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Lymphland International Lymphedema Online
Swollen leg needs doctor's attention
By DR. PAUL DONOHUE
Dear Dr. Donohue: My mother-in-law is 71 and does not like going to the doctor. For the past two
years, her right leg swells up every day. She says that when she wakes up, she is fine and the leg doesn't
hurt. She refuses to see a doctor. My husband said, "I'm taking you," and she started crying. Is there
anything you can say to encourage her to see a doctor?
- Anon.
A: I can assure your mother-in-law that doctors aren't such bad people. She might be surprised and
actually like the one she sees. She has to find out the cause of her swelling and the appropriate treatment
for it. Delaying treatment can lead to changes that are close to impossible to undo.
Our bodies are supplied with lymph vessels, tiny hoses that suction up tissue fluid and return it to the
circulation. When something obstructs those lymph vessels, fluid remains in that part of the body. Most
likely, this is what's wrong with your mother's leg. She has a lymph-vessel obstruction that causes her leg
to swell. It goes down at night because the leg is elevated and gravity stops pulling fluid into the leg.
Or she could have trouble with the veins in her legs. Their valves might not be working well. In that case,
blood stays in the leg veins and fluid oozes into the tissues.
If your mother-in-law is adamant about not consulting a doctor, she can do some things that will help her
leg. She must elevate her leg as often as she can and for as long as she can during the day. By
"elevation," I mean her leg has to be higher than her heart. She can attain that position only by lying
down with her leg propped up on pillows. She should never cross her legs when she's sitting. A swollen
leg encourages infections, so she should never go barefoot or wear sandals. Compression hose (elastic
hose), preferably fitted for her leg, squeeze fluid out of the leg and back into the circulation.
The booklet on edema and lymphedema (swelling) discusses these matters and their treatment in detail.
To obtain a copy, write: Dr. Donohue - No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a
check or money order for $4.75 with the recipient's printed name and address. Allow four weeks for
delivery.
Cure for dry mouth
Dear Dr. Donohue: I take high blood pressure medicine, and it gives me a dry mouth. It keeps me
awake all night. I gargle with Biotene, but that doesn't last long. Can you suggest something else?
- G.J.
A: Have you asked your doctor for a different blood pressure medicine?
I can give you the names of a number of products that might keep your mouth moistened longer.
Numoisyn Lozenges and Numoisyn Liquid require a doctor's prescription. OraMoist, a time-release
disc that sticks to the roof of the mouth, can keep the mouth from drying out for many hours. You can
find it in most drugstores. MouthKote Oral Moisturizer and spray work well. Biotene also comes as a
gel, and that might last longer than the gargle preparation you're using.
Medicines that promote saliva production include pilocarpine, Salagen and Evoxac. You need a
prescription for these.
Best time for flu shot?
Dear Dr. Donohue: When is the best time to get a regular flu shot? I read that the shot is effective for
only four months. Getting it in September or October will leave you unprotected from January on.
- R.H.
A: Vaccines promote the production of antibodies, ammunition against germs. Within two weeks of the
flu shot, antibodies to the flu virus are at a level high enough to afford protection. Peak antibody levels
are reached in two to four months. They remain high for some time. By the next flu season, however,
their level has waned and protection is gone.
Influenza most often hits its high attack rate in January and February. Vaccine administered as early as
September still affords good protection in those months and later. October is the usual month for
vaccination, but it can be effectively given in November and December, and even into January.
Dr. Paul Donohue writes for North America Syndicate. Send letters to Box 536475, Orlando, FL
32853-6475.
http://www.herald-review.com/news/opinion/editorial/columnists/dr_donohue/article_f9976174-b521-
5c37-9d21-9f6e10bfd175.html
Possible state cuts worry Tri-City seniors
By John Trumbo, Herald staff writer
KENNEWICK — Elderly and disabled senior citizens in the Tri-Cities are speaking out to prevent
billions of dollars worth of services from being cut from the state budget later this year.
From $2 billion to $3 billion could be lost from the $31 billion state budget under proposed cuts from
Gov. Chris Gregoire's budget , said Virginia A. Janin, a coordinator with Southeast Washington's Aging
and Long Term Care office in Kennewick.
Janin and several senior citizens held a news conference Wednesday at the agency's offices in
Kennewick to explain the importance of fully funding the programs.
"I am very grateful for the services I've received through aging and long term care," said Denise Brown
of Richland.
Brown, who suffers from lymphedema and cerebral palsy, said the in-home care she receives is the only
way she can continue to stay in her home. "Please keep these services available and make the cuts
elsewhere," she said.
In-home care, the Meals on Wheels program and reductions of other services for seniors could affect
dozens of clients in the Tri-Cities, said John Rupp, CEO for the Kennewick nonprofit Senior Life
Resources Northwest, which administers several programs, including Meals on Wheels, in Benton and
Franklin counties.
Rupp said state budget cuts in 2009 already trimmed 15 percent in funding affecting the number of hours
of service to seniors, and that health, dental and insurance reductions would come in 2010 unless the
governor and legislators find a way to buy back the proposed cuts.
Larry Gettman, one of 30 volunteers who take Meals on Wheels door to door weekly, said clients
eagerly await the deliveries and visits.
"I go to homes three days a week and see people who are ready to meet someone at the door. It helps
them get up and going for the day," he said.
Dorothy Stone, 87, of Kennewick, said she depends on the services provided through the Aging and
Long Term Care office.
"I really appreciate the Meals on Wheels and I go to the senior center twice a week, and the day care
on Wednesdays. I really appreciate them," said Stone, who is blind, hard of hearing and has heart
trouble.
