloan-Kettering Cancer Center, New York, NY; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute, Columbus, OH; Roswell Park Cancer Institute, Buffalo, NY; Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO; St. Jude Children's Research Hospital/University of Tennessee Cancer Institute, Memphis, TN; Stanford Comprehensive Cancer Center, Stanford, CA; University of Alabama at Birmingham Comprehensive Cancer Center, Birmingham, AL; UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; University of Michigan Comprehensive Cancer Center, Ann Arbor, MI; UNMC Eppley Cancer Center at The Nebraska Medical Center, Omaha, NE; The University of Texas M. D. Anderson Cancer Center, Houston, TX; and Vanderbilt-Ingram Cancer Center, Nashville, TN. SOURCE National Comprehensive Cancer Network Megan Martin, NCCN, +1-215-690-0576, martin@nccn.org © Thomson Reuters 2009 All rights reserved http://www.reuters.com/article/pressRelease/idUS165474+28-Oct-2009+PRN20091028 -------------------- Position posted by St. Joseph's Hospital. Created: Oct 28, 2009 Job Title: Occupational Therapist Job Status: Part Time Job Category: Healthcare Experience: 3-5 Years Location: Chippewa Falls Salary Type: Hourly Education: Bachelors Job ID: 66938542 Job Description St. Joseph’s Hospital in Chippewa Falls is currently seeking an Occupational Therapist to join their progressive rehabilitation team. Successful candidates will have a degree in Occupational Therapy from an accredited school and possess current Wisconsin licensure or be eligible for licensure. Individuals with certifications or clinical interests in outpatient orthopedics, lymphedema, industrial rehabilitation and acute care are urged to apply. 3-5 years of hospital based inpatient and outpatient clinical experience is desired. This part time position will work 40 hours per two week pay period on the day shift with the possibility of weekend rotation. Qualified applicants that appreciate working with a highly skilled team of professionals in an atmosphere where each individual is valued and given opportunities for personal and professional growth are encouraged to apply. We welcome those with prior military experience to apply. An Equal Opportunity Employer Operating Under an Affirmative Action Plan Contact Contact: People Services Address: 2661 County Hwy I, Chippewa Falls, WI 54729 Phone: None Specified Fax: 715/726-3381 Email: hr@sjcf.hshs.org Copyright 2009 Gray Television Group, Inc. Copyright © 2002-2009 http://www.weau.com/jobsearch/listings/66938542.html ----- Breast cancer survivors thriving one year later By Elizabeth Adams | Managing Editor Saturday, October 31, 2009 Their hair growing back. A checkup every four months instead of three. Their last chemo treatment. These are among the milestones breast cancer survivors reach as they distance themselves from the disease. 1 / 2 Jackie Ricciardi/Staff Six years after being diagnosed with breast cancer, Karen Swenson is a 60-year-old, banjo-playing survivor. She has checkups every six months. Click photo for optionsIn October 2008, The Augusta Chronicle profiled 32 survivors. Today, as Breast Cancer Awareness Month comes to an end, they return to the pages with a progress report. Overall, they are eating better, exercising more, traveling and enjoying life. One has a new job; another, a new baby. Karen Swenson has a new hobby. For her 60th birthday, Mrs. Swenson's husband, Steve, and her eight children bought her a banjo. "They all got together and said we want you to choose something you've always wanted to do before but haven't been able to," Mrs. Swenson said. She played the violin in the past, but the lymphedema she suffered as part of her cancer treatment made it hard for her hand to hold up the instrument for long periods. "Then I remembered the banjo. I grew up on Vermont bluegrass and was raised on Pete Seeger," she said. "I never dreamed I would get one." Her husband, who plays five instruments, and other family members who are musicians are helping her learn how to pick and strum her new five-string Epiphone. "I might play a complete song by the time I am 70!" she said. Friday marked the six-year anniversary of Mrs. Swenson's diagnosis. She is cancer free. http://chronicle.augusta.com/stories/2009/10/31/met_553957.shtml --- As if cancer weren`t enough. Some people who battle the disease, go on to develop another condition. one that can be painful and limit a person`s activities . But that pain can be lessened, and the condition can get better. Weeks to years after cancer treatment, or after having lymphnodes removed or damaged, a person is at risk of developing lymphedema, a condition unlike any other. For Tammy Lapp-Harris, symptoms started while she was still being treated for Hodgkin`s lymphoma.. "I started noticing a lot of pain in my arm and then my hand and my finger started to swell and I had swelling in my upper arm or my forearm here," she says. Her swollen right arm was caused by lymphedema, a condition where the lymph fluid in the arm or leg stops draining properly because the lymphatic system has been thrown off. "There`s no cure for lymphedema so it`s something we teach the patient how to manage," says physical therapist Erica Schuler. She works with people like Lapp-Harris to make living with lymphedema bearable. All it takes is two weeks of hands-on therapy. During that time, Schuler spends a lot of time applying pressure on the swollen area to increase the flow of the existing lymphatic system. "We use the manual techniques to promote that flow out of the arm," says Lapp-Harris. Patients also take a daily trip to the compression pump, to move fluid away from the fingers or toes. And before heading home each day they are wrapped up securely with three layer of bandages. "Once you`re diagnosed with cancer and you go through that range of emotions, this is something that`s very manageable," Lapp-Harris says. For her, the process first took away her pain, and then much of her swelling, making her lymphedema something she could live with. Most patients with Lymphedema don`t have to have any other therapy after two weeks of intensive treatment. They`re given a compression garment to wear every day, which helps get circulation in the swollen limb open so swelling doesn`t increase again. http://www.kqcd.com/News_Stories.asp?news=35428 ---------------------------- Breast cancer pain can last for years BREAST CANCER AND PAIN Nearly half of breast cancer survivors experience pain for two to three years after surgery, a study shows: Source: The Journal of the American Medical Association FORUM: LIVING WITH CANCER Patients, survivors, loved ones touched by any type of cancer invited to share questions, advice, experiences By Liz Szabo, USA TODAY Nearly half of breast cancer survivors suffer from persistent pain, even two to three years after surgery, a study shows. Almost 60% of the 3,253 women surveyed experience other symptoms of nerve damage, such as numbness or tenderness, according to a study of all Danish women treated for breast cancer in 2005 and 2006. Women under 40 and those who have more extensive surgery, such as a mastectomy, and radiation are the most likely to report pain, says the University of Copenhagen's Henrik Kehlet, senior author of the report in today's Journal of the American Medical Association. Women also have more pain if surgeons remove many of the lymph nodes in their armpits, a common place for breast cancer to spread, the study says. Fortunately, most breast cancer patients can ease their symptoms with over-the-counter pain relievers, says Loretta Loftus of Tampa's H. Lee Moffitt Cancer Center, who co-wrote an accompanying editorial. Kehlet says his study underscores the need to improve care, both by finding ways to reduce nerve damage during surgery and by learning why some women have so much pain and others do not. Though it's not always possible to prevent chronic pain, doctors say women can reduce their risk. Women should choose doctors who perform "sentinel-node" biopsies, says Moffitt's Christine Laronga, who co-wrote the editorial. In the procedure, surgeons remove and test one or a few key lymph node for malignant cells instead of automatically removing all of the nodes. If the sentinel node is cancer-free, surgeons leave the others in place. The procedure also reduces the risk of lymphedema, a painful swelling in the arm http://www.usatoday.com/news/health/2009-11-11-pain11_ST_N.htm ---------------------------------- Blog EntryComments (0)Pain Lingers More Than 2 Years After Breast Cancer Treatment Ends November 10, 2009 04:01 PM ET | Deborah Kotz | Permanent Link | Print Video: What Is Breast Cancer?Women who've been successfully treated for breast cancer often call themselves "survivors" as if they've been through a trial by fire and made it through unscathed. Unfortunately, that's often not the case. A new study of nearly 3,800 breast cancer patients published today in the Journal of the American Medical Association suggests that nearly half of all patients still experience pain symptoms two to three years after their treatments end. The researchers found the risk of pain was highest in younger women, ages 18 to 39, who had breast- conserving surgery accompanied by radiation treatments. Women of all ages who had mastectomies, however, were more likely to have severe pain than light pain. The pain most often occurred in the breast that was operated upon, in the chest area where tissue was removed, in the upper arm where lymph nodes were removed, or down one side of the body. Some women also experienced sensory disturbances like a loss of feeling or tingling sensations near the surgical site as well as elsewhere in the body. On average, those reporting pain had light to moderate pain that they experienced one to three times a week. About 13 percent of the pain sufferers, however, said they were in severe pain, often on a daily basis. (All of the women in the study remained cancer free two to three years after treatment.) "This study isn't saying to change treatment recommendations based on whether or not a certain treatment is likely to be associated with pain," says Loretta Loftus, a professor of medicine and oncology at H. Lee Moffitt Cancer Center in Tampa, who cowrote an editorial that accompanied the study. "But it's telling oncologists that they need to be more alert to the incidence of pain. It's fairly common, though pretty variable in its intensity." Options for pain relief vary based on a woman's individual needs, Loftus tells me. If she has mild pain, she may do fine with an over-the-counter analgesic. [More details on determining the best pain medication.] Women with painful arm swelling, called lymphedema and resulting from the removal of lymph nodes, may benefit from wearing a compression sleeve. Others with tingling may be helped by physical therapy, and those with truly excruciating pain, says Loftus, may need a nerve block injection to block pain signals to the local area. Some women may simply have a lower tolerance for discomfort, and they may benefit from speaking to a social worker who specializes in pain management. Loftus says this could help explain why younger breast cancer patients report more pain. "They're less likely to have gone through other surgical experiences like hysterectomies, gallbladder removal, or treatment for other cancers," she says, "so they may not have as much experience with pain." On the other hand, she adds, older women may simply have less pain sensation since the neurological system dulls with age. What's clear from this study is that breast cancer patients need to have their pain taken seriously. Doctors certainly need to rule out the possibility of a recurrence and then work to find the most appropriate treatment. Many patients could benefit from the pain management clinics that are becoming more common in cancer centers like Moffitt. [Hospitals that are the best at pain management.] Others may need to seek a referral from their oncologist for a specialist who treats post-surgical pain in breast cancer patients. On the positive side, post-treatment pain doesn't usually linger forever. "For most patients," says Loftus, "it does get better over time." Related News: Managing Your Pain: How to take prescription drugs without getting addicted http://health.usnews.com/blogs/on-women/2009/11/10/pain-lingers-more-than-2-years-after-breast-cancer- treatment-ends.html ------------------------ Garments sock it to edema By JANE SCHORER MEISNER • November 11, 2009 Buzz up!Twitter If Des Moines' team of edema specialists set fashion trends, new styles of compression garments might be the season's hottest accessories. Local health care providers now offer a variety of prescription-grade stockings and other aids as part of an increasingly focused arsenal of treatment for the common — and potentially serious — condition. "Everybody swells when they're on their feet all day long. That's just what people do, thanks to gravity," said Linda Renze, a certified custom lymphedema fitter at Fittings Unlimited in Urbandale. "When you wear compression hose, it helps push the blood back up where it needs to go, and it just helps your general feeling at the end of the day." Edema — an abnormal accumulation of fluid beneath the skin — can stem from a number of causes, including complications of cancer treatment or orthopaedic surgery such as hip or knee replacement. "Anytime surgery is involved, you disrupt either the vascular or the lymphatic flow, so swelling can result," said Steve Galluzzo, a certified orthotist and manager of American Prosthetics & Orthotics Inc. in Clive. Edema can be a symptom in women who are going through menopause, due to hormonal imbalance and fluid retention, said Dr. David K. Chew, a vascular specialist at Iowa Heart Center's Iowa Vascular Institute in Des Moines. But it also can be a warning sign of deep vein thrombosis (blood clots) or other dangerous medical problems. "Edema that is persistent and progressive can be a symptom of an underlying serious illness," Chew said. "See your doctor if you should have persistent leg swelling, especially if your legs are painful." A physician first will check to see if a patient's edema is being caused by an infection or cellulitis, said Nancy Fellows, a physical therapist and certified lymphedema specialist at Iowa Health — Des Moines' Lymphedema Clinic at John Stoddard Cancer Center. "Often, those respond to medical management or antibiotics," she said. "The other thing that should be ruled out is a blood clot. That tends to be a little grayer and a little more frightening." If the edema is not related to those possibilities, patients may be referred the Lymphedema Clinic. "We do an assessment of their tissue and measurement and activities and then determine an appropriate course of treatment," Fellows said. "Our goal is to get the tissue caught back up so it's working more efficiently and to allow the person to maintain that at a realistic level." Treatment could consist of manual lymph drainage, which is a light type of massage, some kind of compression and specialized compression bandages, Fellows said. "Or if they're a mild case, then our overall goal is to most likely get them into some type of medical-grade compression garment." The Lymphedema Clinic specialists also teach patients how to do visual inspections of their extremities, Fellows said, and to monitor signs and symptoms of edema. "Their shoes might be tight at the end of the day, they have to loosen their laces or women are swelling over the top of their pumps," she said. "For more general edema, we'll also look at their activities and lifestyle and give them more practical ways to minimize the effect of the swelling," Fellows said. "Leg elevation, ideal body weight, exercise, drinking fluids - things they can work into their daily lifestyle." Chew says diuretic therapy may be prescribed along with treatment of incompetent veins. And, of course, those compression garments. "Almost everyone can experience some relief from good compression stockings," Chew said. In fact, physician-prescribed, moderate-compression hose often are recommended not just for patients with serious edema, but for anyone who is on his or her feet a lot and for people who are frequent-flyers, Galluzzo said. "When you get up into the higher altitudes, the outside pressure is lower so the internal pressure is higher. They recommend compression garments for people who have (edema) problems who fly and preventively for people who fly. Preventive measures seem to be the way to go these days," Galluzzo said. http://www.desmoinesregister.com/article/20091111/LIFE02/911110302/1042/Garments-sock-it-to-edema --------------------- Biking in Whitby for Children's Wish Foundation SABRINA BYRNES / METROLANDBiking in Whitby for Children's Wish FoundationWHITBY -- Thomas Gilbert smiled November 10 as he looked at the video clip of a boy named Darcy Lee, who was his inspiration to raise money for the Children's Wish Foundation. Darcy Lee, a boy from PEI, wished he could have his grandparents move closer to him. Thomas rode 21 kilometeres a week to raise money for the charity, totalling 168 kilometers and $834.55 in funds. November 10, 2009.Map data ©2009 Google, Tele Atlas - Terms of UseMapSatelliteHybridTools Smaller Text | Larger Text Nov 17, 2009 - 02:11 PM By Emily Wrigglesworth WHITBY -- Thomas Gilbert took a school project about changing the world to heart, The 11-year-old Whitby boy was given an assignment about local charities by his teacher. He would have to chose one and say how he could help. Thomas chose the Children's Wish Foundation but he did not stop at just writing down what he could do. While researching the charity, Thomas came across a video of a then six-year-old boy living in Prince Edward Island. As Thomas watched the video, his eyes teared up, said Thomas's mother, Tricia Munro- Gilbert. The boy in the video had idiopathic lymphedema, which is lymphedema of an unknown origin. In the video, the little boy described that his only wish was to have his grandparents move back to P.E.I. from Edmonton. This little boy became Thomas's inspiration for July and August. "I felt so bad for this little seven-year-old who had to go through so much pain," said Thomas. While the little boy's wish had been granted, Thomas knew he wanted to help other children's wishes come true. Already wanting to improve his bike skills for triathlons, Thomas set out a cycling route he would follow three times a week in July and August while raising money. The path was roughly seven kilometres long, in the area around his house. He raised awareness about his efforts by creating a poster informing people about what he was doing. Thomas also raised money through lemonade stands and his family held a garage sale. â?¨ "He did two lemonade stands," said Mrs. Munro-Gilbert. "One at kind of the beginning of the summer, one at the end." Thomas raised $834.55 between his Ride 4 a Wish/Refresh 4 a Wish campaign, and getting neighbourhood sponsors. Mrs. Munro-Gilbert wanted to make the efforts official and a recognized event, so Thomas could show people exactly where the money was going. The Gilberts contacted the Children's Wish Foundation to find out what could be done about it. The organization sent Thomas a letter of appreciation and a sponsor sheet. The highlight for Thomas was while he was on a family vacation, along with his mom, dad and younger twin sisters Moriah and Claire, to the Maritime provinces to visit family. While there, Thomas took two weeks off from biking, but on a trail, he rode 10 kilometres, adding to his eventual overall total of around 168 kilometres. In preparation before the trip, Mrs. Munro-Gilbert contacted the Children's Wish Foundation to see if they could set up a meeting with the boy who inspired Thomas. The boy's family agreed and the two families met and had dinner together. Thomas said that the few times he felt like giving up, he just thought of his inspiration, and all the good he would be doing if he continued. He added meeting the boy made him work much harder at raising the money. Thomas says he will "probably want to" do his campaign again next year, saying that "it was fun." http://www.newsdurhamregion.com/news/article/140252 ---------------------- -------------------------------------------------------------------------------- New! Outer Jackets for Caresia Arm Garments Published on Wednesday, November 18, 2009 Lymphedema Depot Ltd., the exclusive Canadian distributor of Solaris lymphedema-care garments, announced today that the mildly compressive Outer Jacket that has long been available only with the Solaris custom made Tribute™ nighttime bandage-replacement garment is now available with the Caresia Bandage Liners™ for arms. Lymphedema Depot Ltd., the exclusive Canadian distributor of Solaris lymphedema-care garments, announced today that the mildly compressive Outer Jacket that has long been available only with the Solaris custom made Tribute™ nighttime bandage-replacement garment is now available with the Caresia Bandage Liners™ for arms. According to the company, Caresia Bandage Liners are standard sized arm and leg sleeves filled with medical grade foam chips sewn into channels that are shaped to guide lymphatic fluid out of an area of chronic swelling. The Bandage liners fit against the limb and are meant to have short stretch bandaging applied over them to achieve therapeutic compression for the patient. This helps reduce and control swelling. Now, with the availability of the Caresia Outer Jacket it is possible that the application of short-stretch bandaging may, in some cases, be eliminated and the Caresia Bandage Liner along with a simple Caresia Outer Jacket, may be sufficient to reduce and control lymphedema. According to Lymphedema Depot‘s Clinical Specialist John Mulligan, “The availability of the Outer Jacket to use with the Caresia Bandage Liner will be a great relief to many lymphedema patients. I would recommend this management tool to be used where lymphedema is mild and one of the standard sizes of Caresia is a good fit for the patient. In those cases, patients may be relieved of the burden of self-bandaging and find this new application to be a simple and effective alternative.” Mulligan goes on to say “This means that the Caresia Bandage Liner can easily be used as a nighttime lymphedema garment to wear while sleeping, if the user fits comfortably and effectively into the standard sizes. This is a real breakthrough in living with lymphedema. “ The Caresia Bandage Liner and Outer Jacket are available in Canada exclusively from Lymphedema Depot Ltd. Lymphedema Depot Ltd. is the exclusive Canadian distributor for Solaris lymphedema-care garments. It is based in St. Catharines, Ontario. For more information contact Lymphedema Depot Ltd. at 905-687-8500, or visit their website at www. LymphedemaDepot.com. Media Contact: John Mulligan, Clinical Specialist Lymphedema Depot Ltd. 12-111 Fourth Ave Suite 347 St. Catharines, ON L2S 3P5 905-687-8500 ### http://www.wireservice.ca/index.php?name=News&file=article&sid=1824 ---- Lymphedema Therapist Calls Meeting “Historic” - November 16, 2009 - St. Catharines Ontario… John Mulligan, a massage and lymphedema therapist and educator, and his wife, Bonnie Baker, recently participated in the Canadian Lymphedema Framework (CLF) meeting, which was held at the Canadian Institute for the Blind in Toronto on November 6, 2009. Mulligan, who, along with his wife, is co-owner of Lymphedema Depot Ltd. in St. Catharines, said “It was an honor to be invited. I have been a lymphedema therapist for eleven years now, and this was the most historic and unique conference I have attended. This is the first time that all of the major stakeholders in lymphedema care have come together in a national meeting.” According to the CLF website, the Canadian Lymphedema Framework is… “an international initiative aiming to promote research, best practice guidelines and lymphedema clinical development, worldwide.” The Framework meeting, said Mulligan, included over a hundred “lymphedema patients, garment fitters, vendors of lymphedema care products, researchers, educators, therapists and doctors.” “Lymphedema is a condition of chronic swelling, usually in an arm or leg but it can also occur in the torso or head and neck. Often it is the result of surgery. It can also be an inherited condition. It is an under-diagnosed and under-treated condition in North America. The treatment for this debilitating condition is not usually funded by government or health insurance. This historic meeting was about finding ways to address those problems. I’d say we made a good beginning. The CLF has adopted best practice guidelines for the treatment of lymphedema and several ongoing initiatives were established at the meeting,” Mulligan said. The purpose of the meeting, according to the CLF’s website, is to “elicit the input of all key Canadian stakeholders in developing a national strategy and agenda for lymphedema research and education and to advocate for effective and accessible clinical services” for lymphedema patients. Lymphedema Depot Ltd. is the exclusive Canadian distributor for Solaris lymphedema-care garments. It is based in St. Catharines, Ontario. For more information contact John Mulligan or Bonnie Baker at 905-687-8500, or visit their website at www.LymphedemaDepot.com Persistent Pain Common After Breast Cancer Surgery - no date on article but date of sending from Google is November 16, 2009 - Researchers from Denmark have reported that pain and sensory disturbances persist for two to three years after breast cancer surgery. The details of this study were published in the November 11, 2009 issue of the Journal of the American Medical Association.[1] The most common complication of breast surgery is lymphedema related to axillary lymph node dissection. Very little has been written about persistent pain in the breast. Researchers sought to determine the incidence of persistent pain and sensory disturbances after breast cancer surgery. They performed a questionnaire study in 2008 involving 3,754 women who had received surgery for primary breast cancer in 2005 and 2006. •47% reported pain, which was severe in 13%. •Factors associated with chronic pain included young age and axillary lymph node dissection. •Women with sentinel lymph node dissection had less pain than women with axillary lymph node dissection. •Sensory disturbances were also associated with younger age and axillary lymph node dissection. •Pain in other parts of the body was associated with increased pain in the surgical area. •20% of women had contacted a physician within the past three months concerning pain in the surgical area. • Comments: These data suggest that pain and sensory disturbances related to breast cancer surgery are much greater and persist for a longer period of time than generally appreciated. Reference: [1] Gartner R, Jensen M-B, Nielsen J, et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. Journal of the American Medical Association. 