Stone's son, Ed, who is her care provider, said his mother would not be able to remain in her own home
without the state's assistance.
"They really do a good job. These services help keep a family together. I believe it costs (the state) less
than if she had to be placed in a care home," Ed Stone said.
Dorothy Stone's husband died in 1986, and she lived alone without state help for 20 years. But when
she started two fires trying to cook her own meals about five years ago, her son decided he needed to
do something to get her the help she needed.
"This program allows me to stay with her," said Ed Stone, who also was taking care of his grandparents
in Toppenish until they died a few years ago.
Janin said the governor's proposed cuts in seniors services and people with disabilities can be reduced if
legislators are willing to make cuts elsewhere.
"This is not a good time to receive cuts. It will be very difficult to gain the funds back," said Marcee
Woffinden, Meals on Wheels program director at Senior Life Resources Northwest.
-- John Trumbo: 582-1529
Inimitable Mary Ann
Even out of her checkstand for two years, customers still care about Mary Ann Corbin
By Rodger Nichols
The Chronicle
Some people are perfectly fitted to what they do. It’s hard to imagine them doing anything else. And
when they fit so well, you miss them when they’ve gone.
For the past two years, Safeway customers in The Dalles have been missing Mary Ann Corbin.
Even if you didn’t know her name, you knew who she was — the feisty lady with the short dark hair
who had a word or a smile or a horrible pun for everyone who came through her line.
Many customers automatically headed for her checkstand, no matter if it meant waiting in a longer
line, sometimes even if there were other checkstands open.
“Safeway had a policy that you shouldn’t have to stand in line and they’d drag you to another line,”
Corbin said. “The people in my line wouldn’t go and the manager said ‘You’re ruining my policy!’ I said
‘It’s not me; it’s those guys [the customers]. You want to kick them out?’”
Corbin has kept the scrappy attitude she learned growing up in Kentucky. It’s a quality she would
need over the years.
“My dad had a bar, and I didn’t like living in a bar. All I wanted was out,” said Corbin. “I graduated
on Tuesday; I started working in Cincinnati on Wednesday and on Sunday I moved there.”
The 20-mile trip from her home town to the bright lights was a much longer move in lifestyle.
“I lived in a town the size of Mosier and I went to a town bigger than Portland,” she said.
In Cincinnati, she met her future husband, Donald. They were married in 1969. He talked her into
moving to Oregon; first to Woodburn then The Dalles.
Sons Kevin and Sean arrived in 1971 and 1972.
Corbin worked at the old Jantzen swim suit plant in Hood River until the plant closed down. She
started at Safeway in November 1979.
That led to the end of her marriage.
“When I started selling groceries, I didn’t realize he was living another life, because I was in Hood
River all the time,” she said. “When I filed for a divorce, Ron Somers said ‘What took you so long?’”
She never remarried. “I didn’t have patience to find another one,” she said. “I was taking care of
these two boys. I don’t need another one to raise.”
Being a single mom had its problems, but she said there was help as well.
Both her sons were heavily involved with baseball at all levels, which she said brought her into contact
with a number of people she wouldn’t have met otherwise.
“If you can keep kids busy in the fields and off the streets, you’ve got it made,” she said. “And in a
small town, people tell you what’s going on.”
Corbin started on the swing shift at Safeway.
“I’m not a night person,” she said. “That was hard on me. And with boys in the house, you don’t
want to be gone at night.”
In two months she earned her way to the 10 a.m. to 7 p.m. shift. That’s where she stayed until breast
cancer forced her off the job in 2007.
For 28 years, she worked at brightening people’s days.
“When you go into a grocery store you don’t want to be there,” she said. “It’s a bad mood to begin
with. So I tried to know what was on sale, where it was at, if we were out, what we would substitute. I
was the mother-in-law, you know. Nag, nag, nag. That’s what you need.”
Most of that “nagging” was directed at helping customers
“John Wolf, the lawyer would come into the store and I’d yell ‘John, get an Oregonian. Open up the
Living section; there’s a $10 coupon.’ They’d just come back from church and hadn’t seen it yet.
“Or I’d tell him to buy five Coca-Colas and when he’d come through the line, I’d tell him that if you
buy two, you get three free. He would always thank me.
“Randy [Dodd, the store manager] hated it when I did that.”
She loved steering people to better deals and would send a “courtesy clerk” running down the aisle to
swap out something in the customer’s grocery cart for something better once she’d talked them into it.
Over the years, she rang up sales for orchardists, aluminum plant workers — who would buy steak
dinners in good times — and once, a couple of very tall black guys who turned out to be members of
the Portland Trailblazers.
She sold panty hose to guys when Mt. St. Helens blew its top, so they could cover the air filters in
their cars against the volcanic ash.
She sold expensive imported beer and gourmet items to Rajneesh followers and food to the Salvation
Army the day the commune dumped busloads of homeless people from Portland at the Salvation Army
just across the street.
Then there was the time the store was robbed during Cherry Festival in the 1980s.
“The guy with the gun is behind me. I’m thinking ‘Oh, sweet Jesus, I’m raising kids and this guy’s got
a gun. Down. That’s where you want to go, Mary Ann.’
“And pretty soon, all hell broke lose. City cops showed up. [Wasco County Sheriff’s Deputy]
Scattergood came running across. He had something — a rifle, a sawed-off-shotgun. They tackled the
guy in the office.”
Nobody was hurt in the incident, though Corbin said it gave her the shakes.
What really shook her was when her health started to deteriorate in late 2007.
“I got a call from Dr. Moon and he said ‘You have cancer. I’m doing a mastectomy tomorrow
morning at eight o’clock.’ That’s how much notice I had.”
The surgery also removed lymph nodes, giving her lymphedema in her left arm.
That was eight o’clock in the morning.
At eight o’clock that night, they operated again, telling her she had bleeders.
“It feels like there’s a real tight cinch here to this day,” she said, touching her chest, “because they
stitched it up twice; they short-sheeted it.”
Corbin said she is especially sensitive to drugs
“They tried one chemo,” she said. “After a week, Dr. Fu called me and said ‘That almost killed you. I’
m going to cut it in half.’ And I’m thinking, ‘You’re going to just half kill me.’”
After the half dose, the oncologist told her any more chemo definitely would kill her.
That meant radiation and Herceptin, a drug which suppresses a protein that causes breast cells to
reproduce uncontrollably, causing cancer.
Her body didn’t take it well.
“I either threw it up or passed it the other way,” she said. “It was a contest to see which end it would
come out. It got to the point where people would invite you to dinner and you’d look at it and think ‘Is it
worth it?’”
Corbin calls that time her “year on Elm Street,” referring to the movie “Nightmare on Elm Street.”
She was so weak, she had difficulty in holding her 9-pound granddaughter.
She said she had “chemo head,” and would read a book and be unable to remember it.
Corbin, who habitually walks a mile each day with Nigel, her golden retriever, was also affected by
retained liquid
“I had to stop and sit down on the transformers when I did my walk because it was smothering my
heart,” she said. “I would lose my breath. I would say ‘Nigel, stay with mommy, OK? I can’t go any
farther.’ She’d put her head on my knee. We’d sit on the transformer over here at the little Head Start.
Then we’d sit on the wall down at Rite Aid and then coming up by Dr. Alleman’s I’d sit on that
transformer because that little grade would just kill me. But we kept going.”
By August 2008 her kidneys had failed.
After her first dialysis treatment removed 22 pounds of water, she weighed 119 pounds.
When they stopped the Herceptin at the end of 2008, she said, it took until May 2009 until her body
settled down.
“That took a lot of pressure off,” she said. “I didn’t have to fight the diarrhea or the throwing up any
more.
“When you’re on the [dialysis] machine, you’re on for three and a half hours straight. If they have to
take you off, it throws you way back. So they didn’t like me the first five months, but I had no control
over it. They finally came around and realized how bad I was.”
Corbin says this without any hint of a whine or expecting any pity. She just reports how it is.
That includes a union pension she hadn’t expected. But the second check came with a notice that the
union’s solvency was in “catastrophic status” and there may be no more checks.
But all those years of being kind to customers have led to a lot of support in the community.
“I got a stack of get well cards,” she said.
“The guys from the store came over on three or four occasions and did my yardwork and cleaned my
house. I sat out in the front yard like a zombie.”
Dialysis takes her to the Ray Yasui Center in Hood River every Tuesday, Thursday and Saturday.
Michael Kennedy drives her every Tuesday, and Janet Block every Thursday. Saturdays, she drives
herself. She says she’s about 60 percent of where she was, but couldn’t check groceries anymore
because of the shunt in her right arm and because she couldn’t stand for the hours needed.
Though she hasn’t worked at the store for two years, she still gets Christmas cards from customers.
And Safeway awarded her a 30-year pin last November.
Corbin doesn’t believe in just sitting around, even with serious medical conditions.
When her children left home, she taught herself how to crochet from a library book, and a customer
donated 17 boxes of yarn. She makes lap robes, stocking caps and ear warmers for residents of the
Oregon Veterans Home and for the gift shop.
She has a garden and last year grew 21 tomato plants, even though she can no longer eat the
tomatoes, due to the dialysis.
“I like to give,” she said
Her neighbor, Fran King, worked for many years for Hospice. One particualr patient used to tell her
he had to go get some groceries and his “daily dose of Corbin.”
King said Corbin “kept a lot of senior citizens going and happy. She was always cheerful and people
miss her greatly.”
Corbin said her philosophy was “Just be kind to everybody. Because what goes around, comes
around two and threefold. Some people just love getting in a hole and feeling sorry for themselves. Pity-
partying isn’t going to get them anything. When you feel like that, get a dog. Get somebody to talk to.”
And her reaction to her illnesses?
“You have to treat it like baseball; walk it off. Even when it hurts, you got to keep going. Because if
you don’t go, you’re going to stop. And if you stop, they’ll bury you — so I try to keep moving as much
as possible.”
http://www.thedalleschronicle.com/news/2010/01/news01-10-10-01.shtml
Therapeutic approach can help relieve lymphedema
In the United States, the most common cause of lymphedema is breast cancer. Approximately 25 to 35
percent of women who have had mastectomies develop this condition. Andi Garris, lymphedema
therapist and a doctor of physical therapy with Blount Memorial Total Rehabilitation, says the sooner a
lymphedema diagnosis is made and therapeutic help is received, the better the outcomes are to try and
normalize the affected area.
Lymphedema is a condition where the lymphatic pathways are unable to transport lymphatic fluid out of
an area of the body. "The area then becomes congested with lymph fluid, and the skin swells causing
discomfort," Garris says. Mild swelling occurs in the first stage, which comes and goes and can be
alleviated in the arms and legs with elevation. Some people feel tightness, heaviness or aching, but may
not see any swelling, she says. Stage two begins when the swelling no longer leaves the area. After a
period of time, some people may experience fibrous and tough skin, as the protein and waste materials
in the lymph fluid accumulate and pack in around the skin cells. When these changes begin to take place,
it has progressed to stage three.