2009;302:1985-1992 Remembering Marian Benner - Nov 15 2009 - Marian Benner was many things to many people. She was a mother of four. A friend to many. A good neighbor. And she was truly an unsung hero in east Bakersfield. Today, people will gather at St. Joseph's Catholic Church and Hillcrest Cemetery to remember the life of Benner, who died Oct. 26. She was 46. Benner is survived by her four children, Juan Jose Benner, 19; Francisco Javier Benner, 17; Mariana Louisa Benner, 16; and Jose Luis Benner, 15, along with her father, Erno Benner, of Oregon, a sister, brother and other relatives and friends. Benner was a longtime community activist in east Bakersfield, often volunteering for the local youth and seeking ways to improve the nearby neighborhoods. She did this, despite her constant struggle with acute lymphedema.. When I first met Marian and the Benner family, she was already struggling with acute lymphedema, a condition of localized fluid retention brought on by a compromised lymphatic system. Despite her health issues, she joined the efforts of the East Bakersfield Faith Community Alliance and worked with fellow residents on several projects, neighborhood socials, and community meetings She was sick and tired of being sick, but not too tired to work for change. And the unsinkable Benner never came alone. Her four teenager kids always joined in and volunteered their time too! Many know Benner from her involvement with the East Bakersfield Community Coalition, where she spearheaded activities for children via the after-school Kid's Club program, the Girl Scouts, and Boy Scouts. She even chauffeured many neighborhood kids to and from activities. Even more impressive, without a "community center" building, she became, for many, the center of the community. Many families would seek her out for advice about anything from help with filing their taxes or legal documents to getting information about health and other resources. For a time, she even held English as a Second Language classes in her living room. "She'd come over to my house to use the internet to download and print whatever materials she might need for her classes and brainstorm some ideas and strategies," said good friend and another East Bakersfield community leader, Brandi De La Garza. "She gave her time and talent to the community not for public recognition or anything like that, but because she could, and I think she could because she was not concerned with hierarchies of any kind, but more with each and every human being she came in contact with... Marian really saw you, heard you, and gave of herself based on that." In a world where people living next door are more often strangers than neighbors, Benner symbolized the true meaning of a neighbor. "Not only did Marian not allow her own struggles with her health to be a reason not to help others, but she also did not allow language barriers, shyness, appearances or cultural differences stop her from helping anyone who came to her for guidance or friendship," De La Garza said. Let's hope her legacy will live on through her children and others who give compassionately without expecting anything in return. Andrae Gonzales is a local Latino columnist whose work appears regularly in The Californian. These are the opinions of Gonzales, not necessarily The Californian. Write to him at agonzales@bakersfield. com. Special program gives seniors a life of independence - 13abc.com - November 25, 2009 - A Gibsonburg woman has a place of her own for the holidays after nearly a year in a nursing home. After nearly a year in a nursing home, a Gibsonburg woman has a place of her own for the holidays. It's all thanks to a special program that is giving thousands of seniors a passport to a life of independence. Pat Oren says, "I knew I wanted to experience life. I've been an observer for a long time. Pat Oren, 68, is still getting used to having her own space. Years ago, a car accident left her with lymphedema. The condition caused her legs to swell, leading to weight gain and ultimately left Pat in a wheelchair. Since then she's spent time in assisted living and a nursing home. Pat says, "What I saw, so many people who thought their lives were over." That's when Pat decided to take life by the horns and get back on her own with help from Passport. It's a program offered by the Area Office on Aging that helps people transition from a nursing home back to independent living. Pam Wilson of the Area Office on Aging of NWO says, "If someone is improving and can go home, it becomes very difficult because they don't have an income to move home." Pat says, "This gave me the means to do something I couldn't do." Passport assists with rent, household items, medical care and food. Pat receives prepackaged meals, making it easy for her to maintain a balanced diet without having to find a way to the store. Therapists and aids provide convenient independence if Pat needs them, giving her everything she needs to continue her life experience. "It's like Christmas 16 times over. It's incredible that things that have happened to me," says Pat. Right now there is a rolling wait list of about two months for the Passport program. If you want to apply or get more information, contact the Area Office on Aging of Northwestern Ohio at 419-382-0624 ----- http://www.abc15.com/content/style/beauty/story/3-products-to-treat-your-eyes-in-time- for/OtDV3PjAsECX6FdqGyNsBw.cspx ----------------------- http://www.medicalnewstoday.com/articles/173259.php Kaposi's sarcoma (KS) is a type of cancer. It causes growths under the skin, although they can grow in the lining of the mouth, nose, throat and other organs. It is different from other cancers as it starts in several areas of the body at once. Most cancers start in one place and then spread. KS causes abrasions or tumors (growths). They most commonly appear on the skin as small, flat, colored lesions that can be brown, blue, red or deep purple. Lesions can also develop on the internal organs, such as the lymph nodes (part of the immune system), the lungs, and the digestive system, including the bowel, liver and spleen. It was originally described by Moritz Kaposi, a Hungarian dermatologist practicing at the University of Vienna in 1872. It became more broadly known as one of the AIDS defining illnesses in the 1980s. The viral cause for this cancer was discovered in 1994. According to Medilexicon's medical dictionary: Kaposi's sarcoma is: "A multifocal malignant neoplasm of primitive vasoformative tissue, occurring in the skin and sometimes in the lymph nodes or viscera, consisting of spindle cells and irregular small vascular spaces frequently infiltrated by hemosiderin-pigmented macrophages and extravasated red blood cells. Clinically manifested by cutaneous lesions consisting of reddish-purple to dark-blue macules, plaques, or nodules; seen most commonly in men older than 60 years of age and in AIDS patients, as an opportunistic disease associated with human herpes virus-8 infection." There are four types of Kaposi's sarcoma (KS): HIV- or AIDS-related KS Classic KS Endemic or African KS Transplant-related KS HIV- or AIDS-related KS: KS can develop in people whose immune system has been severely weakened by HIV or AIDS. Gay men with HIV or AIDS are mostly affected. It is thought that the virus that causes KS is spread during unprotected anal sex. In the past, HIV- or AIDS-related KS used to be the most common complication affecting gay men living with HIV and was a leading cause of death. This is no longer the case due to anti-HIV medications that were developed in the 1990s, known as highly active antiretroviral therapy (HAART). The outlook for HIV- or AIDS-related KS is variable and depends on a person's age and the state of their immune system. In an older person with a weakened immune system, the cancer often spreads aggressively to other parts of the body (metastasis). The estimated survival rate for HIV- or AIDS-related KS is five years, although many people live a lot longer. The improvement of survival rate is directly linked to the improvement in medication for treating HIV. Classic KS: It is a rare condition, usually only affecting men between 50 and 70 years of age who are of Mediterranean or eastern European descent. It is thought that people who develop classic KS were born with a pre-existing genetic vulnerability to the virus that causes it. The outlook for classic KS is good. The cancer tends to spread slowly and does not usually spread to other parts of the body. Classic KS primarily affects older people. Endemic or African KS: It is common in parts of Africa. It is one of the most widespread types of cancer in that region. As with classic KS, endemic KS is thought to develop due to a pre-existing genetic vulnerability to the virus that causes it. Many people may now be more vulnerable to the virus because of the HIV epidemic in Africa and a weakened immune system due to HIV or AIDS. The outlook for endemic KS is poor. In addition, access to treatment such as chemotherapy is often limited in parts of the world where endemic KS is widespread. Transplant-related KS: It is an uncommon complication of organ transplants. People who have had an organ transplant usually take medication to weaken their immune system (immunosuppressant) to prevent their body rejecting the new organ. The weakening of their immune system makes them more vulnerable to the virus that causes KS. The outlook for transplant-related KS is generally good because the condition can usually be successfully treated by reducing or stopping a person's course of immunosuppressant. However, there is a higher risk of rejection of the donated organ. What are the symptoms of Kaposi´s sarcoma? A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. The symptoms of KS depend on where the lesions or growths develop. Skin Any part of the skin, including the inside of the mouth, can be affected. KS usually appears as small, painless flat lesions or lumps. They can be of different colors (brown, red, blue and purple). They often look like bruises but do not lose their color when pressed like a bruise does. KS growths may start in one place and then can develop in more than one area. The growths often eventually merge into each other to form a larger tumor. Internal organs The lymph nodes, lungs and organs of the digestive system are most commonly affected. The symptoms of KS depend on which organs are affected. Lymph nodes: There may be swelling in the arms and legs. It can be very painful and uncomfortable. This is known as lymphedema and is caused by the KS cells blocking the flow of fluid through the lymph nodes. As a result, the tissue fluid backs up. This causes swelling in the body's tissues. Lungs: symptoms may include breathlessness. Organs in the digestive system: symptoms include nausea, vomiting and bleeding. What causes Kaposi´s sarcoma? Cancer Cancer initiates with a change in the structure of DNA, which is found in all human cells. DNA provides our cells with a basic set of instructions such as when to grow and reproduce. A change in its structure, called a genetic mutation, can cause the cells to reproduce uncontrollably. This produces a lump of tissue known as a tumor. Left untreated, cancer can quickly grow and spread to other parts of the body. It usually spreads through the lymphatic system. Once the cancer reaches the lymphatic system, it can spread to any other part of the body, including the bones, blood and organs. The human herpes virus 8 (HHV-8) Kaposi's sarcoma (KS) is caused by a virus called the human herpes virus 8 (HHV-8). It is also known as the Kaposi's sarcoma-associated herpes virus (KSHV). It is thought that HHV-8 contains genetic material that interferes with the normal working of cells. This causes them to reproduce in an uncontrollable manner. However, HHV-8 does not cause Kaposi's sarcoma in everyone who contracts the virus. It only seems to cause Kaposi's sarcoma in: people who have an inherited (genetic) vulnerability to HHV-8 people with a weakened immune system HHV-8 was first identified in 1994. There is no firm evidence as to how the virus is spread. However, there is indication that HHV-8 can be spread during unprotected anal sex. The rates of HHV-8 in specific countries reveal that the virus is almost always more widespread in the gay community. There is circumstantial evidence that HHV-8 can be passed on through saliva. This means the virus could also be spread by kissing. How is Kaposi´s sarcoma diagnosed? Before diagnosing Kaposi's sarcoma (KS), the patient´s general health is reviewed and there is a careful examination of the skin. If KS is suspected, further testing may be required. People with HIV or AIDS, will usually have their tests carried out at a specialist centre where staff are experienced in treating complications of HIV and AIDS. Biopsy: It is the most effective way to confirm a diagnosis of KS. This involves taking a small sample of cells from an affected area of skin. The sample is then checked at a laboratory for the presence of KS cells. Endoscopy: It may be carried out if KS is suspected in the digestive system. The procedure involves inserting a thin, flexible tube called an endoscope down the throat. It allows looking inside parts of the digestive system, such as the bowel, liver and spleen, for any abnormalities or signs that KS is present. A biopsy may be taken. A mild sedative may be given. A local anesthetic will be sprayed on to the throat to prevent discomfort as the tube is passed down. A similar method can be used to look at the lungs (bronchoscopy) if KS in the lungs is suspected. Computerized tomography scan (CT): In the case it is suspected that KS has spread to the lymph nodes or other parts of the body. A CT scan works by taking a series of X-rays which build up a three-dimensional picture of the inside of the body. A radioactive dye may be given to drink before the CT scan, to allow particular areas of the body to been seen in greater detail. What is the treatment of Kaposi´s sarcoma? The treatment of KS depends on: the severity of the symptoms the size and location of the lesions the type of KS the patient´s general health Treatment plans can vary from person to person, but the usual plan for each type of KS is outlined below. HIV- or AIDS-related KS Patients with HIV- or AIDS-related KS will usually be given a course of highly active antiretroviral therapy (HAART) to help strengthen their immune system. HAART may be followed by courses of radiotherapy and/or chemotherapy. Classic KS As classic KS spreads slowly, immediate treatment is not usually required. Doctors may recommend waiting and closely monitor the evolution. Treatment will be delayed to see if any symptoms of progressive cancer develop. This is often recommended for older people when it is unlikely that the cancer will affect their natural life span. If treatment is required, radiotherapy is normally used to treat classic KS. Endemic KS Usually, endemic KS is treated using a combination of radiotherapy and chemotherapy. Transplant-related KS Transplant-related KS is usually treated by reducing or stopping the immunosuppressants. The goal is to strengthen the immune system in order to fight off the humanherpes virus 8 (HHV-8) while ensuring that the body does not reject the transplanted organ. It may be difficult to find the best balance between these two treatment goals. HAART It involves using a combination of medicines that interrupt the reproductive cycle of the HIV virus. This helps to prevent the virus from spreading quickly. It also protects and strengthens the immune system. HIV can quickly adapt and become resistant to a single medicine, therefore a combination of medicines is required. In some people, the medicines used to treat HIV will cause side effects. Usually, there is improvement after a few weeks as the body gets used to the medicines. Common side effects of HIV medication include: diarrhea mood changes nausea skin rashes tiredness gaining fat on one part of your body while losing it on another (lipodystrophy) Surgery If the lesion is small, surgery may be used to remove KS from the skin. Cryotherapy may also be given. This freezes the lesions using liquid nitrogen. Chemotherapy Chemotherapy uses medicines to treat cancer. The medicines destroy rapidly growing cancer cells. The medicines can either be given intravenously or as a tablet that is taken orally. If the lesion is small, chemotherapy may be injected directly into it. This is called intralesional chemotherapy. Chemotherapy can cause side effects including vomiting, hair loss, tiredness, and increased vulnerability to infection. Often, liposomal chemotherapy is used to treat KS. The medicines used in chemotherapy are covered in a fat-based coating called liposome. The extra coating means reduces the side effects and the medication works more efficiently. Radiotherapy Radiotherapy uses high-energy rays to locate and destroy the KS cells. It can be very effective in reducing symptoms of internal KS, such as swelling, pain and bleeding. Possible side effects of radiotherapy include: tiredness, sore skin (particularly for people with HIV or AIDS), stiff joints and muscles, nausea, temporary hair loss, loss of appetite, loss of libido (interest in sex), early menopause, and temporary impotence in men. Once the course of treatment is over, most side effects gradually disappear. Immunotherapy Immunotherapy is also known as biological therapy. It is often used in combination with other treatments such as HAART. Immunotherapy uses special proteins that have been genetically developed in a laboratory. Generally, the body does not consider the cancerous cells as foreign objects. As a result, the immune system does not attack them. In immunotherapy, special antibodies are created in a laboratory. They change the composition of cancerous cells so that the immune system regards them as foreign objects. The immune system then starts to attack the cells in the same way that it would normally attack an infection. Interferon is one of the most common types of medicines used in immunotherapy. It is usually given by daily injections into the skin over a number of weeks. Side effects of immunotherapy include: back ache aching joints and muscles chills headaches high temperature (fever) of 38°C (100.4°F) or above loss of appetite nausea tiredness Written by Stephanie Brunner (B.A.) ------------------- http://www.thevillagesdailysun.com/articles/2009/11/29/news/news02.txt Those coping with life’s challenges find comfort, inspiration in writing about their experiences By AZIA LI FORREST, DAILY SUN Sunday, November 29, 2009 12:04 AM EST THE VILLAGES — Writing was Paul and Loni Walker’s daughter’s way of coping with her husband’s cancer. Their daughter, Julie Walker Mitchell of Solon, Ohio, struggled when her husband Scott was diagnosed with multiple myeloma. Doctors had given him five to eight years to live. “It’s a type of cancer that eats holes in the bones,” said Loni, of the Village of Belle Aire. “At this point, they have no cure for it, but they can slow it down — it does not go into remission. He’s already had one of his vertebrae filled with cement to keep him upright.” Scott remains active — exercises and holds down a job. “He’s totally mentally competent,” Loni said. “I mean you’d look at him and wouldn’t know he’s sick.” After receiving numerous calls and e-mails, Mitchell was encouraged to write a book to help others who were in a similar situation. The book, “365 Days of Hope,” was published this year by Tate Publishing and Enterprises. “Each day is a Bible passage, then she explains how it works in her life, and how it can be applied to situations in other people’s daily life,” Loni said. “Each month has a different theme: November is ‘Praise and Thanksgiving, February is love.’” Paul said he found the book to be very inspirational. “In every passage, she gives the feeling of hope,” he said. “It not only helps people with the disease, but in every way. It’s very worthwhile to read it.” Rose Mary Haverlack Writing has always been Rose Haverlack’s way of coping with life’s challenges. Haverlack, a facilitator for the Tri-County Breast Cancer Support Group, was diagnosed with breast cancer for the first time 14 years ago. Following several years of treatment, she developed lymphedema, a buildup of lymph fluid in the fatty tissues just under the skin that causes tissues to swell mildly or severely. Now, after celebrating another October as a Breast Cancer Awareness Month survivor, Haverlack is coping with the disease again. “I (had) to make up my mind, and I told the doctor I will not go through this a third time,” the Village of Bonnybrook resident said. “I have to be a (role) model for the people who are scared to death.” She made a commitment to herself to stay strong. “I read — did some research — and I told myself I’m going to write — I will get the strength,” she said. “When I write, it’s a very private thing for me. Because it’s private, it’s like a thought.” But when she shares her words with others, it becomes special — which she hopes can inspire others. “They can see the tears and look of anguish,” she said. “When I write, I’m looking into a mirror, not at myself but looking into my soul. You see what your life is like, you want it to continue, and therefore you’ll do whatever it takes. Like I’ve said before, ‘Once it’s on paper, it becomes real.’ It’s a bridge between my inner and outer world.” Haverlack said words are like paintings. “You can make them say anything you want,” she said. Azia Li Forrest is a reporter with the Daily Sun. She can be reached at 753-1119, ext. 9069, or azia. forrest@thevillages media.com. ---- http://www.montrealgazette.com/health/Generations+helping+each+other/2284870/story.html Generations helping each other By SUSAN SCHWARTZ, The GazetteNovember 30, 2009 StoryPhotos ( 1 ) Monique Garry stocks up on warm toques and gloves, then donates them to Le Bon Dieu Dans la Rue. Photograph by: MARIE-FRANCE COALLIER, GAZETTE FILE, The GazetteCome autumn each year of the past five or so, Léry resident Monique Garry starts to stock up on warm toques and hats, scarves and mitts in different sizes and colours she finds at good prices, then matches up in three-piece sets. Once the mercury starts to dip, she delivers them to Le Bon Dieu Dans la Rue, which helps homeless young people (www.danslarue.com). This year, Garry amassed 40 sets of hats and gloves - more for men than for women. It's one of the ways in which she tries to assist people who need help. The focus of Dans la Rue is on young people age 12 to 25. Among its services are a day centre, an emergency shelter and a mobile unit that circulates in downtown Montreal at night. - - - The Rib'n Reef steakhouse held it second annual oyster party fundraiser recently to benefit the Starlight Children's Foundation. More than 140 people attended the event, which featured actor Larry Day as master of ceremonies, a jazz trio, cocktails, all the oysters one could eat as well as dinner; Soeur Angèle, Quebec's cooking nun, was honorary president. The event raised $21,700 for the foundation, which works to improve the quality of life for children who have chronic and life-threatening illnesses or life-altering injuries by providing entertainment, education and family activities intended help them cope with the pain, fear and isolation that accompanies their conditions. Rib'n Reef has chosen to sponsor the Hospital Happenings program at the Montreal Children's Hospital and at Hôpital Ste. Justine. The program includes parties, clowns, crafts, pet therapy and a variety of shows and activities that give young patients the opportunity to be entertained. "We want the oyster party to become an annual tradition of fine dining and giving generously," said Abdo Abouhamad, Rib'n Reef's general manager. - - - Jamie Tajfel, a 19-year-old student at Concordia University, recently launched a youth division of the Lymphedema Association of Quebec (LAQ) and, with the help of an energetic committee and co-chairs Kyra Grinbaum and Lauren Lighter, LAQ Youth held its first fundraiser this month, at the Grand Bayou Café Bar. About 200 people attended, bands Jared Coxford and Vista Cruiser played for the young crowd, and more than $15,000 was raised. Major sponsors were Neon Clothing and Moishes steakhouse. Tajfel said her main goal is to bring awareness of lymphedema to her peer group. Lymphedema is a progressive, non-curable lymphatic disorder; it is caused by damage to the body's lymphatic vessels and can occur near the site where lymph nodes have been damaged or removed. In severe cases, lymphedema causes unsightly swelling, most often in limbs. It occurs most commonly as a result of cancer treatment. Between 20 and 30 per cent of people with breast cancer, for instance, are affected. The LAQ is a volunteer-run charity based in Montreal; it relies entirely on donations to help people living with lymphedema. Visit www.infolympho.ca for more information. applause@thegazette.canwest.com ---- The Treatment of Kenny Farnsworth - November 29, 2009 - For much of a decade, he called 911 routinely for an endless list of medical issues. Now he has an endless stack of bills he is unlikely to ever pay. So what's the diagnosis? Eight miles north of the U.S. Capitol, in Silver Spring, there is an office trailer on a tow lot where the telephone rings throughout the day. As one would expect, a lot of the calls come from stranded drivers who need a tow or a jump-start. But these days, most of the calls tend to come from debt collectors -- both human and automated -- searching doggedly for Ken Farnsworth, a chronically ill hospital regular known to first responders and nurses across the Washington area. A decade in and out of emergency rooms has turned Farnsworth into a wanted man. Seated in an office chair one summer afternoon, Farnsworth stares at the receiver as the line lights up during a string of calls. "That phone never stops ringing," he says, shaking his head as the call goes to voice mail.. Farnsworth is a short and squat 59-year-old who walks like a man in search of a cane. His paunch hangs over his belt, and his eyes blink slowly behind horn-rimmed bifocals. He could easily be mistaken for a retired firefighter, thanks to the clothing he wears daily -- a matching Washington, D.C.., fire department hat and T-shirt, in honor of the men and women who have treated his array of health problems over the years. Farnsworth has no home of his own, so the office trailer is one of a few places where he's been known to crash now and again, with the owner's permission. He lives out of two duffel bags that are stuffed with a few pairs of clothes, some toiletries, and his most recent medical bills and conditions' diagnoses. The medical claims are too much for Farnsworth to keep up with. They arrive by the bundle every week. The bills come from just about every hospital in the Washington area, as well as from the collection agencies that handle overdue accounts for those hospitals. Farnsworth even has a tab with the D.C. government, which is trying to recoup money he owes it for the countless ambulance rides he has taken. "I guess I wore out my welcome a long time ago," he says, managing a laugh. He opens most of the letters and tries to sort through his debts, but the numbers have become too abstract -- "unfathomable" is how he puts it. He piles the bills into neat stacks until they become too unwieldy, then he stuffs them into grocery bags. Eventually, when he starts to face reality, he throws the overflowing bags into the trash. *** The first time paramedic Dave Cole picked up Farnsworth was on Thanksgiving Day in 1997. Cole was one year into the job in Washington, working a 12-hour holiday shift, when a call came over the radio for a man choking on a street corner near downtown. He and his partner raced to the scene. "And there's old Kenny," Cole