Primary lymphedema occurs when lymph vessels and nodes are unable to transport lymph because of
congenital problems, or from no known cause. Secondary lymphedema occurs when the vessels are
damaged as a result of another event including burns, trauma, cancer treatment and removal of lymph
nodes. Secondary lymphedema is more common in women, Garris says. "One of the most common
causes of lymphedema in the arm is due to the treatment of breast cancer. In the legs, other medical
conditions common to both men and women can cause lymphedema, and the prevalence among men is
higher, but still not equal to women."
Symptoms of lymphedema include fullness, tingling, heaviness, tightness, aching and pain. "Some people
do not experience any of these symptoms and only know there is a problem once swelling begins,"
Garris says. If you recently had medical treatment for breast cancer and have any of these symptoms, a
one-time visit to a therapist (with physician recommendation) can determine the status of lymphedema,
provide education for management of the condition, and equip you to head off chronic swelling and pain
that comes with fully-developed lymphedema.
Complete Decongestive Therapy is a therapeutic approach that can reduce lymph congestion and bring
a more-normal fluid balance to the affected area. A therapist uses his or her hands to stimulate the lymph
pathways and open up lymph nodes, so the area can begin to work the fluid out and drain the area. The
massage is followed by a four-layer wrapping that continues the flow of fluid out of the area until the
treatment is repeated the next day, Garris says.
If left untreated, lymphedema begins to change skin into fibrous, hard tissue, causing loss of mobility in
the arms. Fluid can start backing up into adjacent areas leading to bouts of infection in the arms. This
also can occur in the legs, but with the added problem of wound development on the shins and difficulty
walking due to heaviness and leg pain."
Call 640-0517 to speak to a therapist at Blount Memorial Total Rehabilitation, who is available to
answer any questions on lymphedema.
The Women's Health column is provided by the staff and associates of Blount Memorial Hospital. It
appears every Sunday in Women's Times. For more information on this column call 983-7211.
This story was edited for presentation on the Web. Additional information and details are available for
subscribers only. If you want every word of Blount County's best news and information source you can
get home delivery and e-edition subscriptions here. Nobody knows Blount better than The Daily Times,
your hometown newspaper for 125 years and counting.
http://www.thedailytimes.com/article/20100110/WOMEN/301109980
Breast Cancer, Physical Therapy & Lymphedema
By Robert A. Wascher, MD, FACS
Weekly Health Update:
Breast Cancer, Physical Therapy & Lymphedema
Arm lymphedema, or chronic swelling of the arm, occurs in 10 to 30 percent of women following
treatment for breast cancer. When the lymphatic drainage network in the arm and hand has been
disrupted by the surgical removal of axillary (armpit) lymph nodes, or by radiation therapy to the axilla
(or, sometimes, following both types of treatment), the delicate network of lymphatic vessels that return
excess tissue fluid back to the heart can become obstructed. This lymphatic obstruction can then result in
chronic swelling of the hand and arm. Patients with significant lymphedema of the arm following breast
cancer treatment may experience considerable swelling (edema), heaviness, stiffness and discomfort of
the affected hand and arm.
Unfortunately, there are no known effective methods available to prevent lymphedema, and once
significant lymphedema does develop, compression sleeves and soft tissue massage are the primary
treatment modalities currently available. Unfortunately, currently available lymphedema treatments are
often not highly effective for many patients, and there is no known cure for lymphedema once it develops.
Now, a newly published research study, in the British Medical Journal, suggests that physical therapy,
when initiated early after breast cancer surgery, can significantly decrease the risk of arm and hand
lymphedema. In this prospective randomized clinical research study, 120 women who underwent
removal of their axillary lymph nodes for breast cancer were randomized to one of two groups. Women
assigned to the experimental group underwent physical therapy 3 times per week, for a total of 3 weeks.
Physical therapy techniques used in this group included manual lymph drainage and soft tissue massage
techniques, as well as progressive shoulder exercises. Both groups of women also underwent the same
lymphedema management educational course, but the control group of women did not receive any
physical therapy interventions.
Among the 116 women who completed at least one year of follow-up, 18 women (16 percent) went on
to develop lymphedema. Fourteen of the women who developed lymphedema were in the control
group, while the remaining 4 women were in the experimental group. Thus, in this clinical study, early
physical therapy following axillary lymph node dissection (ALND) was associated with a very significant
72 percent reduction in the risk of developing lymphedema, at least within the first year following breast
cancer surgery.
Whether or not the use of early postoperative physical therapy can reduce the incidence of arm
lymphedema over periods longer than one year is unknown at this time, and additional follow-up of the
patients who participated in this clinical research study will be required to answer this very important
question. However, this is one of the very few studies available that suggests a role for physical therapy
in the actual prevention of arm and hand lymphedema following ALND for breast cancer. If additional,
mature follow-up of these patients confirms a long-term benefit from early postoperative physical
therapy in preventing arm lymphedema, then a strong case could be made for the routine use of early
physical therapy in women who undergo ALND, and perhaps, as well, women who undergo sentinel
lymph node biopsy with subsequent radiation therapy to the breast and armpit (axilla) area.
For additional information and resources related to cancer-associated lymphedema, please click on the
links below:
http://www.cancersupportivecare.com/Abstracts/asbdpbtps.html
http://meeting.ascopubs.org/cgi/content/abstract/23/16_suppl/8185
http://www.annalssurgicaloncology.org/cgi/content/abstract/15/7/1996
http://www.cancerlynx.com/sln.html
http://doctorwascher.com/Archives/11-23-08.htm
http://doctorwascher.com/Archives/8-16-09.htm
--------------------------------------------------------------------------------
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any
significant changes in medications, diet, or level of physical activity
--------------------------------------------------------------------------------
Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and
a widely published author
http://mensnewsdaily.com/2010/01/16/breast-cancer-physical-therapy-lymphedema/
At Marysville YMCA, cancer survivors grow stronger
By Sharon Salyer, Herald WriterAfter the hair loss from chemotherapy, after the fatigue of radiation,
even after doctors say that cancer has been blasted from their bodies, a whole new round of healing
must take place: overcoming the physical and emotional toll of a cancer fight.
Cancer survivors, who have survived the ravages of treatment, are left with muscle deficits.
Even 10 to 20 years later, scientists have found, the muscle mass of cancer survivors often lags far
behind people of the same age. Their endurance isn't as great. They have less cardiovascular strength to
power them through activities.
And psychologically, they often feel that the body they thought they knew and trusted has failed them.
“Surviving… dealing with it, it's very emotional,” said Rick Lawson, 49, of Marysville, who has battled
leukemia and a baseball-sized brain tumor.
Cancer patients first must endure the chaotic swirl of seemingly nonstop medical appointments,
treatments and assessments only to be dumped at the “finish line” into the emotional void of discharge.
“First it's, ‘Am I going to survive this?'” Lawson said. “When you're done with treatment, it's like, ‘What
do I do now?' ”
Local YMCAs, working with the Fred Hutchinson Cancer Research Center in Seattle and the Lance
Armstrong Foundation, are trying to provide answers.
A new free program called Exercise and Thrive is being offered at YMCAs in Marysville and Monroe,
designed to meet the special physical and psychological needs of cancer survivors.
The classes include strength training; cardio workouts; flexibility, balance and deep-breathing routines;
and diet and nutrition tips.
Word spread fast about the first classes offered this fall in Snohomish County. Many slots were filled by
word of mouth and referrals from the Providence Regional Cancer Partnership in Everett. The next
classes begin Feb. 23 in Marysville and Monroe.
Scientists aren't sure why cancer survivors have less muscle mass than their peers up to two decades
after their treatment ends, said Karen Syrjala, co- director of the survivorship program at the Fred
Hutchinson Cancer Research Center in Seattle.
Studies are now under way to see if it's the treatment itself that's damaging muscle cells or caused by
patients' inactivity during treatment, she said.
Regardless of the cause, loss of strength from cancer treatments means survivors have a much greater
potential for injuries and flare-ups with lymphedema, which can cause swelling and problems with range
of motion, she said.
YMCA exercise instructors who teach cancer survivors get training on their special needs — how to
slowly build muscle strength and how to avoid strains and injuries that can come with attempting too
much too soon.
“We think it's important to have people who really understand the limits,” Syrjala said.
“One of the things we've learned with cancer survivors is from a long period of inactivity, they do lose
cardiovascular ability, endurance and at the same time they lose muscle mass.”
Cancer survivors, some of whom were participating in marathons before their treatments, have to learn a
whole new way to approach exercise and fitness, she said.
“It's very hard not to push and build as fast as you can,” she said. “Sometimes, we have to help people
slow down.”
Fourteen people signed up for the initial 10-week course in Marysville. Only one — Lawson — was a
man.
While other men said they didn't want to join a class with a female-dominated roster, Lawson took it in
stride.
“I grew up with three older sisters,” he said. “I get along quite well with women.”
The combination of his leukemia treatments and the aftermath of fighting a brain tumor left him blinded in
his right eye, with decreased coordination and stamina, and with body aches in his left hip and leg.
He had previously sought out physical therapy to help him rebuild his strength. But to make progress, he
needed to go about three times a week. His insurance was charging him $50 out of pocket for each visit.
“I couldn't afford PT anymore,” he said.
The twice weekly, 90- minute YMCA classes are customized for cancer patients, he said, and slowly
built up his strength.
There were other benefits, too: a better outlook, more energy, less depression and fatigue.
“My wife has noticed I'm happier,” he said. “My muscles have some sort of definition now.”
Even after the class ended in early December, he has continued his workouts, often going to the Y three
times a week for water aerobics, treadmill workouts and strengthening regimens.
“I'll make the Y my second home – a place for me to go,” he said.
The program has benefits beyond improvements in fitness and tips on stretching and nutrition, class
members say. Among them is spending time with people who know firsthand the ups and downs of a
cancer battle.
“Everybody has gone through the same thing: the diagnosis and response of family and friends,” said
class member Renate Whitcomb of Marysville.
Whitcomb, 44, was diagnosed with breast cancer in October 2006.
A cancer diagnosis often leaves patients feeling alienated, she said. “Most people don't know what to
say.
“I've never been part of a support group,” Whitcomb said, but class members “have really been my
support.
“It helped me deal with my stress,” she added. “It was such a godsend.”
About 200 people have participated in Exercise and Thrive programs, offered at Puget Sound area
YMCAs, including Northshore, West Seattle, Auburn, Bellevue, Marysville and Monroe. Harborview
Medical Center in Seattle has joined hospitals in Spokane and Alaska in offering the program, too.
Cancer centers have offered similar strength and resistance training programs for patients, Syrjala said.
What makes this program different is that they're offered in the community where the patients live.
For people in Snohomish County, that means saving hours of commuting time on I-5 to get to Seattle. “I
hope for most people, it takes 20 minutes or less to get to their local Y,” she said.