remembers. "He said he was eating some turkey and choked on a bone." Farnsworth showed the telltale signs of a blocked passageway -- he was grabbing at his throat and gasping for air -- so Cole put him on oxygen, loaded him into the back of the ambulance and headed to the nearest emergency room. "We went in and saw the hospital staff," Cole says, "and I could see it right on their faces." They had just released Farnsworth a few hours earlier, they said. They didn't think there was anything wrong with him. The medic felt duped. So began a long and complicated relationship between Cole and Farnsworth. Farnsworth quickly carved out a reputation as an emergency room regular. Among even the city's most habitual 911 callers, he was virtually peerless. It wasn't out of the ordinary for a Washington ambulance driver to shuttle Farnsworth more than once on the same shift. His transports were for conditions including choking, high blood pressure, trouble breathing and internal pains. Over the years, he has suffered from convulsive seizures; a deviated septum; pancreatitis; gastritis; two perforated ulcers; a hernia; lymphedema, which causes swelling in his legs; acid reflux disease; and irritable bowel syndrome. His problems have run literally from his head, where he once suffered a skull fracture, to his feet, which are two different sizes, thanks to some bone removal after a break in his left foot. Early on, Cole realized his most regular passenger was taking 15 different pills -- some of them duplicates -- probably because he had seen 15 different doctors in the previous weeks. Together, they worked on weeding out the superfluous medicine. "I was impressed with his knowledge of pharmacology," Cole says. "He knew the meds and their side effects. He's had so much done to him over the years. He would ask me about different medical tests, and they were all tied to his personal medical crises." As Farnsworth puts it, "I've had my little pre-med classes in this life." But for all Farnsworth learned as a patient, preventive care was never his thing. As someone who was often homeless, he came to rely upon the emergency room for all his health problems, whether or not they were life-threatening. When something seemed wrong, he demanded service. "Most of my problems happen on a short-term basis," he explains. "What's wrong is wrong then. If I have to wait three days to see a doctor, it won't do me any good." It didn't matter that ER workers would let him sit for hours in triage or kick him out when he became unruly and cursed in frustration. He simply went to another hospital. And if none of the hospitals in Washington met his standards, he would ride the Metro to Northern Virginia and dial 911. He viewed emergency care as a basic right, and he sought it whenever a problem arose, regardless of how his previous trip went. After so many visits, Farnsworth thought he was unfairly labeled as "very low priority" throughout the metro area. His attitude toward hospitals became a combative one: "I have to fight to get medical care." With each additional ambulance ride, his legend grew. After a while, it seemed as if every firefighter and medic in the city had a Farnsworth yarn to tell at the bar. For instance, there was the time he leaped clear out of the back of an ambulance as it rolled through Northeast Washington, sirens blaring. The medics had told him he was being taken to Washington Adventist Hospital. Farnsworth thought he hadn't been treated well at Washington Adventist in the past. He swung open the back door, dropped to the street and hopped a bus to another hospital, both parties happy to be rid of the other. Then there was the time he called 911 for medical help -- when he was already at the hospital. A couple of D.C. medics had picked him up for high blood pressure and run him to Howard University, where they encountered a long wait in the emergency room. While the medics were inside filling out their report, Farnsworth wandered outside and dialed 911 from a pay phone across the street. The city has no right to refuse service to a citizen, regardless of a situation's absurdity, so a separate ambulance had to pick up Farnsworth at Howard. The new crew hauled him to Providence Hospital. The firefighters probably wouldn't have believed it, but Farnsworth says he never relished the idea of taking them away from their dinner. "I don't mean to wear out anybody," he says. "Many times I've felt like a burden. You can't help but feel like one." In a city that fields a million emergency calls each year, Farnsworth dialed so frequently that some Washington dispatchers seemed to recognize him by his voice alone. In honor of his chronic gastrointestinal problems, he was often called "the Burpin' Man." Farnsworth noticed that a call from the Burpin' Man could spice up a dispatcher's wearisome shift. As he struggled to describe his ailment of the day through a volley of burps and excuse me's, he would sometimes hear the dispatcher say, "It's the Burpin' Man!" But out on the street, the medics called him by another handle: "the Choker." The name was a nod to Farnsworth's greatest affliction. He was constantly choking. He didn't understand what caused it, but at some point nearly every day he started to feel as if his throat were closing in on itself. His panic would accelerate the process, and by the time the medics arrived, he'd be clutching at his throat and speaking in hoarse whispers and grunts. His treatment often amounted to an X-ray or two and a gastrointestinal cocktail, a mixture of antacid and anesthetic, which he growled for in the ERs. Many paramedics thought the problem was self-inflicted; others thought it was a fiction. How could a man choke every day of his life and never manage to die? "They realized he was bouncing from hospital to hospital," Cole says. "It's probably easy to just stick him in the waiting room or kick him out. ... But I started to think this guy really might have a problem." *** In fire departments and emergency rooms around the country, patients such as Farnsworth are known as "frequent fliers" -- people of modest means and poor health who go in and out of emergency rooms day after day, their fundamental health issues rarely resolved, at a tremendous and ever-growing cost to hospitals, municipalities and taxpayers. Though Farnsworth presents an extreme example, the burden of dealing with inveterate patients like him has been straining hospitals in all cities for years now. In a town with as much poverty and homelessness as Washington, frequent fliers are like barbershops -- every neighborhood's got one, and if you walk past it enough, you'll eventually forget it's there. The question of how to handle frequent fliers speaks to health-care reform in a fundamental way. As members of Congress wrangle over whether the government should be in the business of underwriting health care for Americans, we should acknowledge that to a large degree we have already underwritten it, at least on the messiest and most wasteful level. Generally speaking, we don't let people die in the street because they lack money or insurance. Paramedics are required to scoop up repeat callers, and emergency room staffs have no right to refuse patients treatment. For many of the poor and underinsured who are chronically ill, the emergency room itself serves as their health-care system. But providing basic health care in an emergency room makes no economic sense. According to the New England Healthcare Institute, a Cambridge, Mass.-based policy research organization, Americans' overdependence on the ER leads to tremendous waste. By treating chronic and nonurgent problems with emergency care rather than primary care, the group estimates that we fritter away as much as $32 billion nationally each year. The same treatment from a primary care doctor is usually two to five times more expensive through the emergency room. The main reason is that the staff in an ER is practicing defensive medicine: They're often trying to rule out what may be wrong with you, hence all the expensive blood tests and X-rays. ERs also have to be open at all hours and be staffed with high-priced specialists, unlike at primary care offices. If emergency rooms don't help regulars manage their long-term health problems, it's because they're not designed to. According to Melissa McCar-thy, a professor in the Johns Hopkins Department of Emergency Medicine, when it comes to frequent fliers, "It's almost like we have no memory. Each time they come in, we greet them -- 'Hi, Mr. Smith' -- but we don't try to manage their care in a longitudinal fashion. We treat them episodically. But people shouldn't expect us to treat them any other way. It's an emergency room." Some city hospitals have looked for ways to unclog their emergency rooms, but diverting patients to primary care physicians hasn't been easy. Since 2005, the University of Chicago Medical Center has been running a program now known as the Urban Health Initiative, which steers walk-in patients with non-urgent problems away from the medical center's emergency room and toward health clinics and primary care practices on the city's South Side. While some have lauded the program as a health-care model, others have denounced it as a profit-minded "patient dumping" scheme. As controversial as it has been, such an initiative at least tries to address what any paramedic or ER nurse already knows: For many patients, especially frequent fliers, receiving costly emergency care for chronic health problems does little good.. The high costs associated with frequent fliers have led city agencies in Washington and elsewhere to target them for treatment outside of the ambulance and emergency room. The idea was born in California's Bay Area five years ago, after a paramedic named Niels Tangherlini started applying social science theory to emergency care. Tangherlini had taken a break from the ambulance to get his master's in social work at the University of California, Berkeley. The repeat customers he had been handling on the job tended to suffer from alcoholism, drug problems or mental illness. After just a few years in the ambulance, he'd realized that being a paramedic was often closer to doing social work than emergency medicine. "My vision was that six months out of [paramedic] school, I would be dangling beneath a helicopter in a life- and-death struggle," Tangherlini says laughing. "Instead, I was trying to coax a guy back into the ambulance who thought spiders were crawling all over him." The program Tangherlini developed in 2004 sent a small team of paramedics, social workers and nurse practitioners out into San Francisco in search of frequent fliers. "A lot of the problems these folks suffer from are things that are not fixable with an ambulance or an emergency room," Tangherlini says. Soon his crew was probably putting more people into detox than any other organization in the city. After just a year and a half, statistics showed that the city's top 911 users had cut back their ambulance rides by as much as 80 percent. The San Francisco program was soon replicated in Memphis, San Diego and Washington. When Washington's frequent flier program started in March 2008, the city had five patients who were being transported by the fire department every single day on average. "Whether it's a hangnail or a heart attack, they know the ambulance has to come if they call," says Mytonia Newman, director of the program, which is called Street Calls. But after the program had been running for a year, only one of those original callers was still at the top of the city's frequent flier list. Several of the city's most constant 911 callers haven't been transported at all since paramedics and social workers intervened to find them regular treatment, counseling or housing. Weaning ER regulars off of emergency care can save cities a considerable amount of money. Frequent fliers soak up a disproportionate amount of a city's resources, through police, fire and mental health agencies, for starters. Taxpayers bear the costs whether through social services, through government-funded insurance programs such as Medicare and Medicaid, or through unpaid ER bills that are ultimately absorbed into rising health-care prices and insurance premiums. Getting frequent fliers the help they need has another, less calculable effect -- it keeps the medics and ER staffers from burning out before their time. Emergency workers can't help but develop relationships with their regulars. Watching them gradually decline on the streets can take a considerable psychic toll. In the end, most cases resolve themselves in one of two ways: Either the frequent flier moves to another neighborhood and becomes someone else's problem, or whatever's ailing him finally kills him. *** As he sifts through his most recent stack of bills one afternoon, Farnsworth offers an estimate on the total claims he owes: half a million dollars. Probably none of that money will ever be repaid. And what makes this figure so stunning is that Farnsworth is insured; the debt collectors are after him for his Medicare co-pays, which typically account for a small percentage of his health-care tabs. In reality, the price tag of his care in Washington area hospitals has almost surely run into the millions. A quick, random sampling of his bills shows how that could happen. Consider a single visit he recently made to the emergency room for internal pains. According to his Medicare statement, his treatment from doctors during the admission cost $642. Throw in more than a dozen charges for an array of standard procedures -- an electrocardiogram, a chest X-ray, a blood test to check the health of his liver -- and suddenly Medicare is on the hook for more than $1,000, and Farnsworth for more than $150, before he's put back out on the street. The array of standard tests partly explains why treating a non-emergency health problem in the ER is so expensive. Furthermore, constant visits to the ER put a guy such as Farnsworth in contact with dozens of different doctors, few of whom, if any, are on the same page. "There are too many people involved," Farnsworth concedes. "They all have different ideas." Every once in a while, a trip to the ER has led to a needed surgery, such as when he had his spleen removed after a fall several years ago. But for the most part, Farnsworth's visits have been routine. He has logged hundreds of them. (Because of privacy laws, medical personnel are reluctant to discuss particular patients.) He has undergone so many X-rays and CAT scans that Cole, the paramedic who is now a captain, eventually grew concerned with the amount of radiation he was subjected to, urging him to stay out of the ER. Farnsworth guesses he has been to the emergency room at George Washington University Hospital on 150 separate occasions. He approximates the same for Washington Hospital Center, not to mention trips to five or so other hospitals in the area. About half of these visits were by train or bus; the other half, by ambulance. "I don't consider it a free ride," he says. "I don't do it on purpose. It's medical care. I didn't go drink a bottle of wine or do drugs. I've got serious medical problems. ... I don't get my jollies out of going to the hospital. I hate hospitals with a fervor." In his earlier days, Farnsworth's medical needs were perfectly typical.. He was born into a stable, middle- class family in Bethesda, and was the son of a bank manager and a homemaker. He dropped out of high school but picked up his GED before taking classes in emergency care in College Park. He thought he might spend his years in the back of an ambulance -- not as a patient, but as an ambulance assistant. It never panned out, and he wound up bouncing between unstable jobs at gas stations and tow companies, usually in the Washington area. He volunteered at firehouses and earned a decent living as a tow-truck operator, but the health problems of the people in his life sent him toward financial ruin. He married and moved to Southern Virginia, but he says his wife developed liver complications and their life together unraveled. He says he moved back to Washington and cared for his ailing parents for several years. "I just ran out of money," he says. His mother and father died in 1995 and 1996, respectively, leaving him without any family in the area. He filed for bankruptcy protection, and his own health problems soon began. After a series of bad falls starting in 2001, he became eligible for Social Security disability pay, which now comes to $769 a month and serves as his only income. Once he could no longer work, he wasn't able to afford his apartment in Maryland. He started bouncing from one cheap living arrangement to another, sometimes resorting to sleeping in city shelters or camping out in the woods near his childhood home. By 2003, Farnsworth was calling 911 so often that many first responders believed he was gaming the system; by dropping certain trigger words to the dispatcher -- "chest pains," "trouble breathing," "choking" -- he would automatically vault to the front of the queue, per department protocol. He would also take a costlier ride in a more advanced ambulance. Paramedics in the inner city started going out of their way to haul him to far-flung hospitals just to get him out of the neighborhood. Yet, he always managed to reappear, sometimes on the very same day. Cole had experiences where he ran Farnsworth in four consecutive shifts. Even when Cole was running other patients, he was never surprised to stumble upon Farnsworth lying beneath a blanket in one of the local hospitals. Gradually, Farnsworth became everyone's problem, and no one's. By his own admission, he was hard to deal with. What he saw as a fall from respectable middle-class life filled him with anger. With his remarkable call volume, he inspired contempt in many fire department employees. His dealings with them often devolved into shouting matches. A firefighter handling him once lost his temper when another call came over the radio for a man with heart problems nearby. "We could be on that cardiac right now!" he screamed. As it happens, Farnsworth's medical problems have led to a couple of brushes with the law. In 2005, he was charged with second-degree assault and disorderly conduct in Montgomery County after an argument with emergency responders. Court papers allege that Farnsworth dialed 911 from a Silver Spring pay phone and made threats to firefighters because they hadn't helped him the previous night. The cop on the scene called in a request for an ambulance. "When Farnsworth was told he was not going to be transported he became irate and had to be restrained by other fire personnel," the charging papers say. Farnsworth says he took a swing at a firefighter who had put a hand on him. Farnsworth spent a month in the county jail, where the medical staff came to know him well. Then, last year, he was charged again with second-degree assault following an altercation with a Montgomery County paramedic who had taken him to the emergency room. "Farnsworth became agitated with Fire/Rescue and hospital personnel because he was asked to wait in triage," court papers say. "It should be noted that Farnsworth is well known to Fire/Rescue personnel. Farnsworth has a lengthy history of being treated and transported." He pleaded guilty to assault and served another month-long stint in lockup. Farnsworth's imprisonment upset a handful of firefighters on the Washington side of the line, where he has garnered far more sympathy over the years. "He was labeled [a 911] abuser," says Harry Subacz, a recently retired D.C. fire captain, "but he's got legitimate problems." Cole didn't view Farnsworth as a burden, either -- he saw a decent but troubled guy, with no home and no money, who had grown frustrated as he fended for care. Cole kept an ear out for Farnsworth calls over the fire department radio. When Farnsworth needed clothes, Cole managed to scrounge up a shirt or two. And when Farnsworth was short on cash, Cole might lend him a few bucks to get him through the end of the month. Farnsworth has had checkups with a general practitioner from time to time, but it hasn't been enough to keep him out of the emergency room. Like other frequent fliers, he has trouble getting around and showing up for appointments on time, so perhaps a caseworker is in order, as well. And then there are those particular medical conditions -- high blood pressure, pain and swelling in his legs -- that are no doubt connected to the stress and discomfort of sleeping on a chair in a trailer or out in the woods rather than on a mattress each night. "I would like to lie down on a bed at night like a human being," Farnsworth says. "Take my shoes and socks off, maybe take a shower. That would be nice." He splurges a good portion of his disability check on pricey motel rooms early in the month, to get clean and sleep well. He once showered 11 times in two days during a motel stay just to take advantage of the personal bathroom. Farnsworth's case bolsters the argument for the concept known as "housing first": the idea that if you put a homeless person in steady housing, then you can better address his health issues. But he has to want housing badly enough to not be picky. Farnsworth, for instance, refuses to live in a transitional group home or subsidized housing because he worries about cleanliness and theft, which is partly why the D.C. frequent flier program didn't get anywhere with him. What he wants is a clean place of his own, which isn't cheap or easy to find. Instead of thinking only about the economic savings of eliminating frequent fliers, people need to think of the less tangible benefits, says Martha Burt, an expert at the Urban Institute who has studied poverty and homelessness. Even if the costs of detox, a case worker and transitional housing run high, the ER regular is no longer diverting ambulances from where they should be headed. "People think of not doing anything as free, and it's not," Burt says. "So what if you break even? It's better for the people of the community and it's better for the public systems because you don't have drunks lining the walls of the ER." The best argument for spending money on frequent fliers may come from David Rosenbaum. On Jan. 8, 2006, Rosenbaum, a 63-year-old retired political reporter for the New York Times, died at Howard University Hospital after being struck on the head during a mugging in Northwest Washington. The city's Inspector General's report on the incident brought to light a sequence of blunders made on the part of emergency workers, from the scene of the crime to the hospital emergency room. According to the report, the ambulance arrived late; Rosenbaum wasn't properly assessed on the scene; he wasn't taken to the closest hospital; and the nurse at Howard failed to properly diagnose and triage him. Once the firefighters and medics smelled alcohol on Rosenbaum's breath, they stopped focusing on other possible explanations for his unconsciousness, according to the report. He was deemed low priority and "ETOH," which stands for ethanol, shorthand for being drunk. Once Rosenbaum was at Howard, the nurses did what they often have to do with presumed alcoholics -- they left him in the hallway for over an hour. In other words, Rosenbaum was handled as a frequent flier. He died from head trauma, not alcohol. Many of Rosenbaum's handlers seemed to share one thing in common: dulled senses. Perhaps with fewer frequent fliers, emergency workers wouldn't be conditioned to make assumptions. *** Last year, Farnsworth went under the knife at George Washington University Hospital. What had been bothering him for so many years was a damaged hyoid bone, the horseshoe-shaped bone above the Adam's apple. Cole and a few other paramedics encouraged him to undergo throat surgery. Specialists had had different opinions and recommendations over the years, but in the end, they reached a consensus. "The doctors knew what the problem was," Farnsworth says. "But there were risks with the surgery, and it was complicated. This was known for years. Too many people finally said it was operable." The surgery was a success. Farnsworth almost never experiences the choking sensation anymore, and his 911 call volume has fallen dramatically. He still checks into the hospital every couple of weeks for health issues, usually swelling in his legs, but he almost never calls for an ambulance. To a small degree, he has also rehabilitated his image among some of the city's emergency workers. "He really changed after the operation," Cole says. "He became pleasant to be around." Not long after the surgery, Farnsworth started dropping by the Tenleytown firehouse, where Cole works. Firehouses can be like neighborhood parlors; citizens are free to stop in and say hello. Farnsworth likes to come by when Cole is on duty. These days, Farnsworth is more of a guest than a patient. He is invited to dine with the firefighters and medics whenever the third platoon is working. In return for the meals, Farnsworth tries to pitch in around the firehouse, cleaning up and doing small chores. Firefighters there and at other houses in Washington have been known to offer him a cot when he needs it, and one of Cole's co-workers has put in a favor to see if he can get him an apartment. The firefighters have even given him a new nickname: "the Fonz," a play on Farnsworth that he greatly prefers over "the Burpin' Man." "Since I've been hanging around these firefighters," Farnsworth says, "I've learned how to care about other people. These guys have literally saved my life." He and the city's first responders have reached something of a detente.. Rather than calling 911, Farnsworth shows up at the firehouse when he's not feeling well and asks to have his vitals checked. On the now-rare occasion when he needs a hospital, they run him to the ER. For all the goodwill, Farnsworth feels indebted to the department. And after all those ambulance rides, he doesn't like knowing he owes the city so much money. He recognizes that he's physically broken, but he says he would like to do something, anything, to mitigate the time and money devoted to him over the years. In light of his past experience as a dispatcher, Farnsworth says he would like to make the fire chief an offer. "I would gladly be a dispatcher for D.C. Fire," Farnsworth says, admitting that it's a long a shot. "I would gladly work my bill off. I know it's extremely excessive ... [but] I was brought up to be a gentleman. All the anger, it came from the health problems. I used to be a hateful person, but I don't want to be that kind of person anymore. I want to go on living decently." ---- http://www.massagetoday.com/mpacms/mt/article.php?id=14142 Learning and Unlearning By Tracy Walton, LMT, MS In oncology massage, we work with a diverse clientele, with wide-ranging clinical presentations. There are clients in survivorship, perhaps with lingering effects of cancer and cancer treatment in their bodies. There are clients in treatment, whose health can change from week to week, or hour to hour. There are clients at the end of life, whose body systems adapt gamely each day to shifting internal environments. And there are clients who are in the throes of diagnosis, in varying stages of health, navigating a barrage of information that we can only imagine, if we haven't been there ourselves. In watching thousands of people with cancer and cancer histories, I am struck by how much information, and how many skills, patients learn along the way. They master medical information, often unfamiliar at first. They learn which people to bring into the loop, and whom to hold at bay. They learn how to care for their bodies, under "new normal" conditions. They discover how to filter information, and listen deeply to their hearts, their families, and their physicians. Massage therapists learn, as well, alongside their clients with cancer and cancer histories. We learn how to listen better, and when to keep our beliefs or judgments about illness to ourselves. We learn to accompany someone along their path, following their lead, bearing witness, remaining present to the process that unfolds, however it unfolds. Changing the Mechanics of Massage We also learn and refine the mechanics of working with people in illness and treatment. We adapt many different massage elements, including our pressure, the movement of joints in the session, the client's position, our speeds and rhythms, and even the draping and lubricant we use. (MacDonald, 2007; Walton, 2006) We adapt these and other things in response to myriad physical changes: bone metastasis, surgical incisions, medical devices, or vital organs functioning at less than ideal levels. We adjust massage to the risk of lymphedema, and to the reality of it. We accommodate symptoms, such as nausea, fatigue, and pain. We work around skin lesions, and adapt to easily bruised tissues. In order to work well and safely in these conditions, we also have to unlearn some things we might have previously held as true. I can think of three beliefs that we've reexamined. The Belief that Massage Spreads Cancer The belief that massage could spread cancer has persisted in our field, and it is still taught in some training settings. The belief has kept our hands tied. But with the right interview questions and complete client answers, skillfully applied massage is not expected to spread cancer any more than normal movement or exercise would, and these activities are typically encouraged by physicians, nurses, and PTs in oncology. There are numerous sources of thought and reasoning to help massage therapists unlearn this belief. (Curties, 2000; MacDonald, 2007; Walton, 2006) Because the belief has persisted for so long, it takes thought, discussion, and full understanding in order to educate others. Simply casting off the belief, without putting proper massage precautions in its place, leads to an empty, uncertain, and unsafe application of massage. Letting the Client Direct the Session There are other things to unlearn, as well. We may have to unlearn our tendency to always follow the client's lead in directing the session. Although respect and empowerment of each client is important, as is handling a client's body within his or her comfort zone, there are times that a 100 percent client-centered session is at odds with what we know to be safe. Gayle MacDonald, author of Medicine Hands: Massage Therapy for People with Cancer, points out rightly that the oncology massage therapist may need to take a stronger leadership role in session planning, to avoid overstimulating a client in strong treatment, or injuring unstable tissue. (MacDonald, 2005) This can be challenging, at moments, when a client wants the strong, vigorous massage that he or she had before cancer treatment. It can be hard to sell a gentler session, against protests that we are treating a client as though he or she is fragile. Yet our professional and ethical responsibilities mean that the client's safety trumps the client's preferences. In the best outcome, the therapist and client plan a massage session together: one that is safe, effective, and addresses the client's needs. Intuition vs. Information The role of intuition is another thing we examine closely, and question. For some of us, this means unlearning our reliance on intuition, alone. We may have been taught, "If you're not sure what to do, just follow your intuition, and everything will be okay." In massage therapy, intuition is a highly prized decision-making tool. For good reasons, our intuitive skills are sacred. But intuition can be fallible. Not all of us have well-developed intuitive skills. Intuition may not be sending us clear signals every day, or we may not be interpreting them well. People tell me from experience that intuition may be "off" on days they've not eaten or slept well, or are under undue stress. Moreover, our own needs and fears, which may be easily provoked when working with clients who are seriously ill, can cloud our intuition and decision-making. In the other extreme, our decisions are technical, based on information, alone. Intuition may be fallible, but information isn't always perfect, either. Information changes with the times, with the situation, and there are information gaps in our understanding of cancer. By working with people with cancer, we pledge to keep our information as current as possible. One of my favorite teachers taught me that the best combination of intuition and information amounts to wisdom. Resources in Oncology Massage For most of us, to unlearn and learn the important issues in oncology massage, we need live, hands-on training. In order to work well and safely, we need a classroom with the give and take of class discussion, opportunities to practice interviewing and massage planning, actual clients with cancer to practice with, and concrete cases to discuss. Others of us have the skills to educate ourselves: we can carefully study the literature, research practices in oncology, have access to the input of health care providers, and learn from our clients along the way. All of us can turn to growing resources, like the Society for Oncology Massage (www.s4om.org), the newest edition of Medicine Hands by Gayle MacDonald, and the expanding body of research on massage and cancer. For convenience, I've indexed much of the literature on my Web site, at www.tracywalton.com. The best massage decisions combine the sturdiest information available, professional experience, legwork, possible correspondence with a client's physician, and our own intuition. Sessions are planned in collaboration with the client, and designed to address the client's needs. Learning and unlearning requires giving up old beliefs, and being open to new information and skills. This is a rich process, and sometimes a challenging one. On the way to wisdom, it's good to know that there are resources to support us. Resources Curties D. Could massage promote cancer metastasis? Journal of Soft Tissue Manipulation April/May 1994: 3-6. Reprinted in Massage Therapy Journal Fall 2000;39(3):83-8. MacDonald G. Understanding metastasis-putting 'old wive's tales' to rest. Medicine Hands: Massage Therapy for People with Cancer [2e], 2007. MacDonald G. Bodywork for cancer patients: the need for a less-demanding approach. Massage & Bodywork Jun/Jul 2005:16-26. Walton T. Cancer and massage: essential contraindications. Massage Therapy Journal Summer 2006;45(2): 119-35. Walton T. Cancer and massage: contraindications and cancer treatment. Massage Therapy Journal Fall 2006;45(3):119-35. Tracy Walton, LMT, MS, consults to hospitals and massage schools, does research and teaches "Caring for Clients with Cancer," continuing education courses offered nationally for massage therapists. She also offers a condensed course for spas, hospitals, and clinics in the basic contraindications for working with people with cancer. Back home in Boston, she has worked with Harvard Medical School's Osher Institute and the Beth Israel-Deaconess Medical Center, researching massage therapy for people with metastatic cancer. She has worked in private practice, hospital and spa settings since 1990, and taught physiology and pathology at the Muscular Therapy Institute in Watertown, MA for thirteen years, where she also served as the Academic Dean. She is the 2003 AMTA Council of Schools Teacher of the Year. Tracy holds a Master's degree in Cell Biology and Biochemistry. Currently she is working on a textbook, Medical Conditions in Massage Therapy, a resource to help therapists with clear, thoughtful decisions about mmassage contraindications in student clinics, spas, and other massage settings. In her work, she loves integrating the heart, science and soul of bodywork. She can be reached through her website, www.tracywalton.com, which includes a "help for Massage Therapists" page, current research on cancer and massage, and other resources. ---- http://www.pr.com/press-release/196766 New: Outer Jackets for Caresia Arm Garments Lymphedema Depot, the exclusive Canadian distributor of Solaris lymphedema garments, announces a new addition to its product line. St. Catharines, Canada, December 03, 2009 --(PR.com)-- Lymphedema Depot Ltd., the exclusive Canadian distributor of Solaris lymphedema-care garments, announced today that the mildly compressive Outer Jacket that has long been available only with the Solaris custom made Tribute™ nighttime garment is now available for the Caresia Bandage Liners™ for arms. According to the company, Caresia Bandage Liners are standard sized arm and leg sleeves filled with medical grade foam chips sewn into channels that are shaped to guide lymphatic fluid out of an area of chronic swelling. The Bandage liners fit against the limb and are meant to have short stretch bandaging applied over them to achieve therapeutic compression for the patient. This helps reduce and control swelling. Now, with the availability of the Caresia Outer Jacket it is possible that the application of short-stretch bandaging may, in some cases, be eliminated and the Caresia Bandage Liner along with a simple Caresia Outer Jacket, may be sufficient to reduce and control lymphedema. According to Lymphedema Depot‘s Clinical Specialist John Mulligan, “The availability of the Outer Jacket to use with the Caresia Bandage Liner will be a great relief to many lymphedema patients. I would recommend this management tool to be used where lymphedema is mild and one of the standard sizes of Caresia is a good fit for the patient. In those cases, patients may be relieved of the burden of self-bandaging and find this new application to be a simple and effective alternative.” Mulligan goes on to say “This means that the Caresia Bandage Liner can easily be used as a nighttime lymphedema garment to wear while sleeping, if the user fits comfortably and effectively into the standard sizes. This is a real breakthrough in living with lymphedema.” The Caresia Bandage Liner and Outer Jacket are available in Canada exclusively from Lymphedema Depot Ltd. Lymphedema Depot Ltd. is the exclusive Canadian distributor for Solaris lymphedema-care garments. It is based in St. Catharines, Ontario. For more information contact Lymphedema Depot Ltd. at 905-687-8500, or visit their website at www. LymphedemaDepot.com. Media Contact: John Mulligan, Clinical Specialist Lymphedema Depot Ltd. 12-111 Fourth Ave Suite 347 St. Catharines, ON L2S 3P5 905-687-8500 ---- ---- Morgan Freeman's Hand: What's Wrong With It? (PHOTOS) digg Huffpost - Morgan Freeman's Hand: What's Wrong With It? (PHOTOS) stumble reddit del.ico.us First Posted: 12- 4-09 02:25 PM | Updated: 12- 4-09 05:38 PM Read More: Morgan Freeman, Morgan Freeman Car Accident, Morgan Freeman Hand, Morgan Freeman Left Hand, Slideshow, Entertainment News Be the First to Submit This Story to DiggBuzz up! Get Breaking News Alerts never spam Share Print CommentsNope, it's not a prosthetic. Morgan Freeman let his fingers breathe in what looked like a compression glove at the Thursday night premiere of his new movie 'Invictus,' in which he plays Nelson Mandela. Freeman suffered nerve damage to his arm during a 2008 car accident. He was driving when the car containing him and suspected mistress Demaris Meyer flipped over several times, seriously injuring them both. Four days later he announced his divorce from wife Myrna. Freeman said in January his hand was paralyzed, but it might be getting better as his gloves keep getting smaller. Below you can watch his recovery in reverse chronological order. MSN Canada described his hand as "limp and swaddled in a tan glove" when he was promoting his documentary 'Prom Night In Mississippi' last month. http://www.huffingtonpost.com/2009/12/04/morgan-freemans-hand-what_n_380717.html#comments ---- More kudos for ImpediMed BIS device for early detection - Tuesday, November 24, 2009 - More kudos for ImpediMed BIS device for early detection of lymphedema A University of Sydney study has found that ImpediMed's (ASX: IPD) Bioimpedance Spectroscopy (BIS) device is the most suitable for early detection and monitoring of lymphedema. The share price of ImpediMed moved higher to $0.85 on the news. The study's findings by researchers at the University of Sydney?s Breast Cancer Research Group were published this month in the journal Cancer Investigation - found that "BIS is the only measurement method specific to extracellular fluid, ideally suited for early detection and monitoring of lymphedema." ImpediMed CEO Greg Brown said "this latest study adds weight to the debate presently being held around the globe about the need for standardised objective metrics driving evidence based medicine." "ImpediMed is very focussed on changing the care model for lymphoedema management in cancer patients from a reactive to a prospective one, he said." "If lymphoedema can be detected early, progression to the irreversible stages of the condition may be prevented, affording the patient a far better quality of life. We are pleased to be able to offer our L-Dex® U400 device to clinicians to aid them in the early clinical assessment of lymphoedema." The study was a comparison of physical measurement methods and self report in the assessment of breast cancer-related arm lymphoedema. It observed that the results from physical measurement methods other than BIS may be confounded by changes not related to lymphoedema such as muscle and fat. Therefore, early lymphoedema build up may go undetected when using these measurement methods. Foot ulcers: One of the many challenges of diabetics - 25. November 2009 - Diabetics face many health challenges, and among them is the risk of developing foot ulcers. "Foot ulcers can be painful and can lead to further infections and even limb amputation if they are not monitored or treated correctly," said Marcus M. Riedhammer, M.D., Certified Wound Specialist, Geisinger Medical Center. "Diabetes can cause nerve damage, which lessens a diabetic's ability to feel when an injury develops, and it can adversely affect circulation and the body's ability to help wounds heal or fight off infection. Because of these issues, diabetics are particularly susceptible to developing foot ulcers." Foot ulcers are open sores that usually develop on the ball of the foot or bottom of the big toe. They occur when repeated pressure is applied to an area of the foot, and are characterized by red, crater-shaped wounds that can range from a shallow crater only involving the surface skin to holes that reach as far as the bone. "Foot ulcers are often uncomfortable, but diabetics may not feel them as they develop or know that they have one at all," Dr. Riedhammer said. "This can be especially dangerous because it can lead to a variety of infections and other complications. An infection acquired through an open wound can spread quickly, become an abscess and lead to gangrene and other harmful medical complications, which may necessitate amputating a toe, foot or part of the lower leg." Prevention is easy, Dr. Riedhammer said. By checking and washing feet daily and wearing shoes that fit correctly, most patients can avoid developing these ulcers. Meeting with a podiatrist can help patients understand their risk for developing ulcers as well, he said. If an open sore develops, consult a physician immediately, he advised. Often times, diseased skin needs to be removed, and wound dressing is applied to the affected area. Rest and limiting pressure to the ulcer are very important as well, and antibiotics may need to be prescribed in the case of an infection. Geisinger Medical Center's Wound Care Center treats patients affected by foot ulcers, leg ulcers, ischemic or arterial ulcers, and chronic, non-healing wounds. A multidisciplinary team - which includes experts in orthopedics, vascular and plastic surgery, nutrition counseling, lymphedema and orthotics - collaborates to provide patients with the most effective treatment. "Foot ulcers may seem like a minor issue, but they can pose a serious threat to your health," Dr. Riedhammer said. "By checking your feet every day, being aware of the risks ulcers pose and consulting a doctor upon the first sign of a wound developing, the risks and side effects of foot ulcers can be minimized." SOURCE Geisinger Health System SHAREing & CAREing - November 25, 2009 - SHAREing & CAREing, the only community nonprofit organization to provide grassroots support services to breast and ovarian cancer patients and their families through counseling, educational forums and advocacy services in Queens and throughout New York City, held their 15th anniversary benefit and silent auction on Wednesday, November 18 at Riccardo's by the Bridge, Astoria. First Central Savings Bank sponsored the event and in keeping with longstanding tradition, First Central Savings Bank President, Chief Executive Officer and Chairman and Pistilli Real Estate Chairman of the Board Joseph Pistilli acted as master of ceremonies and auctioneer. SHAREing & CAREing Guests of Honor for 2009 were Donald Gelestino and William J. Krapf, Ver-Tech Elevator president and vice president, respectively, Alrose Group President and Founder Allen Rosenberg and Fiduciary Insurance Company of America CEO Peter Skenderis. Five area physicians received Physician Recognition Awards: Farah E. Atallah Lajam M..D., Mount Sinai School of Medicine assistant clinical professor and Mount Sinai Hospital attending cardiologist; Vladimir Benisovich M.D., chief, division of oncology, Elmhurst Hospital Center Department of Medicine and Mount Sinai School of Medicine assistant professor, Department of Medicine; The Mount Sinai Hospital of Queens Vice President and Chief Medical Officer David M. Nierman, M.D., M.M.M., F.C.C.M., F.C.C.P.; Jean- Bernard Poulard, M.D., M.B.A., F.A.C.S., Queens Health Network Deputy Medical Director Queens Hospital Center Department of Surgery Attending Physician and Mount Sinai School of Medicine Department of Surgery assistant professor, and Jay D. Tartell M.D., The Mount Sinai Hospital of Queens assistant chief of radiology. First Central Savings Bank First Vice President and Branch Coordinator Christine Lolas received the Community Recognition Award. As has been the case in previous years, funding from New York state and New York City has virtually dried up, so the need for private donations realized through fundraising events such as the SHAREing & CAREing benefit and silent auction is extremely imperative, according to Anna Kril, SHAREing & CAREing president. “Insurance companies routinely deny payment for chemotherapy treatments, lymphedema pumps and other much needed services. We are very proud that when we receive a request for help, we have been able to say ‘yes’—always free of cost,” she said. “At this moment, SHAREing & CAREing is facing a precarious financial situation,” she noted. Kril extended special thanks to the situation,” she noted. Kril extended special thanks to the committees whose members put in the hours and effort that made the event a financial success and helped to bring it to the public’s notice. Linda Perno and Eartha Washington comprised the Benefit Committee; Patricia and Edward Babor together made up the Journal Committee; the Silent Auction Committee included Larissa Marchesi, John Spellman and Mercedes Pinzino and members Grace Addabbo, Enza Ferrara, Jennifer DeLellis and Andrea Mardach. Roseanne Alafogiannis served as Ticket Chairman and Charlene Mulhall and Charlene Perno, R.N comprised the Ticket Committee. SHAREing & CAREing is the only community nonprofit organization which provides grassroots support services to breast and ovarian cancer patients and their families through counseling, educational forums and advocacy services in Queens and throughout New York City. As advocates, SHAREing & CAREing seeks to dramatically improve medical services to all women through early detection, treatment and information about living with the effects of breast cancer, regardless of economic stratum. The founder and executive board members of SHAREing & CAREing are breast cancer survivors and first- generation Americans who are bilingual and represent the multi-ethnic fabric of communities in Queens. For more than 10 years, SHAREing & CAREing has partnered with local physicians and hospitals to offer health forums and mammography screening, and provided unique counseling and culturally sensitive support services for women seeking information, and for those diagnosed with breast cancer. All services are free of charge. SHAREing & CAREing serves cancer patients and women seeking information about the disease throughout the five boroughs. For more information, call 718-777- 5766 Mountainside Hospital - November 26, 2009 - A group of Mountainside Hospital employees are going the "extra mile" — more specifically, 507 miles — to demonstrate their personal commitment to breast cancer research and call attention to the hospital's extensive breast cancer resources. While physically preparing to participate in the annual 39-mile Avon Walk for Breast Cancer in New York, 13 Mountainside employees have also been fundraising in support of their journey. In fact, even five weeks after the Oct. 10-11 event, the group is still receiving donations, having raised nearly $41,000 through a 50/50 raffle, a car wash and other activities. The Avon Walk supports research for a cure and medical care for all breast cancer patients regardless of their ability to pay. The employees include the following area residents: Laurie Barbalinardo, RN of Glen Ridge, Diane Heiser, RN of Glen Ridge and Robin Bernice, RN of Wayne (Obstetrics); Terry Dolan, RN of Cranford (Post Anesthesia Care Unit); Barbara Files, RN of Pompton Plains (Nursing Education); Debbie Matthews, PT of Glen Ridge (Physical Therapy); Carol McGrath, RN of Montclair (Bariatric Center); Gloria Meyer of Bloomfield (Operating Room); Carol Quiroz, CRNA of Montclair (Anesthesia); Alison Miller, RN of Fairfield (Same Day Surgery) and Dr. Mary Voytus of Chatham (Dentistry). "We are actively engaged in breast cancer awareness, diagnosis and treatment at Mountainside Hospital. As a result, we are acutely aware of the life-altering impact it has on patients and their loved ones," said John Fromhold, CEO and president. "We are very proud of these staff members who have demonstrated that their caring and compassionate spirit extends beyond their work at the hospital into every aspect of their lives." Mountainside's breast cancer program encompasses state-of-the art diagnostic and treatment tools, as well as support programs that ease the physical and emotional toll of the disease. Early detection tools include large field digital mammography, which produces clearer and more comprehensive images of large, dense breasts. Treatment, when needed, is provided by a multidisciplinary team of experienced physicians and other medical professionals. after care For some Mountainside patients, after care now integrates a novel approach to physical therapy featured in the New England Journal of Medicine and the New York Times in August. A specially trained therapist leads patients through a slow, progressive weight training regimen designed to prevent lymphedema, painful and unsightly swelling that occurs when lymph nodes are surgically removed or damaged by radiation. The successful use of controlled weight training is a departure from traditional weightlifting restrictions for breast cancer patients that impede their day-to-day routines. Commendation The Mountainside Hospital Cancer Center has received commendation from the Commission on Cancer, an accrediting organization that has awarded the distinction to only about one-fourth of all hospitals that treat cancer patients nationwide. The hospital also has an active partnership agreement with the Cancer Institute of New Jersey. Broadstone to speak at Meditation Society meeting - November 24, 2009 - SANTA ROSA BEACH — On Dec. 3 the Emerald Coast Meditation Society will have as its guest speaker Mindy Broadstone, a long-time practitioner of Qigong. She will talk about “Qigong for Enhancing Meditation” and will teach the group some Qigong principles and movements. The ECMS, open to the public, meets at Christ the King Episcopal Church parish hall at 6:30 p.m. on the first and third Thursdays of the month. Qigong, Broadstone explains, is an ancient practice that translates to energy work. More than 30,000 forms have been documented, both quiet and active. “We will use focused attention, breath and movement to move energy through the pathways of the body to clear areas of restrictions that are distractions to meditation” she says. “Qigong has a unique ability to help clear all three aspects, thus leading one to a higher probabililty of having a lovely meditation.” Broadstone was trained by Tianyou Hao and Ken Weintraub in Qigong, and by Swami J in meditation. Swami J heads the Center for Non-Dualism in Fort Walton Beach, where Broadstone is a Council Member. Broadstone is certified in massage therapy and lymphedema therapy, and holds a bachelor of science degree in occupational therapy from Cleveland State University. She works for Gentiva Home Health, providing occupational therapy in clients’ homes. From 2001 to 2008 she was an OT clinician at Fort Walton Beach Medical Center. From 1997 to the present she has taught patients and therapists how to work with their body, breath and mind to reduce stress. After speaker, the ECMS will have a 30-minute meditation so attendees can immediately practice some of the Qigong principles just learned. Following a discussion, a guided meditation will close the meeting around 8 p.m. Christ the King church is at 480 N. Co. Hwy. 393, Santa Rosa Beach. --- Lymphedema Therapist Calls Meeting “Historic” - November 16, 2009 - St. Catharines Ontario… John Mulligan, a massage and lymphedema therapist and educator, and his wife, Bonnie Baker, recently participated in the Canadian Lymphedema Framework (CLF) meeting, which was held at the Canadian Institute for the Blind in Toronto on November 6, 2009. Mulligan, who, along with his wife, is co-owner of Lymphedema Depot Ltd. in St. Catharines, said “It was an honor to be invited. I have been a lymphedema therapist for eleven years now, and this was the most historic and unique conference I have attended. This is the first time that all of the major stakeholders in lymphedema care have come together in a national meeting.” According to the CLF website, the Canadian Lymphedema Framework is… “an international initiative aiming to promote research, best practice guidelines and lymphedema clinical development, worldwide.” The Framework meeting, said Mulligan, included over a hundred “lymphedema patients, garment fitters, vendors of lymphedema care products, researchers, educators, therapists and doctors.” “Lymphedema is a condition of chronic swelling, usually in an arm or leg but it can also occur in the torso or head and neck. Often it is the result of surgery. It can also be an inherited condition. It is an under-diagnosed and under-treated condition in North America. The treatment for this debilitating condition is not usually funded by government or health insurance. This historic meeting was about finding ways to address those problems. I’d say we made a good beginning. The CLF has adopted best practice guidelines for the treatment of lymphedema and several ongoing initiatives were established at the meeting,” Mulligan said. The purpose of the meeting, according to the CLF’s website, is to “elicit the input of all key Canadian stakeholders in developing a national strategy and agenda for lymphedema research and education and to advocate for effective and accessible clinical services” for lymphedema patients. Lymphedema Depot Ltd. is the exclusive Canadian distributor for Solaris lymphedema-care garments. It is based in St. Catharines, Ontario. For more information contact John Mulligan or Bonnie Baker at 905-687-8500, or visit their website at www.LymphedemaDepot.com Persistent Pain Common After Breast Cancer Surgery - no date on article but date of sending from Google is November 16, 2009 - Researchers from Denmark have reported that pain and sensory disturbances persist for two to three years after breast cancer surgery. The details of this study were published in the November 11, 2009 issue of the Journal of the American Medical Association.