Reports on 158 of the 200 people who have participated so far showed improvements in flexibility,
strength, waist measurements and blood pressure.
“It's one of our most positive programs in terms of impact on lives,” Syrjala said.
“People said they felt better physically, had more stamina and less fatigue,” she said. “In a relatively
short time… that's a lot of change.”
Sharon Salyer: 425-339-3486, salyer@heraldnet.com.
http://www.heraldnet.com/article/20100117/NEWS01/701179891&news01ad=1
AtlantiCare Cancer Care Institute offers CyberKnife® Technology targets hard-toreach tumors non-
invasively
TheAtlantiCare Cancer CareInstitute, a Fox Chase Cancer Center Partner, in Egg Harbor Township,
New Jersey, offers CyberKnife® Robotic Radiosurgery – the world’s only robotic radiosurgery system
designed to treat tumors anywhere in the bodynon- invasively.
CyberKnife compares X- ray images to the patient’s original CT scan before each treatment to ensure
unparalleled targeting accuracy. It continually tracks, detects and corrects for any patient or
tumormovement.
“Through this technology our experienced team delivers high-dose radiation with pinpoint precision,
while minimizing damage to surrounding healthy tissue,” said Lauren Ochs, executive director,
AtlantiCare Oncology Services, AtlantiCare. “ We are pleased to offer patients this advanced
technology as a non- invasive alternativetosurgeryforthetreatmentof both cancerous and non-cancerous
tumorsanywhereinthebody.”
“ We can now treat previously hard to reach cancers, includingthoseofthe lung, brain, spine, liver,
pancreas and kidney – non- invasively,” said Jonathan Law, MS, DABR, DABMP, director, Medical
Physics AtlantiCare Regional Medical Center. “Side effects are minimal and there is littleor no recovery
time.”
The AtlantiCare Cancer Care Institute offersCyberknife® surgeryasanoutpatient procedure. It also
offers radiation therapy, chemotherapy/infusion treatments, diagnostic services, as well as access to the
latest clinical trials as a Fox Chase Cancer Center Partner. The AtlantiCare Cancer Care Institute has
on-site laboratory, pharmacy, social work, nutrition and lymphedema therapy services.
“ The CyberKnife’s flexible robotics allows us to treat tumors from nearly any direction and in nearly
any location in the body,” said Law. “At the AtlantiCare Cancer Care Institute, tumors have nowhere to
hide,”saidLaw.
http://www.jewishtimes-sj.com/news/2010-01-
22/Health_and_Nutrition/AtlantiCare_Cancer_Care_Institute_offers_CyberKnif.html
TOMBALL REGIONAL MEDICAL CENTER RANKED TOP FIVE PERCENT IN NATION
Recognized by HealthGrades as a Distinguished Hospital for Clinical Excellence
Tomball, TX – HealthGrades has announced that Tomball Regional Medical Center ranks among the
top 5% in the nation for clinical excellence. A study by HealthGrades, the leading independent
healthcare ratings organization, analyzed patient outcomes at each of the nation’s 5,000 nonfederal
hospitals over the years 2006, 2007 and 2008.
“This ranking is an outside affirmation that attests to the excellence of our physicians and entire team,”
said Lynn LeBouef, President/CEO of TRMC.
According to the eighth annual HealthGrades Hospital Quality and Clinical Excellence study, Tomball
Regional Medical Center and the other hospitals in the top 5% demonstrated patient outcomes that far
exceeded those of other hospitals. Patients admitted to these hospitals had risk-adjusted mortality rates
that were, on average, 29% lower than all other hospitals and complication rates 9% lower than all other
hospitals.
Tomball Regional Medical Center is one of only 269 hospitals that received this distinction from
HealthGrades.
“Our data show that only a select few hospitals achieve high-quality patient outcomes not just in a few
categories of care, but across the board and over time,” said Rick May, MD, a vice president with
HealthGrades and an author of the study. “Patients in communities with a Distinguished Hospital for
Clinical Excellence should feel proud of the hospital’s accomplishments, and confident that the level of
care there is among the very best in the nation.”
The study states: “Patients who choose to receive their care at a Distinguished Hospital for Clinical
Excellence certainly will have a lower risk for an adverse clinical outcome relative to all other hospitals.”
Methodology
This is the eighth year that HealthGrades has independently analyzed the clinical quality performance of
all non-federal hospitals across the country in 27 procedures and diagnoses. In the study, the company
reviewed approximately 40 million hospitalization records from the Centers for Medicare and Medicaid
Services, part of the U.S. Department of Health and Human Services, over the years 2006, 2007 and
2008. All hospitals that participate in the Medicare program were part of the independent study.
Hospitals that receive the HealthGrades Distinguished Hospital Award for Clinical Excellence are those
hospitals that rank in the top 5% when all 26 individual scores are aggregated into an overall score.
About Tomball Regional Medical Center
Recognized for its full continuum of services and remarkable growth over the years, Tomball Regional
Medical Center (TRMC) serves a population of 330,000 area residents. TRMC has earned specialty
accreditation for both stroke care and cardiac care and has been ranked by HealthGrades as among
America’s top 5% of all hospitals for clinical excellence. Through exceptional technology and a
specialized medical staff, area residents receive a full range of medical services close to home. Services
provided include open-heart surgery, neurosurgery, a new maternity floor and level III neonatal intensive
care unit, inpatient rehabilitation, skilled nursing, and home health care. The 150-acre campus also
includes designated specialty centers: the Robert F. Schaper Heart Center, the Texas Wound and
Lymphedema Center, the Texas Sports Medicine Center, a Cancer Treatment Center, and the Heritage
Retirement Community. To learn more, call 281-401-7500.