[1] The most common complication of breast surgery is lymphedema related to axillary lymph node dissection. Very little has been written about persistent pain in the breast. Researchers sought to determine the incidence of persistent pain and sensory disturbances after breast cancer surgery. They performed a questionnaire study in 2008 involving 3,754 women who had received surgery for primary breast cancer in 2005 and 2006. •47% reported pain, which was severe in 13%. •Factors associated with chronic pain included young age and axillary lymph node dissection. •Women with sentinel lymph node dissection had less pain than women with axillary lymph node dissection. •Sensory disturbances were also associated with younger age and axillary lymph node dissection. •Pain in other parts of the body was associated with increased pain in the surgical area. •20% of women had contacted a physician within the past three months concerning pain in the surgical area. • Comments: These data suggest that pain and sensory disturbances related to breast cancer surgery are much greater and persist for a longer period of time than generally appreciated. Reference: [1] Gartner R, Jensen M-B, Nielsen J, et al. Prevalence of and factors associated with persistent pain following breast cancer surgery. Journal of the American Medical Association. 2009;302:1985-1992 Remembering Marian Benner - Nov 15 2009 - Marian Benner was many things to many people. She was a mother of four. A friend to many. A good neighbor. And she was truly an unsung hero in east Bakersfield. Today, people will gather at St. Joseph's Catholic Church and Hillcrest Cemetery to remember the life of Benner, who died Oct. 26. She was 46. Benner is survived by her four children, Juan Jose Benner, 19; Francisco Javier Benner, 17; Mariana Louisa Benner, 16; and Jose Luis Benner, 15, along with her father, Erno Benner, of Oregon, a sister, brother and other relatives and friends. Benner was a longtime community activist in east Bakersfield, often volunteering for the local youth and seeking ways to improve the nearby neighborhoods. She did this, despite her constant struggle with acute lymphedema.. When I first met Marian and the Benner family, she was already struggling with acute lymphedema, a condition of localized fluid retention brought on by a compromised lymphatic system. Despite her health issues, she joined the efforts of the East Bakersfield Faith Community Alliance and worked with fellow residents on several projects, neighborhood socials, and community meetings She was sick and tired of being sick, but not too tired to work for change. And the unsinkable Benner never came alone. Her four teenager kids always joined in and volunteered their time too! Many know Benner from her involvement with the East Bakersfield Community Coalition, where she spearheaded activities for children via the after-school Kid's Club program, the Girl Scouts, and Boy Scouts. She even chauffeured many neighborhood kids to and from activities. Even more impressive, without a "community center" building, she became, for many, the center of the community. Many families would seek her out for advice about anything from help with filing their taxes or legal documents to getting information about health and other resources. For a time, she even held English as a Second Language classes in her living room. "She'd come over to my house to use the internet to download and print whatever materials she might need for her classes and brainstorm some ideas and strategies," said good friend and another East Bakersfield community leader, Brandi De La Garza. "She gave her time and talent to the community not for public recognition or anything like that, but because she could, and I think she could because she was not concerned with hierarchies of any kind, but more with each and every human being she came in contact with... Marian really saw you, heard you, and gave of herself based on that." In a world where people living next door are more often strangers than neighbors, Benner symbolized the true meaning of a neighbor. "Not only did Marian not allow her own struggles with her health to be a reason not to help others, but she also did not allow language barriers, shyness, appearances or cultural differences stop her from helping anyone who came to her for guidance or friendship," De La Garza said. Let's hope her legacy will live on through her children and others who give compassionately without expecting anything in return. Andrae Gonzales is a local Latino columnist whose work appears regularly in The Californian. These are the opinions of Gonzales, not necessarily The Californian. Write to him at agonzales@bakersfield. com. Special program gives seniors a life of independence - 13abc.com - November 25, 2009 - A Gibsonburg woman has a place of her own for the holidays after nearly a year in a nursing home. After nearly a year in a nursing home, a Gibsonburg woman has a place of her own for the holidays. It's all thanks to a special program that is giving thousands of seniors a passport to a life of independence. Pat Oren says, "I knew I wanted to experience life. I've been an observer for a long time. Pat Oren, 68, is still getting used to having her own space. Years ago, a car accident left her with lymphedema. The condition caused her legs to swell, leading to weight gain and ultimately left Pat in a wheelchair. Since then she's spent time in assisted living and a nursing home. Pat says, "What I saw, so many people who thought their lives were over." That's when Pat decided to take life by the horns and get back on her own with help from Passport. It's a program offered by the Area Office on Aging that helps people transition from a nursing home back to independent living. Pam Wilson of the Area Office on Aging of NWO says, "If someone is improving and can go home, it becomes very difficult because they don't have an income to move home." Pat says, "This gave me the means to do something I couldn't do." Passport assists with rent, household items, medical care and food. Pat receives prepackaged meals, making it easy for her to maintain a balanced diet without having to find a way to the store. Therapists and aids provide convenient independence if Pat needs them, giving her everything she needs to continue her life experience. "It's like Christmas 16 times over. It's incredible that things that have happened to me," says Pat. Right now there is a rolling wait list of about two months for the Passport program. If you want to apply or get more information, contact the Area Office on Aging of Northwestern Ohio at 419-382-0624 ----- http://www.abc15.com/content/style/beauty/story/3-products-to-treat-your-eyes-in-time- for/OtDV3PjAsECX6FdqGyNsBw.cspx ----------------------- http://www.medicalnewstoday.com/articles/173259.php Kaposi's sarcoma (KS) is a type of cancer. It causes growths under the skin, although they can grow in the lining of the mouth, nose, throat and other organs. It is different from other cancers as it starts in several areas of the body at once. Most cancers start in one place and then spread. KS causes abrasions or tumors (growths). They most commonly appear on the skin as small, flat, colored lesions that can be brown, blue, red or deep purple. Lesions can also develop on the internal organs, such as the lymph nodes (part of the immune system), the lungs, and the digestive system, including the bowel, liver and spleen. It was originally described by Moritz Kaposi, a Hungarian dermatologist practicing at the University of Vienna in 1872. It became more broadly known as one of the AIDS defining illnesses in the 1980s. The viral cause for this cancer was discovered in 1994. According to Medilexicon's medical dictionary: Kaposi's sarcoma is: "A multifocal malignant neoplasm of primitive vasoformative tissue, occurring in the skin and sometimes in the lymph nodes or viscera, consisting of spindle cells and irregular small vascular spaces frequently infiltrated by hemosiderin-pigmented macrophages and extravasated red blood cells. Clinically manifested by cutaneous lesions consisting of reddish-purple to dark-blue macules, plaques, or nodules; seen most commonly in men older than 60 years of age and in AIDS patients, as an opportunistic disease associated with human herpes virus-8 infection." There are four types of Kaposi's sarcoma (KS): HIV- or AIDS-related KS Classic KS Endemic or African KS Transplant-related KS HIV- or AIDS-related KS: KS can develop in people whose immune system has been severely weakened by HIV or AIDS. Gay men with HIV or AIDS are mostly affected. It is thought that the virus that causes KS is spread during unprotected anal sex. In the past, HIV- or AIDS-related KS used to be the most common complication affecting gay men living with HIV and was a leading cause of death. This is no longer the case due to anti-HIV medications that were developed in the 1990s, known as highly active antiretroviral therapy (HAART). The outlook for HIV- or AIDS-related KS is variable and depends on a person's age and the state of their immune system. In an older person with a weakened immune system, the cancer often spreads aggressively to other parts of the body (metastasis). The estimated survival rate for HIV- or AIDS-related KS is five years, although many people live a lot longer. The improvement of survival rate is directly linked to the improvement in medication for treating HIV. Classic KS: It is a rare condition, usually only affecting men between 50 and 70 years of age who are of Mediterranean or eastern European descent. It is thought that people who develop classic KS were born with a pre-existing genetic vulnerability to the virus that causes it. The outlook for classic KS is good. The cancer tends to spread slowly and does not usually spread to other parts of the body. Classic KS primarily affects older people. Endemic or African KS: It is common in parts of Africa. It is one of the most widespread types of cancer in that region. As with classic KS, endemic KS is thought to develop due to a pre-existing genetic vulnerability to the virus that causes it. Many people may now be more vulnerable to the virus because of the HIV epidemic in Africa and a weakened immune system due to HIV or AIDS. The outlook for endemic KS is poor. In addition, access to treatment such as chemotherapy is often limited in parts of the world where endemic KS is widespread. Transplant-related KS: It is an uncommon complication of organ transplants. People who have had an organ transplant usually take medication to weaken their immune system (immunosuppressant) to prevent their body rejecting the new organ. The weakening of their immune system makes them more vulnerable to the virus that causes KS. The outlook for transplant-related KS is generally good because the condition can usually be successfully treated by reducing or stopping a person's course of immunosuppressant. However, there is a higher risk of rejection of the donated organ. What are the symptoms of Kaposi´s sarcoma? A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. The symptoms of KS depend on where the lesions or growths develop. Skin Any part of the skin, including the inside of the mouth, can be affected. KS usually appears as small, painless flat lesions or lumps. They can be of different colors (brown, red, blue and purple). They often look like bruises but do not lose their color when pressed like a bruise does. KS growths may start in one place and then can develop in more than one area. The growths often eventually merge into each other to form a larger tumor. Internal organs The lymph nodes, lungs and organs of the digestive system are most commonly affected. The symptoms of KS depend on which organs are affected. Lymph nodes: There may be swelling in the arms and legs. It can be very painful and uncomfortable. This is known as lymphedema and is caused by the KS cells blocking the flow of fluid through the lymph nodes. As a result, the tissue fluid backs up. This causes swelling in the body's tissues. Lungs: symptoms may include breathlessness. Organs in the digestive system: symptoms include nausea, vomiting and bleeding. What causes Kaposi´s sarcoma? Cancer Cancer initiates with a change in the structure of DNA, which is found in all human cells. DNA provides our cells with a basic set of instructions such as when to grow and reproduce. A change in its structure, called a genetic mutation, can cause the cells to reproduce uncontrollably. This produces a lump of tissue known as a tumor. Left untreated, cancer can quickly grow and spread to other parts of the body. It usually spreads through the lymphatic system. Once the cancer reaches the lymphatic system, it can spread to any other part of the body, including the bones, blood and organs. The human herpes virus 8 (HHV-8) Kaposi's sarcoma (KS) is caused by a virus called the human herpes virus 8 (HHV-8). It is also known as the Kaposi's sarcoma-associated herpes virus (KSHV). It is thought that HHV-8 contains genetic material that interferes with the normal working of cells. This causes them to reproduce in an uncontrollable manner. However, HHV-8 does not cause Kaposi's sarcoma in everyone who contracts the virus. It only seems to cause Kaposi's sarcoma in: people who have an inherited (genetic) vulnerability to HHV-8 people with a weakened immune system HHV-8 was first identified in 1994. There is no firm evidence as to how the virus is spread. However, there is indication that HHV-8 can be spread during unprotected anal sex. The rates of HHV-8 in specific countries reveal that the virus is almost always more widespread in the gay community. There is circumstantial evidence that HHV-8 can be passed on through saliva. This means the virus could also be spread by kissing. How is Kaposi´s sarcoma diagnosed? Before diagnosing Kaposi's sarcoma (KS), the patient´s general health is reviewed and there is a careful examination of the skin. If KS is suspected, further testing may be required. People with HIV or AIDS, will usually have their tests carried out at a specialist centre where staff are experienced in treating complications of HIV and AIDS. Biopsy: It is the most effective way to confirm a diagnosis of KS. This involves taking a small sample of cells from an affected area of skin. The sample is then checked at a laboratory for the presence of KS cells. Endoscopy: It may be carried out if KS is suspected in the digestive system. The procedure involves inserting a thin, flexible tube called an endoscope down the throat. It allows looking inside parts of the digestive system, such as the bowel, liver and spleen, for any abnormalities or signs that KS is present. A biopsy may be taken. A mild sedative may be given. A local anesthetic will be sprayed on to the throat to prevent discomfort as the tube is passed down. A similar method can be used to look at the lungs (bronchoscopy) if KS in the lungs is suspected. Computerized tomography scan (CT): In the case it is suspected that KS has spread to the lymph nodes or other parts of the body. A CT scan works by taking a series of X-rays which build up a three-dimensional picture of the inside of the body. A radioactive dye may be given to drink before the CT scan, to allow particular areas of the body to been seen in greater detail. What is the treatment of Kaposi´s sarcoma? The treatment of KS depends on: the severity of the symptoms the size and location of the lesions the type of KS the patient´s general health Treatment plans can vary from person to person, but the usual plan for each type of KS is outlined below. HIV- or AIDS-related KS Patients with HIV- or AIDS-related KS will usually be given a course of highly active antiretroviral therapy (HAART) to help strengthen their immune system. HAART may be followed by courses of radiotherapy and/or chemotherapy. Classic KS As classic KS spreads slowly, immediate treatment is not usually required. Doctors may recommend waiting and closely monitor the evolution. Treatment will be delayed to see if any symptoms of progressive cancer develop. This is often recommended for older people when it is unlikely that the cancer will affect their natural life span. If treatment is required, radiotherapy is normally used to treat classic KS. Endemic KS Usually, endemic KS is treated using a combination of radiotherapy and chemotherapy. Transplant-related KS Transplant-related KS is usually treated by reducing or stopping the immunosuppressants. The goal is to strengthen the immune system in order to fight off the humanherpes virus 8 (HHV-8) while ensuring that the body does not reject the transplanted organ. It may be difficult to find the best balance between these two treatment goals. HAART It involves using a combination of medicines that interrupt the reproductive cycle of the HIV virus. This helps to prevent the virus from spreading quickly. It also protects and strengthens the immune system. HIV can quickly adapt and become resistant to a single medicine, therefore a combination of medicines is required. In some people, the medicines used to treat HIV will cause side effects. Usually, there is improvement after a few weeks as the body gets used to the medicines. Common side effects of HIV medication include: diarrhea mood changes nausea skin rashes tiredness gaining fat on one part of your body while losing it on another (lipodystrophy) Surgery If the lesion is small, surgery may be used to remove KS from the skin. Cryotherapy may also be given. This freezes the lesions using liquid nitrogen. Chemotherapy Chemotherapy uses medicines to treat cancer. The medicines destroy rapidly growing cancer cells. The medicines can either be given intravenously or as a tablet that is taken orally. If the lesion is small, chemotherapy may be injected directly into it. This is called intralesional chemotherapy. Chemotherapy can cause side effects including vomiting, hair loss, tiredness, and increased vulnerability to infection. Often, liposomal chemotherapy is used to treat KS. The medicines used in chemotherapy are covered in a fat-based coating called liposome. The extra coating means reduces the side effects and the medication works more efficiently. Radiotherapy Radiotherapy uses high-energy rays to locate and destroy the KS cells. It can be very effective in reducing symptoms of internal KS, such as swelling, pain and bleeding. Possible side effects of radiotherapy include: tiredness, sore skin (particularly for people with HIV or AIDS), stiff joints and muscles, nausea, temporary hair loss, loss of appetite, loss of libido (interest in sex), early menopause, and temporary impotence in men. Once the course of treatment is over, most side effects gradually disappear. Immunotherapy Immunotherapy is also known as biological therapy. It is often used in combination with other treatments such as HAART. Immunotherapy uses special proteins that have been genetically developed in a laboratory. Generally, the body does not consider the cancerous cells as foreign objects. As a result, the immune system does not attack them. In immunotherapy, special antibodies are created in a laboratory. They change the composition of cancerous cells so that the immune system regards them as foreign objects. The immune system then starts to attack the cells in the same way that it would normally attack an infection. Interferon is one of the most common types of medicines used in immunotherapy. It is usually given by daily injections into the skin over a number of weeks. Side effects of immunotherapy include: back ache aching joints and muscles chills headaches high temperature (fever) of 38°C (100.4°F) or above loss of appetite nausea tiredness Written by Stephanie Brunner (B.A.) ------------------- http://www.thevillagesdailysun.com/articles/2009/11/29/news/news02.txt Those coping with life’s challenges find comfort, inspiration in writing about their experiences By AZIA LI FORREST, DAILY SUN Sunday, November 29, 2009 12:04 AM EST THE VILLAGES — Writing was Paul and Loni Walker’s daughter’s way of coping with her husband’s cancer. Their daughter, Julie Walker Mitchell of Solon, Ohio, struggled when her husband Scott was diagnosed with multiple myeloma. Doctors had given him five to eight years to live. “It’s a type of cancer that eats holes in the bones,” said Loni, of the Village of Belle Aire. “At this point, they have no cure for it, but they can slow it down — it does not go into remission. He’s already had one of his vertebrae filled with cement to keep him upright.” Scott remains active — exercises and holds down a job. “He’s totally mentally competent,” Loni said. “I mean you’d look at him and wouldn’t know he’s sick.” After receiving numerous calls and e-mails, Mitchell was encouraged to write a book to help others who were in a similar situation. The book, “365 Days of Hope,” was published this year by Tate Publishing and Enterprises. “Each day is a Bible passage, then she explains how it works in her life, and how it can be applied to situations in other people’s daily life,” Loni said. “Each month has a different theme: November is ‘Praise and Thanksgiving, February is love.’” Paul said he found the book to be very inspirational. “In every passage, she gives the feeling of hope,” he said. “It not only helps people with the disease, but in every way. It’s very worthwhile to read it.” Rose Mary Haverlack Writing has always been Rose Haverlack’s way of coping with life’s challenges. Haverlack, a facilitator for the Tri-County Breast Cancer Support Group, was diagnosed with breast cancer for the first time 14 years ago. Following several years of treatment, she developed lymphedema, a buildup of lymph fluid in the fatty tissues just under the skin that causes tissues to swell mildly or severely. Now, after celebrating another October as a Breast Cancer Awareness Month survivor, Haverlack is coping with the disease again. “I (had) to make up my mind, and I told the doctor I will not go through this a third time,” the Village of Bonnybrook resident said. “I have to be a (role) model for the people who are scared to death.” She made a commitment to herself to stay strong. “I read — did some research — and I told myself I’m going to write — I will get the strength,” she said. “When I write, it’s a very private thing for me. Because it’s private, it’s like a thought.” But when she shares her words with others, it becomes special — which she hopes can inspire others. “They can see the tears and look of anguish,” she said. “When I write, I’m looking into a mirror, not at myself but looking into my soul. You see what your life is like, you want it to continue, and therefore you’ll do whatever it takes. Like I’ve said before, ‘Once it’s on paper, it becomes real.’ It’s a bridge between my inner and outer world.” Haverlack said words are like paintings. “You can make them say anything you want,” she said. Azia Li Forrest is a reporter with the Daily Sun. She can be reached at 753-1119, ext. 9069, or azia. forrest@thevillages media.com. ---- http://www.montrealgazette.com/health/Generations+helping+each+other/2284870/story.html Generations helping each other By SUSAN SCHWARTZ, The GazetteNovember 30, 2009 StoryPhotos ( 1 ) Monique Garry stocks up on warm toques and gloves, then donates them to Le Bon Dieu Dans la Rue. Photograph by: MARIE-FRANCE COALLIER, GAZETTE FILE, The GazetteCome autumn each year of the past five or so, Léry resident Monique Garry starts to stock up on warm toques and hats, scarves and mitts in different sizes and colours she finds at good prices, then matches up in three-piece sets. Once the mercury starts to dip, she delivers them to Le Bon Dieu Dans la Rue, which helps homeless young people (www.danslarue.com). This year, Garry amassed 40 sets of hats and gloves - more for men than for women. It's one of the ways in which she tries to assist people who need help. The focus of Dans la Rue is on young people age 12 to 25. Among its services are a day centre, an emergency shelter and a mobile unit that circulates in downtown Montreal at night. - - - The Rib'n Reef steakhouse held it second annual oyster party fundraiser recently to benefit the Starlight Children's Foundation. More than 140 people attended the event, which featured actor Larry Day as master of ceremonies, a jazz trio, cocktails, all the oysters one could eat as well as dinner; Soeur Angèle, Quebec's cooking nun, was honorary president. The event raised $21,700 for the foundation, which works to improve the quality of life for children who have chronic and life-threatening illnesses or life-altering injuries by providing entertainment, education and family activities intended help them cope with the pain, fear and isolation that accompanies their conditions. Rib'n Reef has chosen to sponsor the Hospital Happenings program at the Montreal Children's Hospital and at Hôpital Ste. Justine. The program includes parties, clowns, crafts, pet therapy and a variety of shows and activities that give young patients the opportunity to be entertained. "We want the oyster party to become an annual tradition of fine dining and giving generously," said Abdo Abouhamad, Rib'n Reef's general manager. - - - Jamie Tajfel, a 19-year-old student at Concordia University, recently launched a youth division of the Lymphedema Association of Quebec (LAQ) and, with the help of an energetic committee and co-chairs Kyra Grinbaum and Lauren Lighter, LAQ Youth held its first fundraiser this month, at the Grand Bayou Café Bar. About 200 people attended, bands Jared Coxford and Vista Cruiser played for the young crowd, and more than $15,000 was raised. Major sponsors were Neon Clothing and Moishes steakhouse. Tajfel said her main goal is to bring awareness of lymphedema to her peer group. Lymphedema is a progressive, non-curable lymphatic disorder; it is caused by damage to the body's lymphatic vessels and can occur near the site where lymph nodes have been damaged or removed. In severe cases, lymphedema causes unsightly swelling, most often in limbs. It occurs most commonly as a result of cancer treatment. Between 20 and 30 per cent of people with breast cancer, for instance, are affected. The LAQ is a volunteer-run charity based in Montreal; it relies entirely on donations to help people living with lymphedema. Visit www.infolympho.ca for more information. applause@thegazette.canwest.com ---- The Treatment of Kenny Farnsworth - November 29, 2009 - For much of a decade, he called 911 routinely for an endless list of medical issues. Now he has an endless stack of bills he is unlikely to ever pay. So what's the diagnosis? Eight miles north of the U.S. Capitol, in Silver Spring, there is an office trailer on a tow lot where the telephone rings throughout the day. As one would expect, a lot of the calls come from stranded drivers who need a tow or a jump-start. But these days, most of the calls tend to come from debt collectors -- both human and automated -- searching doggedly for Ken Farnsworth, a chronically ill hospital regular known to first responders and nurses across the Washington area. A decade in and out of emergency rooms has turned Farnsworth into a wanted man. Seated in an office chair one summer afternoon, Farnsworth stares at the receiver as the line lights up during a string of calls. "That phone never stops ringing," he says, shaking his head as the call goes to voice mail.. Farnsworth is a short and squat 59-year-old who walks like a man in search of a cane. His paunch hangs over his belt, and his eyes blink slowly behind horn-rimmed bifocals. He could easily be mistaken for a retired firefighter, thanks to the clothing he wears daily -- a matching Washington, D.C.., fire department hat and T-shirt, in honor of the men and women who have treated his array of health problems over the years. Farnsworth has no home of his own, so the office trailer is one of a few places where he's been known to crash now and again, with the owner's permission. He lives out of two duffel bags that are stuffed with a few pairs of clothes, some toiletries, and his most recent medical bills and conditions' diagnoses. The medical claims are too much for Farnsworth to keep up with. They arrive by the bundle every week. The bills come from just about every hospital in the Washington area, as well as from the collection agencies that handle overdue accounts for those hospitals. Farnsworth even has a tab with the D.C. government, which is trying to recoup money he owes it for the countless ambulance rides he has taken. "I guess I wore out my welcome a long time ago," he says, managing a laugh. He opens most of the letters and tries to sort through his debts, but the numbers have become too abstract -- "unfathomable" is how he puts it. He piles the bills into neat stacks until they become too unwieldy, then he stuffs them into grocery bags. Eventually, when he starts to face reality, he throws the overflowing bags into the trash. *** The first time paramedic Dave Cole picked up Farnsworth was on Thanksgiving Day in 1997. Cole was one year into the job in Washington, working a 12-hour holiday shift, when a call came over the radio for a man choking on a street corner near downtown. He and his partner raced to the scene. "And there's old Kenny," Cole remembers. "He said he was eating some turkey and choked on a bone." Farnsworth showed the telltale signs of a blocked passageway -- he was grabbing at his throat and gasping for air -- so Cole put him on oxygen, loaded him into the back of the ambulance and headed to the nearest emergency room. "We went in and saw the hospital staff," Cole says, "and I could see it right on their faces." They had just released Farnsworth a few hours earlier, they said. They didn't think there was anything wrong with him. The medic felt duped. So began a long and complicated relationship between Cole and Farnsworth. Farnsworth quickly carved out a reputation as an emergency room regular. Among even the city's most habitual 911 callers, he was virtually peerless. It wasn't out of the ordinary for a Washington ambulance driver to shuttle Farnsworth more than once on the same shift. His transports were for conditions including choking, high blood pressure, trouble breathing and internal pains. Over the years, he has suffered from convulsive seizures; a deviated septum; pancreatitis; gastritis; two perforated ulcers; a hernia; lymphedema, which causes swelling in his legs; acid reflux disease; and irritable bowel syndrome. His problems have run literally from his head, where he once suffered a skull fracture, to his feet, which are two different sizes, thanks to some bone removal after a break in his left foot. Early on, Cole realized his most regular passenger was taking 15 different pills -- some of them duplicates -- probably because he had seen 15 different doctors in the previous weeks. Together, they worked on weeding out the superfluous medicine. "I was impressed with his knowledge of pharmacology," Cole says. "He knew the meds and their side effects. He's had so much done to him over the years. He would ask me about different medical tests, and they were all tied to his personal medical crises." As Farnsworth puts it, "I've had my little pre-med classes in this life." But for all Farnsworth learned as a patient, preventive care was never his thing. As someone who was often homeless, he came to rely upon the emergency room for all his health problems, whether or not they were life-threatening. When something seemed wrong, he demanded service. "Most of my problems happen on a short-term basis," he explains. "What's wrong is wrong then. If I have to wait three days to see a doctor, it won't do me any good." It didn't matter that ER workers would let him sit for hours in triage or kick him out when he became unruly and cursed in frustration. He simply went to another hospital. And if none of the hospitals in Washington met his standards, he would ride the Metro to Northern Virginia and dial 911. He viewed emergency care as a basic right, and he sought it whenever a problem arose, regardless of how his previous trip went. After so many visits, Farnsworth thought he was unfairly labeled as "very low priority" throughout the metro area. His attitude toward hospitals became a combative one: "I have to fight to get medical care." With each additional ambulance ride, his legend grew. After a while, it seemed as if every firefighter and medic in the city had a Farnsworth yarn to tell at the bar. For instance, there was the time he leaped clear out of the back of an ambulance as it rolled through Northeast Washington, sirens blaring. The medics had told him he was being taken to Washington Adventist Hospital. Farnsworth thought he hadn't been treated well at Washington Adventist in the past. He swung open the back door, dropped to the street and hopped a bus to another hospital, both parties happy to be rid of the other. Then there was the time he called 911 for medical help -- when he was already at the hospital. A couple of D.C. medics had picked him up for high blood pressure and run him to Howard University, where they encountered a long wait in the emergency room. While the medics were inside filling out their report, Farnsworth wandered outside and dialed 911 from a pay phone across the street. The city has no right to refuse service to a citizen, regardless of a situation's absurdity, so a separate ambulance had to pick up Farnsworth at Howard. The new crew hauled him to Providence Hospital. The firefighters probably wouldn't have believed it, but Farnsworth says he never relished the idea of taking them away from their dinner. "I don't mean to wear out anybody," he says. "Many times I've felt like a burden. You can't help but feel like one." In a city that fields a million emergency calls each year, Farnsworth dialed so frequently that some Washington dispatchers seemed to recognize him by his voice alone. In honor of his chronic gastrointestinal problems, he was often called "the Burpin' Man." Farnsworth noticed that a call from the Burpin' Man could spice up a dispatcher's wearisome shift. As he struggled to describe his ailment of the day through a volley of burps and excuse me's, he would sometimes hear the dispatcher say, "It's the Burpin' Man!" But out on the street, the medics called him by another handle: "the Choker." The name was a nod to Farnsworth's greatest affliction. He was constantly choking. He didn't understand what caused it, but at some point nearly every day he started to feel as if his throat were closing in on itself. His panic would accelerate the process, and by the time the medics arrived, he'd be clutching at his throat and speaking in hoarse whispers and grunts. His treatment often amounted to an X-ray or two and a gastrointestinal cocktail, a mixture of antacid and anesthetic, which he growled for in the ERs. Many paramedics thought the problem was self-inflicted; others thought it was a fiction. How could a man choke every day of his life and never manage to die? "They realized he was bouncing from hospital to hospital," Cole says. "It's probably easy to just stick him in the waiting room or kick him out. ... But I started to think this guy really might have a problem." *** In fire departments and emergency rooms around the country, patients such as Farnsworth are known as "frequent fliers" -- people of modest means and poor health who go in and out of emergency rooms day after day, their fundamental health issues rarely resolved, at a tremendous and ever-growing cost to hospitals, municipalities and taxpayers. Though Farnsworth presents an extreme example, the burden of dealing with inveterate patients like him has been straining hospitals in all cities for years now. In a town with as much poverty and homelessness as Washington, frequent fliers are like barbershops -- every neighborhood's got one, and if you walk past it enough, you'll eventually forget it's there. The question of how to handle frequent fliers speaks to health-care reform in a fundamental way. As members of Congress wrangle over whether the government should be in the business of underwriting health care for Americans, we should acknowledge that to a large degree we have already underwritten it, at least on the messiest and most wasteful level. Generally speaking, we don't let people die in the street because they lack money or insurance. Paramedics are required to scoop up repeat callers, and emergency room staffs have no right to refuse patients treatment. For many of the poor and underinsured who are chronically ill, the emergency room itself serves as their health-care system. But providing basic health care in an emergency room makes no economic sense. According to the New England Healthcare Institute, a Cambridge, Mass.-based policy research organization, Americans' overdependence on the ER leads to tremendous waste. By treating chronic and nonurgent problems with emergency care rather than primary care, the group estimates that we fritter away as much as $32 billion nationally each year. The same treatment from a primary care doctor is usually two to five times more expensive through the emergency room. The main reason is that the staff in an ER is practicing defensive medicine: They're often trying to rule out what may be wrong with you, hence all the expensive blood tests and X-rays. ERs also have to be open at all hours and be staffed with high-priced specialists, unlike at primary care offices. If emergency rooms don't help regulars manage their long-term health problems, it's because they're not designed to. According to Melissa McCar-thy, a professor in the Johns Hopkins Department of Emergency Medicine, when it comes to frequent fliers, "It's almost like we have no memory. Each time they come in, we greet them -- 'Hi, Mr. Smith' -- but we don't try to manage their care in a longitudinal fashion. We treat them episodically. But people shouldn't expect us to treat them any other way. It's an emergency room." Some city hospitals have looked for ways to unclog their emergency rooms, but diverting patients to primary care physicians hasn't been easy. Since 2005, the University of Chicago Medical Center has been running a program now known as the Urban Health Initiative, which steers walk-in patients with non-urgent problems away from the medical center's emergency room and toward health clinics and primary care practices on the city's South Side. While some have lauded the program as a health-care model, others have denounced it as a profit-minded "patient dumping" scheme. As controversial as it has been, such an initiative at least tries to address what any paramedic or ER nurse already knows: For many patients, especially frequent fliers, receiving costly emergency care for chronic health problems does little good.. The high costs associated with frequent fliers have led city agencies in Washington and elsewhere to target them for treatment outside of the ambulance and emergency room. The idea was born in California's Bay Area five years ago, after a paramedic named Niels Tangherlini started applying social science theory to emergency care. Tangherlini had taken a break from the ambulance to get his master's in social work at the University of California, Berkeley. The repeat customers he had been handling on the job tended to suffer from alcoholism, drug problems or mental illness. After just a few years in the ambulance, he'd realized that being a paramedic was often closer to doing social work than emergency medicine. "My vision was that six months out of [paramedic] school, I would be dangling beneath a helicopter in a life- and-death struggle," Tangherlini says laughing. "Instead, I was trying to coax a guy back into the ambulance who thought spiders were crawling all over him." The program Tangherlini developed in 2004 sent a small team of paramedics, social workers and nurse practitioners out into San Francisco in search of frequent fliers. "A lot of the problems these folks suffer from are things that are not fixable with an ambulance or an emergency room," Tangherlini says. Soon his crew was probably putting more people into detox than any other organization in the city. After just a year and a half, statistics showed that the city's top 911 users had cut back their ambulance rides by as much as 80 percent. The San Francisco program was soon replicated in Memphis, San Diego and Washington. When Washington's frequent flier program started in March 2008, the city had five patients who were being transported by the fire department every single day on average. "Whether it's a hangnail or a heart attack, they know the ambulance has to come if they call," says Mytonia Newman, director of the program, which is called Street Calls. But after the program had been running for a year, only one of those original callers was still at the top of the city's frequent flier list. Several of the city's most constant 911 callers haven't been transported at all since paramedics and social workers intervened to find them regular treatment, counseling or housing. Weaning ER regulars off of emergency care can save cities a considerable amount of money. Frequent fliers soak up a disproportionate amount of a city's resources, through police, fire and mental health agencies, for starters. Taxpayers bear the costs whether through social services, through government-funded insurance programs such as Medicare and Medicaid, or through unpaid ER bills that are ultimately absorbed into rising health-care prices and insurance premiums. Getting frequent fliers the help they need has another, less calculable effect -- it keeps the medics and ER staffers from burning out before their time. Emergency workers can't help but develop relationships with their regulars. Watching them gradually decline on the streets can take a considerable psychic toll. In the end, most cases resolve themselves in one of two ways: Either the frequent flier moves to another neighborhood and becomes someone else's problem, or whatever's ailing him finally kills him. *** As he sifts through his most recent stack of bills one afternoon, Farnsworth offers an estimate on the total claims he owes: half a million dollars. Probably none of that money will ever be repaid. And what makes this figure so stunning is that Farnsworth is insured; the debt collectors are after him for his Medicare co-pays, which typically account for a small percentage of his health-care tabs. In reality, the price tag of his care in Washington area hospitals has almost surely run into the millions. A quick, random sampling of his bills shows how that could happen. Consider a single visit he recently made to the emergency room for internal pains. According to his Medicare statement, his treatment from doctors during the admission cost $642. Throw in more than a dozen charges for an array of standard procedures -- an electrocardiogram, a chest X-ray, a blood test to check the health of his liver -- and suddenly Medicare is on the hook for more than $1,000, and Farnsworth for more than $150, before he's put back out on the street. The array of standard tests partly explains why treating a non-emergency health problem in the ER is so expensive. Furthermore, constant visits to the ER put a guy such as Farnsworth in contact with dozens of different doctors, few of whom, if any, are on the same page. "There are too many people involved," Farnsworth concedes. "They all have different ideas." Every once in a while, a trip to the ER has led to a needed surgery, such as when he had his spleen removed after a fall several years ago. But for the most part, Farnsworth's visits have been routine. He has logged hundreds of them. (Because of privacy laws, medical personnel are reluctant to discuss particular patients.) He has undergone so many X-rays and CAT scans that Cole, the paramedic who is now a captain, eventually grew concerned with the amount of radiation he was subjected to, urging him to stay out of the ER. Farnsworth guesses he has been to the emergency room at George Washington University Hospital on 150 separate occasions. He approximates the same for Washington Hospital Center, not to mention trips to five or so other hospitals in the area. About half of these visits were by train or bus; the other half, by ambulance. "I don't consider it a free ride," he says. "I don't do it on purpose. It's medical care. I didn't go drink a bottle of wine or do drugs. I've got serious medical problems. ... I don't get my jollies out of going to the hospital. I hate hospitals with a fervor." In his earlier days, Farnsworth's medical needs were perfectly typical.. He was born into a stable, middle- class family in Bethesda, and was the son of a bank manager and a homemaker. He dropped out of high school but picked up his GED before taking classes in emergency care in College Park. He thought he might spend his years in the back of an ambulance -- not as a patient, but as an ambulance assistant. It never panned out, and he wound up bouncing between unstable jobs at gas stations and tow companies, usually in the Washington area. He volunteered at firehouses and earned a decent living as a tow-truck operator, but the health problems of the people in his life sent him toward financial ruin. He married and moved to Southern Virginia, but he says his wife developed liver complications and their life together unraveled. He says he moved back to Washington and cared for his ailing parents for several years. "I just ran out of money," he says. His mother and father died in 1995 and 1996, respectively, leaving him without any family in the area. He filed for bankruptcy protection, and his own health problems soon began. After a series of bad falls starting in 2001, he became eligible for Social Security disability pay, which now comes to $769 a month and serves as his only income. Once he could no longer work, he wasn't able to afford his apartment in Maryland. He started bouncing from one cheap living arrangement to another, sometimes resorting to sleeping in city shelters or camping out in the woods near his childhood home. By 2003, Farnsworth was calling 911 so often that many first responders believed he was gaming the system; by dropping certain trigger words to the dispatcher -- "chest pains," "trouble breathing," "choking" -- he would automatically vault to the front of the queue, per department protocol. He would also take a costlier ride in a more advanced ambulance. Paramedics in the inner city started going out of their way to haul him to far-flung hospitals just to get him out of the neighborhood. Yet, he always managed to reappear, sometimes on the very same day. Cole had experiences where he ran Farnsworth in four consecutive shifts. Even when Cole was running other patients, he was never surprised to stumble upon Farnsworth lying beneath a blanket in one of the local hospitals. Gradually, Farnsworth became everyone's problem, and no one's. By his own admission, he was hard to deal with. What he saw as a fall from respectable middle-class life filled him with anger. With his remarkable call volume, he inspired contempt in many fire department employees. His dealings with them often devolved into shouting matches. A firefighter handling him once lost his temper when another call came over the radio for a man with heart problems nearby. "We could be on that cardiac right now!" he screamed. As it happens, Farnsworth's medical problems have led to a couple of brushes with the law. In 2005, he was charged with second-degree assault and disorderly conduct in Montgomery County after an argument with emergency responders. Court papers allege that Farnsworth dialed 911 from a Silver Spring pay phone and made threats to firefighters because they hadn't helped him the previous night. The cop on the scene called in a request for an ambulance. "When Farnsworth was told he was not going to be transported he became irate and had to be restrained by other fire personnel," the charging papers say. Farnsworth says he took a swing at a firefighter who had put a hand on him. Farnsworth spent a month in the county jail, where the medical staff came to know him well. Then, last year, he was charged again with second-degree assault following an altercation with a Montgomery County paramedic who had taken him to the emergency room. "Farnsworth became agitated with Fire/Rescue and hospital personnel because he was asked to wait in triage," court papers say. "It should be noted that Farnsworth is well known to Fire/Rescue personnel. Farnsworth has a lengthy history of being treated and transported." He pleaded guilty to assault and served another month-long stint in lockup. Farnsworth's imprisonment upset a handful of firefighters on the Washington side of the line, where he has garnered far more sympathy over the years. "He was labeled [a 911] abuser," says Harry Subacz, a recently retired D.C. fire captain, "but he's got legitimate problems." Cole didn't view Farnsworth as a burden, either -- he saw a decent but troubled guy, with no home and no money, who had grown frustrated as he fended for care. Cole kept an ear out for Farnsworth calls over the fire department radio. When Farnsworth needed clothes, Cole managed to scrounge up a shirt or two. And when Farnsworth was short on cash, Cole might lend him a few bucks to get him through the end of the month. Farnsworth has had checkups with a general practitioner from time to time, but it hasn't been enough to keep him out of the emergency room. Like other frequent fliers, he has trouble getting around and showing up for appointments on time, so perhaps a caseworker is in order, as well. And then there are those particular medical conditions -- high blood pressure, pain and swelling in his legs -- that are no doubt connected to the stress and discomfort of sleeping on a chair in a trailer or out in the woods rather than on a mattress each night. "I would like to lie down on a bed at night like a human being," Farnsworth says. "Take my shoes and socks off, maybe take a shower. That would be nice." He splurges a good portion of his disability check on pricey motel rooms early in the month, to get clean and sleep well. He once showered 11 times in two days during a motel stay just to take advantage of the personal bathroom. Farnsworth's case bolsters the argument for the concept known as "housing first": the idea that if you put a homeless person in steady housing, then you can better address his health issues. But he has to want housing badly enough to not be picky. Farnsworth, for instance, refuses to live in a transitional group home or subsidized housing because he worries about cleanliness and theft, which is partly why the D.C. frequent flier program didn't get anywhere with him. What he wants is a clean place of his own, which isn't cheap or easy to find. Instead of thinking only about the economic savings of eliminating frequent fliers, people need to think of the less tangible benefits, says Martha Burt, an expert at the Urban Institute who has studied poverty and homelessness. Even if the costs of detox, a case worker and transitional housing run high, the ER regular is no longer diverting ambulances from where they should be headed. "People think of not doing anything as free, and it's not," Burt says. "So what if you break even? It's better for the people of the community and it's better for the public systems because you don't have drunks lining the walls of the ER." The best argument for spending money on frequent fliers may come from David Rosenbaum. On Jan. 8, 2006, Rosenbaum, a 63-year-old retired political reporter for the New York Times, died at Howard University Hospital after being struck on the head during a mugging in Northwest Washington. The city's Inspector General's report on the incident brought to light a sequence of blunders made on the part of emergency workers, from the scene of the crime to the hospital emergency room. According to the report, the ambulance arrived late; Rosenbaum wasn't properly assessed on the scene; he wasn't taken to the closest hospital; and the nurse at Howard failed to properly diagnose and triage him. Once the firefighters and medics smelled alcohol on Rosenbaum's breath, they stopped focusing on other possible explanations for his unconsciousness, according to the report. He was deemed low priority and "ETOH," which stands for ethanol, shorthand for being drunk. Once Rosenbaum was at Howard, the nurses did what they often have to do with presumed alcoholics -- they left him in the hallway for over an hour. In other words, Rosenbaum was handled as a frequent flier. He died from head trauma, not alcohol. Many of Rosenbaum's handlers seemed to share one thing in common: dulled senses. Perhaps with fewer frequent fliers, emergency workers wouldn't be conditioned to make assumptions. *** Last year, Farnsworth went under the knife at George Washington University Hospital. What had been bothering him for so many years was a damaged hyoid bone, the horseshoe-shaped bone above the Adam's apple. Cole and a few other paramedics encouraged him to undergo throat surgery. Specialists had had different opinions and recommendations over the years, but in the end, they reached a consensus. "The doctors knew what the problem was," Farnsworth says. "But there were risks with the surgery, and it was complicated. This was known for years. Too many people finally said it was operable." The surgery was a success. Farnsworth almost never experiences the choking sensation anymore, and his 911 call volume has fallen dramatically. He still checks into the hospital every couple of weeks for