----------------------------------------------------
LdB mom on a mission
Posted By Jill Winzoski
Lymphedema. Never heard of it? Neither had Lac du Bonnet mother-of-three Kim Avanthay.
Four-and-a-half years ago, doctors informed Kim that her son Austin was born with lymphedema, a
disease that affects the lymphatic system, causing extreme swelling and hardening of the tissues. He has it
in his right arm and leg.
The first type, known as primary lymphedema (the kind Kim's son has) can be present at birth or
develop at any time, and is the result of inherent defects in the lymphatic system.
Secondary lymphedema, which is more common, is the result of a damaged lymphatic system. Anyone
who's had certain kinds of cancer treatment like radiation therapy or had lymph nodes removed is at a
significantly greater risk for acquiring the disease. Other traumas like an accident, surgery, or severe
infection can also increase the risk of getting lymphedema.
"People need to know about this. You can lower your risks of getting it if you know what to be aware
of," said Avanthay. "Although there's no cure, it can be managed through a combination of things, like
draining the limb, or wearing compression garments."
She also said that those who are at higher risk for developing the disease, like breast cancer survivors,
might think twice about air travel without compression garments, as this can help prevent lymphedema.
Considering as many as one-in-four breast cancer survivors develops the disease, it is presently getting
relatively little attention.
"There is as of yet no support group in Manitoba for lymphedema sufferers," says Avanthay, who is
currently spearheading a Manitoba contact for the Canada-wide lymphedema association.
On Jan. 3, Avanthay sent out requests to various Manitoba municipalities, cities, businesses and to the
Province itself to proclaim March 6th starting this year to be Lymphedema Awareness Day. So far, the
towns and RMs of Beausejour, Lac du Bonnet, Whitemouth, Shoal Lake, St. Francis Xavier, Coldwell,
Neepawa and La Broquerie have agreed to uphold the pledge. More municipalities have yet to respond,
but Avanthay is grateful that the municipalities have been "very supportive."
Although The City of Winnipeg has denied her request, she has yet to hear from the province, which is
currently "looking into it," said Avanthay.
The Lymphovenous Association of Ontario says the condition is "under the medical radar screen," and
that government health officials need pressure put on them by patients, their family members, health care
professionals and lymphedema associations. They say that public health policy needs to be changed
because currently the need for standardized and accessible treatment is not being addressed.
Avanthay, who also works full time in Pinawa, is preparing to attend an international conference in
Brighton, U.K., where she seeks the tools that will help her start a support group here in Manitoba. A
Bud, Spud and Steak fundraiser will be held on Feb. 6 from 7 p.m. – 10 p.m. at the Norvilla Hotel on
north Henderson to help with travel expenses. Anyone wishing to buy tickets for this event (or to
otherwise help with the cause) should call Kim at 345-0441, or e-mail her at kimavant@mts.met.
http://www.beausejourreview.com/ArticleDisplay.aspx?e=2273708
Keller certified as clinical specialist
Victoria Keller, PT, MS, WCS, was certified as a clinical specialist in women’s health physical therapy
by the American Board of Physical Therapy Specialists. Keller is one of 61 physical therapists certified
in women’s health in the U.S., one of two in the state of Texas.
Keller specializes in the treatment of pelvic floor disorders that can result in incontinence, pelvic pain and
constipation in both women and men. She is a certified lymphedema therapist through the Lymphology
Association of North America. She has also worked with women with osteoporosis and has taught pre-
and post-natal exercise.
Keller graduated from Mineral Wells High School and received a bachelor of science degree in physical
therapy from the University of Texas Medical Branch in Galveston. She received a master of science
degree in physical therapy from Texas Woman’s University in 2006. She worked for 10 years at Baylor
Medical Center in Irving prior to moving to Graham. She is employed with Young County Home Health
and will soon be opening a practice called Thrive Physical Therapy.
The ABPTS of the American Physical Therapy Association awards certificates to physical therapists
meeting approved requirements. To obtain board certification, candidates must submit evidence of
required clinical practice in a specialty area and successfully complete a rigorous written examination,
which demonstrates specialized knowledge in advance clinical proficiency in a specialty area of physical
therapy practice.
http://www.grahamleader.com/index.asp?Story=17996
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Everyday people do have a voice in the government
by Larry Kissell
We hear a lot about the people not having a role in their government. There is a feeling that laws aren’t
written with the average person in mind.
I want to share the stories behind three pieces of legislation I have or will introduce in the coming weeks.
Each one of these bills was born out of ideas presented by constituents right here at home. I am proud
to introduce the legislation and even prouder to represent the folks who brought these issues to my
attention.
The first bill would have an impact on veterans across this country. My staff and I were contacted by a
100 percent permanently disabled American veteran who voiced his concerns about the vast difference
in benefits offered by states to 100 percent permanently disabled veterans. While some states provide a
very robust package of benefits, demonstrating its commitment and appreciation for its disabled
veterans, other states’ benefits packages are lacking in comparison.
The most bothersome is that despite North Carolina’s large veteran population, our state’s benefit
package is far from what our veterans deserve. Our veterans have answered our nation’s call for duty
and served this country with honor and distinction. They deserve the very best benefit package we can
offer.