health issues, usually swelling in his legs, but he almost never calls for an ambulance. To a small degree, he has also rehabilitated his image among some of the city's emergency workers. "He really changed after the operation," Cole says. "He became pleasant to be around." Not long after the surgery, Farnsworth started dropping by the Tenleytown firehouse, where Cole works. Firehouses can be like neighborhood parlors; citizens are free to stop in and say hello. Farnsworth likes to come by when Cole is on duty. These days, Farnsworth is more of a guest than a patient. He is invited to dine with the firefighters and medics whenever the third platoon is working. In return for the meals, Farnsworth tries to pitch in around the firehouse, cleaning up and doing small chores. Firefighters there and at other houses in Washington have been known to offer him a cot when he needs it, and one of Cole's co-workers has put in a favor to see if he can get him an apartment. The firefighters have even given him a new nickname: "the Fonz," a play on Farnsworth that he greatly prefers over "the Burpin' Man." "Since I've been hanging around these firefighters," Farnsworth says, "I've learned how to care about other people. These guys have literally saved my life." He and the city's first responders have reached something of a detente.. Rather than calling 911, Farnsworth shows up at the firehouse when he's not feeling well and asks to have his vitals checked. On the now-rare occasion when he needs a hospital, they run him to the ER. For all the goodwill, Farnsworth feels indebted to the department. And after all those ambulance rides, he doesn't like knowing he owes the city so much money. He recognizes that he's physically broken, but he says he would like to do something, anything, to mitigate the time and money devoted to him over the years. In light of his past experience as a dispatcher, Farnsworth says he would like to make the fire chief an offer. "I would gladly be a dispatcher for D.C. Fire," Farnsworth says, admitting that it's a long a shot. "I would gladly work my bill off. I know it's extremely excessive ... [but] I was brought up to be a gentleman. All the anger, it came from the health problems. I used to be a hateful person, but I don't want to be that kind of person anymore. I want to go on living decently." ---- http://www.massagetoday.com/mpacms/mt/article.php?id=14142 Learning and Unlearning By Tracy Walton, LMT, MS In oncology massage, we work with a diverse clientele, with wide-ranging clinical presentations. There are clients in survivorship, perhaps with lingering effects of cancer and cancer treatment in their bodies. There are clients in treatment, whose health can change from week to week, or hour to hour. There are clients at the end of life, whose body systems adapt gamely each day to shifting internal environments. And there are clients who are in the throes of diagnosis, in varying stages of health, navigating a barrage of information that we can only imagine, if we haven't been there ourselves. In watching thousands of people with cancer and cancer histories, I am struck by how much information, and how many skills, patients learn along the way. They master medical information, often unfamiliar at first. They learn which people to bring into the loop, and whom to hold at bay. They learn how to care for their bodies, under "new normal" conditions. They discover how to filter information, and listen deeply to their hearts, their families, and their physicians. Massage therapists learn, as well, alongside their clients with cancer and cancer histories. We learn how to listen better, and when to keep our beliefs or judgments about illness to ourselves. We learn to accompany someone along their path, following their lead, bearing witness, remaining present to the process that unfolds, however it unfolds. Changing the Mechanics of Massage We also learn and refine the mechanics of working with people in illness and treatment. We adapt many different massage elements, including our pressure, the movement of joints in the session, the client's position, our speeds and rhythms, and even the draping and lubricant we use. (MacDonald, 2007; Walton, 2006) We adapt these and other things in response to myriad physical changes: bone metastasis, surgical incisions, medical devices, or vital organs functioning at less than ideal levels. We adjust massage to the risk of lymphedema, and to the reality of it. We accommodate symptoms, such as nausea, fatigue, and pain. We work around skin lesions, and adapt to easily bruised tissues. In order to work well and safely in these conditions, we also have to unlearn some things we might have previously held as true. I can think of three beliefs that we've reexamined. The Belief that Massage Spreads Cancer The belief that massage could spread cancer has persisted in our field, and it is still taught in some training settings. The belief has kept our hands tied. But with the right interview questions and complete client answers, skillfully applied massage is not expected to spread cancer any more than normal movement or exercise would, and these activities are typically encouraged by physicians, nurses, and PTs in oncology. There are numerous sources of thought and reasoning to help massage therapists unlearn this belief. (Curties, 2000; MacDonald, 2007; Walton, 2006) Because the belief has persisted for so long, it takes thought, discussion, and full understanding in order to educate others. Simply casting off the belief, without putting proper massage precautions in its place, leads to an empty, uncertain, and unsafe application of massage. Letting the Client Direct the Session There are other things to unlearn, as well. We may have to unlearn our tendency to always follow the client's lead in directing the session. Although respect and empowerment of each client is important, as is handling a client's body within his or her comfort zone, there are times that a 100 percent client-centered session is at odds with what we know to be safe. Gayle MacDonald, author of Medicine Hands: Massage Therapy for People with Cancer, points out rightly that the oncology massage therapist may need to take a stronger leadership role in session planning, to avoid overstimulating a client in strong treatment, or injuring unstable tissue. (MacDonald, 2005) This can be challenging, at moments, when a client wants the strong, vigorous massage that he or she had before cancer treatment. It can be hard to sell a gentler session, against protests that we are treating a client as though he or she is fragile. Yet our professional and ethical responsibilities mean that the client's safety trumps the client's preferences. In the best outcome, the therapist and client plan a massage session together: one that is safe, effective, and addresses the client's needs. Intuition vs. Information The role of intuition is another thing we examine closely, and question. For some of us, this means unlearning our reliance on intuition, alone. We may have been taught, "If you're not sure what to do, just follow your intuition, and everything will be okay." In massage therapy, intuition is a highly prized decision-making tool. For good reasons, our intuitive skills are sacred. But intuition can be fallible. Not all of us have well-developed intuitive skills. Intuition may not be sending us clear signals every day, or we may not be interpreting them well. People tell me from experience that intuition may be "off" on days they've not eaten or slept well, or are under undue stress. Moreover, our own needs and fears, which may be easily provoked when working with clients who are seriously ill, can cloud our intuition and decision-making. In the other extreme, our decisions are technical, based on information, alone. Intuition may be fallible, but information isn't always perfect, either. Information changes with the times, with the situation, and there are information gaps in our understanding of cancer. By working with people with cancer, we pledge to keep our information as current as possible. One of my favorite teachers taught me that the best combination of intuition and information amounts to wisdom. Resources in Oncology Massage For most of us, to unlearn and learn the important issues in oncology massage, we need live, hands-on training. In order to work well and safely, we need a classroom with the give and take of class discussion, opportunities to practice interviewing and massage planning, actual clients with cancer to practice with, and concrete cases to discuss. Others of us have the skills to educate ourselves: we can carefully study the literature, research practices in oncology, have access to the input of health care providers, and learn from our clients along the way. All of us can turn to growing resources, like the Society for Oncology Massage (www.s4om.org), the newest edition of Medicine Hands by Gayle MacDonald, and the expanding body of research on massage and cancer. For convenience, I've indexed much of the literature on my Web site, at www.tracywalton.com. The best massage decisions combine the sturdiest information available, professional experience, legwork, possible correspondence with a client's physician, and our own intuition. Sessions are planned in collaboration with the client, and designed to address the client's needs. Learning and unlearning requires giving up old beliefs, and being open to new information and skills. This is a rich process, and sometimes a challenging one. On the way to wisdom, it's good to know that there are resources to support us. Resources Curties D. Could massage promote cancer metastasis? Journal of Soft Tissue Manipulation April/May 1994: 3-6. Reprinted in Massage Therapy Journal Fall 2000;39(3):83-8. MacDonald G. Understanding metastasis-putting 'old wive's tales' to rest. Medicine Hands: Massage Therapy for People with Cancer [2e], 2007. MacDonald G. Bodywork for cancer patients: the need for a less-demanding approach. Massage & Bodywork Jun/Jul 2005:16-26. Walton T. Cancer and massage: essential contraindications. Massage Therapy Journal Summer 2006;45(2): 119-35. Walton T. Cancer and massage: contraindications and cancer treatment. Massage Therapy Journal Fall 2006;45(3):119-35. Tracy Walton, LMT, MS, consults to hospitals and massage schools, does research and teaches "Caring for Clients with Cancer," continuing education courses offered nationally for massage therapists. She also offers a condensed course for spas, hospitals, and clinics in the basic contraindications for working with people with cancer. Back home in Boston, she has worked with Harvard Medical School's Osher Institute and the Beth Israel-Deaconess Medical Center, researching massage therapy for people with metastatic cancer. She has worked in private practice, hospital and spa settings since 1990, and taught physiology and pathology at the Muscular Therapy Institute in Watertown, MA for thirteen years, where she also served as the Academic Dean. She is the 2003 AMTA Council of Schools Teacher of the Year. Tracy holds a Master's degree in Cell Biology and Biochemistry. Currently she is working on a textbook, Medical Conditions in Massage Therapy, a resource to help therapists with clear, thoughtful decisions about mmassage contraindications in student clinics, spas, and other massage settings. In her work, she loves integrating the heart, science and soul of bodywork. She can be reached through her website, www.tracywalton.com, which includes a "help for Massage Therapists" page, current research on cancer and massage, and other resources. ---- http://www.pr.com/press-release/196766 New: Outer Jackets for Caresia Arm Garments Lymphedema Depot, the exclusive Canadian distributor of Solaris lymphedema garments, announces a new addition to its product line. St. Catharines, Canada, December 03, 2009 --(PR.com)-- Lymphedema Depot Ltd., the exclusive Canadian distributor of Solaris lymphedema-care garments, announced today that the mildly compressive Outer Jacket that has long been available only with the Solaris custom made Tribute™ nighttime garment is now available for the Caresia Bandage Liners™ for arms. According to the company, Caresia Bandage Liners are standard sized arm and leg sleeves filled with medical grade foam chips sewn into channels that are shaped to guide lymphatic fluid out of an area of chronic swelling. The Bandage liners fit against the limb and are meant to have short stretch bandaging applied over them to achieve therapeutic compression for the patient. This helps reduce and control swelling. Now, with the availability of the Caresia Outer Jacket it is possible that the application of short-stretch bandaging may, in some cases, be eliminated and the Caresia Bandage Liner along with a simple Caresia Outer Jacket, may be sufficient to reduce and control lymphedema. According to Lymphedema Depot‘s Clinical Specialist John Mulligan, “The availability of the Outer Jacket to use with the Caresia Bandage Liner will be a great relief to many lymphedema patients. I would recommend this management tool to be used where lymphedema is mild and one of the standard sizes of Caresia is a good fit for the patient. In those cases, patients may be relieved of the burden of self-bandaging and find this new application to be a simple and effective alternative.” Mulligan goes on to say “This means that the Caresia Bandage Liner can easily be used as a nighttime lymphedema garment to wear while sleeping, if the user fits comfortably and effectively into the standard sizes. This is a real breakthrough in living with lymphedema.” The Caresia Bandage Liner and Outer Jacket are available in Canada exclusively from Lymphedema Depot Ltd. Lymphedema Depot Ltd. is the exclusive Canadian distributor for Solaris lymphedema-care garments. It is based in St. Catharines, Ontario. For more information contact Lymphedema Depot Ltd. at 905-687-8500, or visit their website at www. LymphedemaDepot.com. Media Contact: John Mulligan, Clinical Specialist Lymphedema Depot Ltd. 12-111 Fourth Ave Suite 347 St. Catharines, ON L2S 3P5 905-687-8500 ---- Woman takes ‘passport’ out of nursing home Written by Autumn Lee | | news@toledofreepress.com It’s not even Christmas, and Patricia Oren has already received several “blessings.” The Gibsonburg resident was able to cut an expected yearlong stay at a nursing home down by two months thanks to the Passport Program offered through the Area Office on Aging of Northwestern Ohio (AOoA). And it was just in time for Oren to be home with her family during the holidays. “I’m having blessings I’d never envisioned,” Oren said. Patricia Oren Oren, a retired teacher, said she put herself in Windsor Lane Healthcare because of lymphedema and to get her weight down. The treatment that she received allowed her to lose nearly 60 pounds. Oren, 68, started having trouble with her lymphatic system after a serious car accident in 1968 where she was ejected from a vehicle and went into a ditch. She nearly lost her left leg, which had to be reattached and was later told she was dead for more than six minutes. When she went on Medicaid, Oren said she was encouraged to check out Passport. The program is part of a statewide initiative designed to provide homebound senior citizens with options for their long-term care. It is operated by the Ohio Department of Aging and the AOoA. Funding comes from Medicaid. Passport is a beautiful program, Oren said. “It’s been awesome,” she said. Passport provides her with meals that are delivered to her home, health care supplies and an aide who helps her dress and bathe herself. She also receives occupational and physical therapy. Oren said having that assistance is a big help. That is not the only “big help” Oren has received. The Helping Ohioans Move, Expanding Choice program — also known as HOME Choice — helped her transition from the nursing home back into the community, Oren said. Through the program, she received a bed and other household items in addition to her first month’ s rent for her new apartment. Oren said it helped her get her initial start. “I’m hopefully on the way to get back to society and be a contributing member again,” she said. “I’m getting the care I need as I go along.” Oren said she is ready to get out there so she can do things on her own. In the meantime, she is helping others. Oren said she recently helped another person obtain a GED. That brings Oren’s total to 187. Since leaving the nursing home, she went to her nephew’s for Thanksgiving where 29 people gathered, and she is preparing to spend Christmas at home. Her daughter will travel from Virginia to visit, and her son will travel from McComb. “I’m in a home where my family can come share it with me,” she said. “This would be impossible in a nursing home.” Oren said being home is the greatest blessing she’s ever had. “All of it is blessings,” she said. “I’ll never take any of it for granted.” http://www.toledofreepress.com/2009/12/11/woman-takes-%E2%80%98passport%E2%80%99-out-of- nursing-home/ http://www.lacdubonnetleader.com/ArticleDisplay.aspx?e=2218056 Fact-finding mission begins Posted By Marc Zienkiewicz Posted 1 month ago Lac du Bonnet's Kim Avanthay is still on a mission. Avanthay recently returned from Toronto, where she attended a convention of the Canadian Lymphedema Framework, which works to improve the management of lymphedema and related disorders in Canada. Avanthay's young son Austin suffers from lymphedema, which causes swelling of the limbs and face. "There were only two delegates there from Manitoba, of which I was one," she said. "It really helped me see that we have a long way to go to increasing awareness of the disorder and finding more and better treatment options." Lymphedema is not a widely understood condition in Canada, but it is surprisingly common — primary lymphedema (caused by congenital abnormalities) only affects around one in every 6,000 people, while secondary lymphedema affects as many as one in every four breast cancer patients. According to the World Health Organization, over 250 million people worldwide suffer from it. There is no cure, but the condition can be managed with proper therapy and skin care. Advertisement It's not Avanthay's first time participating in a major lymphedema-related event. Avanthay was one of seven patient advocates who participated in the Lymph Science Advocacy Program in California in 2008. This time, however, is different. Avanthay returned from the convention with the task of helping spearhead a fact-finding initiative to find influential Manitobans to help in the search for better awareness and treatment options for lymphedema. She helped host a conference call earlier this week to try and recruit knowledgeable people who can make that goal a reality. "We have a whole range of questions that have to be answered, and it's going to be a lot of work," she said. Avanthay is working on the fact-finding mission with Edith Mulhall, a registered nurse and Lymphedema Association of North America certified therapist working out of Winnipeg. Austin is Mulhall's first pediatric patient with lymphedema. The Canadian Lymphedema Framework was formed in February of this year, based on the UK's International Lymphoedema Framework which, since its formation in 2002, has been very successful in raising awareness of lymphedema in the UK. The vision of the Canadian framwork is that ultimately all persons across Canada will have access to comprehensive, effective treatment for lymphedema and related disorders. Anyone wishing to aid in the fact-finding mission can contact Avanthay at 345-0441 Article ID# 2218056 -------------------- http://www.docguide.com/news/content.nsf/news/852576140048867A852576890077F905 Lymphedema Continues to Appear Years After Breast Cancer Treatment: Presented at SABCS By Ed Susman SAN ANTONIO, Tex -- December 11, 2009 -- The risk of developing lymphedema can continue for at least 30 months following definitive treatment for breast cancer, researchers stated here today at the 32nd Annual San Antonio Breast Cancer Symposium (SABCS). In the unique study design, women undergoing treatment for breast cancer were measured prior to treatment to determine which women met the criteria for lymphedema before undergoing therapy, and therefore could be eliminated from the study. "That [helped] prevent discrepancies in reporting the impact of lymphedema seen in other studies," said Robin Shook, Sinclair School of Nursing, University of Missouri, Columbia, Missouri, during his poster presentation. Depending on the type of measurement employed before treatment, the occurrence rates of lymphedema increased from 10% to 27% in the 18 months that followed 1-year post treatment, he said. "These preliminary findings provide additional evidence that breast cancer survivors are at a risk for developing lymphedema beyond the first year of treatment," he said. His report described outcomes in 211 of the 300 women participating in the ongoing study. The average age of the women in the trial was 57 years; 48% of them had undergone mastectomies; 39% had undergone lumpectomies; and 115 had both treatments. About 16% of the women did not have any axillary exploration; 43% had sentinel node biopsies performed; 30% underwent axially node dissection; 11% had sentinel node and axillary dissections. Women were assessed for lymphedema every 3 months for the first year and then every 6 months for a total of 30 months. Shook said 4 different methods of identifying lymphedema were used in the study, with the most conservative method proving to be a self-report of limb heaviness and swelling. Using that criterion 41% of the women experienced lymphedema -- 10% more than reported the problem after 1 year. The most liberal definitive was a 2 cm circumferential change in any part of the limb measured. Under that criterion 91% of women reported lymphedema at the end of 30 months, 19% more than after 1 year. Funding for this study was provided by the National Institutes of Health and the Missouri University PRIME Fund. [Presentation title: Occurrence of Lynphedema Continues to Increase Twelve Months After Breast Cancer Treatment. Abstract 2070] --------- http://blog.al.com/living-news/2009/12/kathy_kemp_my_good_doctor_and.html Kathy Kemp: My good doctor and me By Kathy Kemp -- The Birmingham News December 20, 2009, 5:30AM Kathy KempI had a chat with my oncologist last week. We were going over the pros and cons of the new chemo I was starting, and the question popped out. I asked, "Am I running out of time?" We'd never talked about this before, not since I was first diagnosed with Stage IV breast cancer. At the time, I didn't ask how long I might live. I asked if I should get my affairs in order. "Everybody should get their affairs in order," the doctor told me. And that was that. Her matter-of-factness calmed me down, made me laugh and became my lifeline in the eight years since we met in that exam room at Kirklin Clinic. She has become, through the years, a close companion. I see her sometimes every week, and at least every three weeks. In between, we talk on the phone or exchange e-mails or get together for dinner with our families. She once joined me and a group of breast cancer friends for a fishing trip to Louisiana. I'd never before known a doctor like Carla Falkson. She comes from a family of oncologists. Both of her parents were breast cancer specialists, and her brother is also an oncologist. She grew up and was educated in South Africa. She has this lilting, almost British accent that I sometimes find hard to understand. She doesn't seem to think I'm a moron, though I once followed her to a party to demand she inspect my suddenly swollen leg. Carla did so with aplomb. "Hmm, why yes, yes, I see," she said. "Hmm. Could be lymphedema." It was, and I got treatment for it. In fact, Carla has never failed to fix what's wrong with me. In the beginning, her treatment plan seemed counterintuitive. Where my friends with early stage breast cancer were bombarded with chemotherapy and radiation, I started out on gentle hormonal drugs. Carla explained that with late-stage patients, who cannot be cured, the goal is to preserve the arsenal of heavier weaponry - to always have another drug ready to use when the current one stops working. My cancer has responded to every treatment. Over the years, the intervals of stability between treatments have shortened, as my cancer spread to liver, lungs and brain. I've had, I guess, eight different chemos, the latest Navelbine. I spent six months on the chemo Abraxane before taking a break after Thanksgiving. Two weeks ago, my breathing problems returned. When I saw Carla last Monday, we talked of our plans for the holidays. Then came the subject of lessening time. "That does happen," she said. "There are still drugs we can try." She told me of another patient like me, a statistical anomaly, still alive a decade after diagnosis. My problem, I thought, is I'm getting tired of the drugs, the sickness, the inability to plan for things because I never know how I'll feel. "You're alive right now," my doctor told me. I'm grateful to God and to Carla for that. Kathy Kemp's column runs Sundays in The Birmingham News. Join the conversation by commenting below or e-mail her at kkemp@bhamnews.com. ------ http://blog.al.com/living-news/2009/12/kathy_kemp_my_good_doctor_and.htm ------ Cancer survivors do fitness course James Perkins | 14th December 2009 Breast cancer survivors celebrate completing the first breast cancer recovery program at the Tweed River Regional Aquatic Centre. Felicia KosegiBREAST cancer survivors have been assisted in their recovery by a new fitness program at the Tweed Regional Aquatic Centre. The first graduates proved an inspiration to organisers Ricarda Funke and Sue Phillips. The 11 ladies were put through their paces in the pool over an eight week period and the benefits proved to be more than just physical. “It has been a very positive and inspirational experience for us as co-ordinators and we feel very privileged to be able to present this program to the local community,” Ms Funke said. “Along with the exercises there was sharing, lots of laughter, friendships made and learning.” The YWCA Encore program, funded by New South Wales Health, is designed to enhance recovery from breast cancer surgery. It involves gentle floor and hydro pool based exercises for women of any age who have had a mastectomy, lumpectomy or breast reconstruction surgery and aims to increase fitness and minimise the risk of lymphedema. “The women were inspired by local practitioners and therapists who generously gave their time to come and speak on such subjects as nutrition, reflexology, posture, meditation, relaxation, through field therapy and much more,” Ms Funke said. “I believe this program fills a much needed gap to support and assist women recovering from breast cancer.” The next eight-week program starts in February. For details call Sue Phillips on 02 66 795091 or Ricarda Funke on 042 092 5353. Tweed Daily News - Australia -------------------------- http://www.wkowtv.com/Global/story.asp?S=11686213 Mapping the body using night vision technology Posted: Dec 16, 2009 10:39 AM EST Most Read Stories More>>Officials: Pentagon review finds Hasan supervisors at faultMurder victims' family holds domestic violence benefitMakers of Tylenol expand recallMadison named one of the most gay- friendly cities in AmericaMost Watched Video More>>Crohn's DiseaseHealthy Youth BillDomestic Violence BenefitSnow AngelsJulia Cox had the lymph glands under her left arm removed as part of a mastectomy. Now, she suffers from lymphedema. "It means that I have got fluid built up in my arm in this case because I don't have the lymph glands to remove it," says Julia. When something goes wrong with lymphatics, disastrous things happen. Things like infection, which a compromised lymphatic system has trouble fighting. "If it gets a little too swollen, my elbow joint hurts," says Julia. So Julia is taking part in a clinical trial, testing a device using night vision technology developed during the first gulf war. It's called "near-infrared fluorescence" and can help map what the human eye can't see deep within the lymph system. "We put a little bit of dye underneath the skin. And with the camera system that we have, we actually watch it as it propels the lymph nodes and then it ends up going into the bloodstream," says Dr. Eva Sevick. The device allows doctors to image the lymphatic system in real time. "You could actually see the dye moving up the arm on this side and it kind of sat in a lump on this side but they said it did move here," says Dr. Sevick. It's helping them better understand the disease and how the lymphatic system works, which may help with a cure for lymphedema. If it proves itself in tests, it may also help others thanks to a new use for some old gulf war technology. Even with this night vision technology, it's hard to see clear lymphatic fluid. That's why doctors first have to inject that fluorescent dye beneath the skin. This technology could eventually help doctors identify problems in the lymphatic system before symptoms develop. ---------- http://www.htrnews.com/article/20091214/MAN0101/912140509/1984/Mittens-warm-hands-hearts Handmade mittens warm hands, hearts Former North Ridge resident distributes items to children By Cindy Hodgson • Herald Times Reporter • December 14, 2009 Comments (1) Recommend (2) Print this page E-mail this article Share Del.icio.us Facebook Digg Reddit Newsvine Buzz up!Twitter FarkIt Type Size A A A MANITOWOC — Mary Hall came back to Manitowoc from her home in Milwaukee on Thursday to distribute mittens she knit for children from Riverview Head Start. Hall was a resident at North Ridge Medical and Rehabilitation Center from August 2008 until January 2009. She suffers from lymphedema and had come to North Ridge for therapy, because of a friend and because North Ridge has a therapist experienced in working with lymphedema, she said. Meanwhile, Janice Reichwaldt came to North Ridge in August 2008 and lived down the hall from Hall. Hall was confined to bed, and Reichwaldt would wheel into her room in her wheelchair to visit. "We just kind of clicked," Hall said. "Got to be good friends." They were both in their 60s and had children about the same age. "We just felt comfortable with one another," said Hall, 69. "It's always nice to have a companion when you have to be in a place like this." "Her and my mom became known as the welcoming committee," said Reichwaldt's daughter, Vicki Hacker, a certified nursing assistant at North Ridge. "The bond that those two women had was just phenomenal," said Peggy Thor, the center's activity director. But the friendship lasted only a few months. Reichwaldt succumbed to the cancer she was battling and died last December at age 65. Mitten party Every year, a class of 3- to 5-year-olds from Manitowoc's Head Start program comes to North Ridge for a mitten party, Thor said. Through the years, volunteers from the community have knitted mittens and donated them to North Ridge to distribute to the children at the party. The center hadn't received any recently and was using mittens it had saved. After last year's party, there weren't any left, Thor said. Hall said Thor knew she was a knitter and asked if she would make some mittens. Hall wasn't sure she could knit all 20 that were needed, but she did. "I thought it was a nice thing to do in memory of Janice," she said. It's especially fitting because, according to her daughter, Reichwaldt worked for Head Start for several years as a kitchen helper and bus aide. Hacker said she thought Hall's mitten donation in memory of her mom was a "very high honor." Her mom would be "proud but embarrassed," she said, because she never liked attention on herself. After the children sang for the residents, Santa Claus made a loud, bell-ringing, ho-ho-ho-ing entrance. Each of the 15 children who were in attendance had a chance to sit on his lap and receive a present, courtesy of North Ridge. Then they went over to Hall and Hacker and picked out the mittens of their choice. "The children treasure them," said teacher Mary Finnel. Children sometimes lose mittens so they can use an extra pair, she said. In addition, the Head Start staff reinforces that someone took the time to make the mittens for them, Finnel said. ------------- http://7thspace. com/headlines/329673/challenges_of_cellulitis_in_a_lymphedematous_extremity_a_case_report.html Challenges of cellulitis in a lymphedematous extremity: a case report IntroductionLymphedema is a relatively common phenomenon. It is important that clinicians appreciate the relative risks imposed by this condition. While for some it may only represent a flaw in appearance, this condition can potentially have fatal consequences. Our case reports on the challenges of cellulitis in a lymphedematous extremity that progressed to septic shock.Case presentationA 37-year-old Hispanic male was transferred to the Burn Unit from an outside hospital for wound care of an extremely severe case of cellulitis. He suffered massive lymphedema of his lower extremity, with innumerable nodules and chronic skin changes. After 3 days of cellulitis, he was in critical condition and required intubation and vasopressors. With intense wound care and systemic antibiotics, he gradually recovered and was discharged in 16 days with his cellulitis resolved and ambulating independently. Conclusion: Our case highlights the special care and attention that chronic lymphedema deserves. These patients can exhibit marked disfigurement and physical disability affecting them on both social and physical levels. They also are at great medical risk, as cellulitis almost cost our patient his life. Evidence indicates that lymphedema, no matter the etiology, is susceptible to cellulitis with both great propensity and virulence. Physicians should be aware of the great risk of lymphedema, strive to prevent deterioration and complications, and be prepared to educate and closely monitor these patients. Author: Matthew Pierce ConnorRichard Gamelli Credits/Source: Cases Journal 2009, 2:9377 ------ http://newsok.com/duncan-rallies-raising-funds-for-boy/article/3427746 Duncan rallies, raising funds for boy BY VALLERY BROWN The Oklahoman Comments 9 Published: December 27, 2009 DUNCAN — The 4-month old with a rare and incurable condition was the center of attention at a benefit to help raise money for his medical expenses. Three bands and about 30 people showed up Dec. 13 to a fundraiser for Kayden Ward, the Duncan baby born with congenital vascular lymphedema. The condition affects his lymphatic system, causing him to swell beneath the surface of his skin and making him susceptible to dangerous infections. Melissa Howe, Kayden’s grandmother, said the event at the University of Science and Arts of Oklahoma in Chickasha generated about $800 to help defray medical expenses not covered by Medicaid. So far, Howe said the family has received nearly $7,000 in donations for Kayden’s medical treatment and two free compression garments to help control his swelling. den.org. Local businesses also have taken up coin collections, and businesses have donated goods and services, Howe said. "The generosity of people has been staggering,” she said. Last month, SoonerCare officials indicated they would pay for the garments if they were deemed to be medically necessary by a doctor. Wednesday, the family received a letter indicating the garments would be covered through next year. The custom-made garments cost more than $3,000 per month, Howe said. Carmen Wilcox, Kayden’s former lymphedema therapist, said in November the compression suits are a vital part of Kayden’s treatment and are frequently not covered by insurance. "The garments allow him to go through normal development,” Wilcox said. Howe said the results are already showing. In the four weeks he’s been wearing the suits, Kayden has developed more upper body strength and flexibility. He can shake a rattle and move his arms. "He’s even started to scoot himself around,” Howe said. "His pediatrician said he is moving more like a 5-month-old now.” But Kayden’s battle is far from over. Earlier this month, doctors biopsied his intestines to test for another rare disease. The swelling appears to be spreading, and Howe said Kayden has trouble eating and digesting some foods. "This is all he’s ever known,” Howe said. "He’s so happy; he’s a gift from God. But we have a lot of challenges ahead.” Read more: http://newsok.com/duncan-rallies-raising-funds-for-boy/article/3427746#ixzz0chgnMnPB ------- http://examiner.gmnews.com/news/2009-12-31/front_page/003.html Woman's best friend and lifesaver Golden retriever helped detect cancer and nurse owner back to health BY JENNIFER KOHLHEPP Staff Writer If there is a heaven, Brandy is resting at God's feet. More than a friend, confidante and giver of unconditional love, the golden retriever was a lifesaver. Owner Donna Rice, of Millstone, may not have detected that she had breast cancer had it not been for her faithful companion. Donna Rice, of Millstone, and her golden retriever, Brandy, loved each other through sickness and health, and only through death did they part. "She kept coming up to me and sniffing me, always going to my left breast," Rice said. "She knew something was wrong." Although Rice never found a lump or had any other symptoms, she was diagnosed with breast cancer after a mammogram in 2003. She would later have a double mastectomy. "All during my treatment she was there for me," Rice said. "I would come home and she would be happy to see me, which made me feel good." Rice said she needed Brandy as much as the dog needed her. "I got Brandy from a breeder and she started having major health problems after six months," Rice said. "She couldn't breathe and she had red spots under her belly." Over the years, Brandy suffered from throat and skin problems, including allergies and "hot spots," which are external bleeding sores. She had trouble breathing and often gagged when she slept. "I stayed strong for her and she stayed strong for me," Rice said. When Rice returned from reconstructive surgery and cried in pain, the dog cuddled with her on the couch. When groomers stopped bathing Brandy for fear they would break open one of her sores, Rice, who was in recovery, would fill a baby pool on the back deck and bathe Brandy herself. Rice also carried the 105- pound pooch up and down stairs when her back legs weakened. Seeing her pet defy death multiple times after mass removals, major surgeries and spending weeks in intensive care gave Rice the courage to confront her own continuing health complications stemming from surgery and reconstruction. "I couldn't figure out if I was having a reoccurrence of the cancer or if my body was rejecting the implants," Rice said. "The doctor didn't know what was wrong with me. I was in so much pain that I wanted to have the implants taken out." In 2006, Rice's doctor advised her against having the implants removed and suggested she see a specialist to determine if she had lymphedema — failure of the lymphatic system that can be caused by the removal of the lymph nodes as part of the surgery for cancer. Before her appointment with the specialist, Brandy's health deteriorated. Rice had placed sod on her deck because she could no longer help the dog down stairs. Brandy also stopped eating. The night before the appointment on Dec. 11, Rice slept with her arm around Brandy to make sure the dog kept breathing. Although Rice did not want to leave her faithful companion the next morning, "something kept telling me that I had to go to the doctor." "All the way there I kept saying to myself I have to go home and be with Brandy, but the doctor might have the answer I have been looking for," Rice said. The specialist determined that Rice did not have lymphedema, but diagnosed her with costocongitis, an inflammation of the cartilage behind the ribs. Although painful, the symptoms could be treated with medication and the application of heat and ice. Although the news that her condition was manageable and not life threatening made Rice feel immediately better, that day soon turned bittersweet. When she returned home, her husband had to call neighbor John Haines to put Brandy on a stretcher for transport to the Twin Rivers Animal Hospital in East Windsor. Veterinarian Michael Petranto, who had cared for Brandy over the years, discovered the golden retriever was in critical condition as a result of internal bleeding. Letting Brandy go after nearly 13 years of companionship and unconditional love was the most difficult decision Rice ever had to make. "Her next to last day … I knew she wanted to die, but she stayed alive that night, and part of the next day, until I was able to be diagnosed with good news," Rice said. "She needed me to let go of her, knowing I was going to be OK." Rice keeps Brandy's cremains in a locked box in her home, and will never forget the paw prints the golden retriever left on her heart. "She will be with me forever and ever," Rice said. "She saved my life and gave me the strength that I needed to get through." -------- http://www2.journalnow.com/content/2010/jan/01/several-new-nc-laws-are-in-effect-as-of-today/news/ News Email Print Yahoo! Buzz Several new N.C. laws are in effect as of today Tax credit for filmmakers grows; handicapped placards revised ADVERTISEMENT Controller COOK RESTAURANT PREPS ADNET ADVERTISING Stand Up Forklift Driver Debbie's Staffing Facilities Manager HOSPICE & PALLIATIVE CARE Registered Nurses HOSPICE & PALLIATIVE CARE WANT TO START THE YEAR WITH A RENEWED PURPOSE? BRADLEY PERSONNE; Outside Sales Representative Director, Career Services Davidson County Community Collge Medical Receptionist DRIVERS OWNER OPERATORS Epes Transporrt -------------------------------------------------------------------------------- More Jobs Here are some of the new laws approved in the most recent legislative session that take effect today: • PET RECOVERY/SHELTER CROWDING: Sets new rules for animal shelters intended to help pet owners find their lost pets. • UNEMPLOYMENT INSURANCE: Expands access to certain unemployment benefits. • INCENTIVES TO FILM INDUSTRY: Increases economic incentives that film companies in North Carolina are eligible to receive. • DMV PLACARD ENFORCEMENT: Creates new rules to stop abuse of handicapped-parking placards. • WATER-USE EFFICIENCY: Encourages car washes to participate in a water-conservation program. • ETHICS FOR ELECTED OFFICIALS: Requires all elected members of local governments to receive education on ethics laws. • COVERAGE FOR LYMPHEDEMA: Requires insurance companies to cover the treatment of lymphedema, a blockage of the lymph nodes that commonly occurs after a breast-cancer patient undergoes a mastectomy. • PREVENT RACIAL PROFILING: Changes the way law-enforcement agencies report statistics about traffic stops. Source: General Assembly By James Romoser | Journal Reporter Published: January 1, 2010 RALEIGH With the arrival of a new year comes a slew of new state laws, regulating areas from government ethics to handicapped-parking placards. The most-talked-about new law of 2010 -- the statewide smoking ban in restaurants and bars -- doesn't take effect until Saturday. But at least 36 other new laws that were passed by the General Assembly in 2009 will begin to be enforced for the first time today. One new law is aimed at the motion-picture industry, and supporters say that it will help create jobs this year. The law expands the economic incentive that the state offers to companies involved in film or TV production. Such companies were eligible for a 15 percent tax credit, but starting today, they can qualify for a 25 percent tax credit. The law was sponsored by state Sen. Linda Garrou, D-Forsyth, who described it as a way to make North Carolina more competitive with other states, many of which give generous tax breaks to film companies. Aaron Syrett, the director of the N.C. Film Office, said he is already seeing increased interest from companies that will be more likely to film in North Carolina because of the larger tax credit. "It's very promising and encouraging that we should have a busy 2010," he said. "That's one of the biggest decision factors right now in the movie business on where to land projects -- first and foremost, what kind of incentive can a jurisdiction offer?" Some Republican legislators opposed the law, saying that the state should not be increasing its economic- incentive deals. They cited an outside study commissioned by the state that predicted that, in the first few years, the 25 percent tax credit would not generate more net revenue to the state than the 15 percent tax credit. Another law taking effect today is aimed at cracking down on people who abuse handicapped-parking placards. The expiration date on each placard must now be clearly visible. Previously, the expiration date was printed in small type that could be read only from up close. People who qualify for handicapped-parking placards will also get a registration card to keep in their cars in order to prove that the parking placard belongs to them. The new regulations will allow police officers to spot expired placards and will discourage people from loaning or selling handicapped-parking placards to others. "I'm sure there's an abuse of the system, and this will hopefully eliminate a great deal of it," said Steve Abbott, a spokesman for the N.C. Department of Transportation. Local government officials are also subject to new regulations starting today. A new law requires elected members of local governments to undergo regular ethics training. Officials have until the end of this year to undergo their first session of training. A separate part of the ethics law will require, starting Jan. 1, 2011, that all locally elected boards adopt a code of ethics. The Winston-Salem City Council has already adopted an ethics policy that applies to all city employees, including council members. The policy may need to be tweaked to meet the requirements in the new state law, said Al Andrews, an assistant city attorney. jromoser@wsjournal.com 919-210-6794 ------ |
This condition, which is also known as "travellers' thrombosis" and "economy class syndrome", has recently
received much publicity in the media.
It is not uncommon for adult passengers, particularly the elderly, to develop swollen ankles after a long
distance flight. This swelling reduces without any treatment after a few days. However, a more serious
complication of long distance travelling by air is a thrombosis, or blood clot, which usually develops in a leg
vein, resulting in localised pain, tenderness, swelling and sometimes a fever. This thrombosis is not life
threatening unless a small piece of the clot, called an embolus, breaks off and travels in the blood stream to
become lodged in a blood vessel, often the pulmonary artery, blocking off the blood supply, thus causing
death.
A study conducted at London Heathrow Airport has shown that every fifth sudden death following a long
distance flight is caused by a pulmonary embolus, secondary to DVT. It is believed that the swollen ankles
and the thrombosis develop during the flight from the prolonged period of sitting. The inactivity of the legs
causes the blood circulation to slow down to a minimum, resulting in stagnation of blood in the lower legs
due to the effect of gravity thereby encouraging the formation of a blood clot, usually in a deep vein in the
calf.
Other causative factors are:
the low cabin pressure of 11 pounds per square inch (psi) (compared with the normal atmospheric
pressure of 14.7psi at sea level) which makes it easier for the swelling to develop
dehydration of the body through an excessive intake of alcohol
the taking of sleeping tablets (which increases the period of inactivity)
wearing tight clothing.
Although anyone can develop a thrombosis in theory, passengers may be divided into a high or low risk
category. Travellers who exhibit two or more of the following causative factors are placed in the high-risk
group, the more factors that apply, the higher the risk. These factors are those who:
are over the age of 40 years who have a history of heart failure, thrombosis or varicose veins or whose
ankles have swollen previously when flying
are overweight
have a sedentary occupation and are unfit
take oral contraceptives
have a high cholesterol level
smoke.
Those in the low risk category are under the age of 40 years who have none or only one of the causative
factors in the high-risk group above.
Probably the two most effective ways to reduce the risk are to wear low compression stockings up to the
knees and to practise leg exercises while seated. Leg exercises, such as the following, assist in pumping the
blood back towards the heart:
move your feet and toes up and down
straighten and bend your knees
press your legs together
lift alternate feet off the floor
stand up, have a stretch and walk up and down the aisle.
These exercises are most effective if practised on a "little and often" basis, rather than "a lot occasionally" .
Compression stockings also assist in returning venous blood to the heart, increase the effectiveness of the
exercises and overcome the adverse effect of the reduced cabin pressure, thus reducing the risk of swelling
developing. Compression stockings of 30-40mm Hg are considered to be necessary for most passengers in
the high-risk group while stockings of 20-30mm Hg are suitable for the low-risk group. These garments are
usually referred to as calf or knee-high stockings and should be of the closed toe variety like socks. They
are available in a variety of colours, fabrics and sizes and should be fitted by a suitably qualified person who
is able to accurately measure the limb. It is recommended that the stockings be put on before passengers
leave their homes/hotels on the way to the airport and be removed only on reaching their destination, unless
the journey is broken by an overnight stopover in a hotel.
The Adelaide Lymphoedema Clinic carries a full range of suitable styles of socks and stockings for flying.
Call the clinic to be supplied and fitted. Contact the Clinic
Other measures which may be taken to reduce the risk during the flight include:
elevating the feet by resting them on the seat foot-rest, if provided, or cabin baggage
drinking a reduced amount of alcohol and plenty of water
practising deep breathing exercises
wearing loose clothing
avoiding sitting with legs crossed.
Medical advice should be sought before taking anti-coagulants.
DVT
http://www.lymphoed ema.com.au/ DVT.html
received much publicity in the media.
It is not uncommon for adult passengers, particularly the elderly, to develop swollen ankles after a long
distance flight. This swelling reduces without any treatment after a few days. However, a more serious
complication of long distance travelling by air is a thrombosis, or blood clot, which usually develops in a leg
vein, resulting in localised pain, tenderness, swelling and sometimes a fever. This thrombosis is not life
threatening unless a small piece of the clot, called an embolus, breaks off and travels in the blood stream to
become lodged in a blood vessel, often the pulmonary artery, blocking off the blood supply, thus causing
death.
A study conducted at London Heathrow Airport has shown that every fifth sudden death following a long
distance flight is caused by a pulmonary embolus, secondary to DVT. It is believed that the swollen ankles
and the thrombosis develop during the flight from the prolonged period of sitting. The inactivity of the legs
causes the blood circulation to slow down to a minimum, resulting in stagnation of blood in the lower legs
due to the effect of gravity thereby encouraging the formation of a blood clot, usually in a deep vein in the
calf.
Other causative factors are:
the low cabin pressure of 11 pounds per square inch (psi) (compared with the normal atmospheric
pressure of 14.7psi at sea level) which makes it easier for the swelling to develop
dehydration of the body through an excessive intake of alcohol
the taking of sleeping tablets (which increases the period of inactivity)
wearing tight clothing.
Although anyone can develop a thrombosis in theory, passengers may be divided into a high or low risk
category. Travellers who exhibit two or more of the following causative factors are placed in the high-risk
group, the more factors that apply, the higher the risk. These factors are those who:
are over the age of 40 years who have a history of heart failure, thrombosis or varicose veins or whose
ankles have swollen previously when flying
are overweight
have a sedentary occupation and are unfit
take oral contraceptives
have a high cholesterol level
smoke.
Those in the low risk category are under the age of 40 years who have none or only one of the causative
factors in the high-risk group above.
Probably the two most effective ways to reduce the risk are to wear low compression stockings up to the
knees and to practise leg exercises while seated. Leg exercises, such as the following, assist in pumping the
blood back towards the heart:
move your feet and toes up and down
straighten and bend your knees
press your legs together
lift alternate feet off the floor
stand up, have a stretch and walk up and down the aisle.
These exercises are most effective if practised on a "little and often" basis, rather than "a lot occasionally" .
Compression stockings also assist in returning venous blood to the heart, increase the effectiveness of the
exercises and overcome the adverse effect of the reduced cabin pressure, thus reducing the risk of swelling
developing. Compression stockings of 30-40mm Hg are considered to be necessary for most passengers in
the high-risk group while stockings of 20-30mm Hg are suitable for the low-risk group. These garments are
usually referred to as calf or knee-high stockings and should be of the closed toe variety like socks. They
are available in a variety of colours, fabrics and sizes and should be fitted by a suitably qualified person who
is able to accurately measure the limb. It is recommended that the stockings be put on before passengers
leave their homes/hotels on the way to the airport and be removed only on reaching their destination, unless
the journey is broken by an overnight stopover in a hotel.
The Adelaide Lymphoedema Clinic carries a full range of suitable styles of socks and stockings for flying.
Call the clinic to be supplied and fitted. Contact the Clinic
Other measures which may be taken to reduce the risk during the flight include:
elevating the feet by resting them on the seat foot-rest, if provided, or cabin baggage
drinking a reduced amount of alcohol and plenty of water
practising deep breathing exercises
wearing loose clothing
avoiding sitting with legs crossed.
Medical advice should be sought before taking anti-coagulants.
DVT
http://www.lymphoed ema.com.au/ DVT.html