After hearing this concern, I am sponsoring a bill to create a commission to review each state’s current
disabled veterans benefits package, compare the packages and rank each state based on the benefits it
offers to 100 percent permanently disabled veterans. This commission will provide recommendations to
Congress and each state on how to make each state’s package comparable across the country.
The second bill came about when a constituent visited our office to voice her concerns about
lymphedema and the denial of coverage for treatment of this devastating disease. Her son suffers from
the disease, and she had fought to see that he receives the treatment he needs.
Lymphedema is a chronic disease caused by a weakened lymphatic system, and can be hereditary or
caused by a secondary reason such as injury to the lymph nodes. Many cancer patients suffer from
lymphedema which causes lymphatic fluid to collect in the limbs and cause swelling. The swelling can
become permanent if not treated.
Yet, coverage for treatment is routinely denied by insurance companies as well as Medicare and
Medicaid. Complications from the disease if left untreated can range from severe deformity, disability,
pain and can even lead to death. Luckily, treatment is covered for breast cancer patients under the
Women’s Health and Cancer Act, but others suffering from the disease fight an uphill battle just to get
coverage for treatment.
Our constituent has already worked with the state to mandate insurance companies to provide coverage
for lymphedema treatment in North Carolina with the help of Representative Tricia Cotham, but her
concern is the thousands of people across the country that fight on a daily basis to get their insurance
companies to cover this badly-needed treatment. States which have mandated the coverage have
proven that covering the treatment leads to lower medical expenses caused by complications of the
disease.
We must right that wrong, and make sure that people living with this disease are granted access to the
treatments they need. We hope to introduce this important legislation to mandate coverage for
lymphedema treatment in the coming weeks.
The third piece of legislation came straight from a couple in Stanly County. This couple trains service
dogs, and they wanted to voice their concerns about allowing service dogs in training access to the areas
where normally only service dogs at work would be allowed. This would allow service dogs to receive
the best training in the areas where they will actually be working.
Service dogs provide invaluable help to those they serve, allowing individuals freedoms that their
disability might not afford them otherwise. It is critical that these animals receive the best training in any
and all areas they will go while working.
I introduced H.R. 4378 which would amend the Americans with Disabilities Act to require that the
access to transportation and public accommodations be afforded to trainers and handlers of service
animals as is afforded under the ADA to individuals with disabilities who use such service animals. This
gives the trainers and handlers the ability to better train and prepares service dogs for their future uses.
These extraordinary folks saw a need and petitioned their government and I am doing all I can to make
sure that their idea becomes law. Their causes aren’t just about what they need, but about helping
thousands of others who are living with the same problem or facing the same challenges.
I am making sure their voices and yours are heard in Washington.
Congressman Larry Kissell (D-N.C. -8) offices include Rockingham: 230 East Franklin St.,
Rockingham, NC 28379, Phone: 997-2070; Concord number (704) 786-1612; Fayetteville number
(910) 920-2070; Washington office: 512 Cannon House Office Building, Washington, DC 20515;
phone (202) 225-3715. Web site, kissell.house.gov
http://www.yourdailyjournal.com/view/full_story/5638548/article-Everyday-people-do-have-a-voice-in-
the-government?instance=secondary_opinion_left_column
Out of the blue
Dance company creates diverse platform to celebrate nature’s beauty.
By Liana Aghajanian
Bethune Theatredanse is celebrating the company’s 30th anniversary in a new city with a tip of the hat to
nature.
“Silent Roar” was inspired by the marine environmental artist who goes by one name, Wyland, said
Artistic Director Zina Bethune, who wrote, directed and choreographed the production coming Feb. 5
to 7 to Glendale Community College Theatre.
The performance relays the plight of whales as they travel from Alaska to Baja California with the help
of original music, graphics, film and other digital elements, she said.
Bethune plans on making the area a permanent home for her company, saying its collective cultural
mentality is conducive to forming a relationship with the city.
“Glendale wears a kind of cultural signature,” she said. “I think we can be part of that cultural signature
in a very positive way.”
After having done research on the city, Bethune believes the tight-knit and supportive nature it offers will
be a great fit for her company, which comprises diverse dancers, she said.
Although Bethune Theatredanse might not be the only dance group fusing dancing, digital arts and
storytelling, it was a trailblazer in the field when it began 30 years ago, when defined lines separated the
worlds of dance, theater and media, Bethune said.
Because of her story-oriented nature and background in dance, theater and film, Bethune found it natural
to blur the lines and provide audiences with an experience that is difficult to categorize, she said.
She hopes that by forming a solid relationship with the college, she can create an exchange between the
company and students on campus, she said.
“We can really provide an opportunity for students to work alongside seasoned professionals in a
multitude of departments, including dance, drama, graphics and media,” Bethune said.
Glendale resident Marc McCall, a video game programmer by day and the multimedia production
designer for “Silent Roar,” calls Bethune’s unconventional methods admirable.
A former GCC student, McCall thinks the company’s presence in Glendale will be nothing but positive.
With a head start, Bethune Theatredanse already has a few dancers from the Glendale and Burbank
area who are performing in “Silent Roar,” including Ciny Ricalde, who has trained with the National
Academy of Arts and the Joffrey Ballet.
After taking time off to raise her daughter, this production is Ricalde’s comeback into dancing. She has
nothing but praise for Bethune and credits her openness to casting diverse dancers.
“The diversity brings a different look and different qualities, like a canvas and textures on a painting,”
Ricalde said. Different textures is what Bethune is all about, like giving those with disabilities a chance to
explore and showcase their dancing abilities, including break-dancer and aerialist Jacob “Kujo” Lyons,
who is severely hard of hearing. He has about five roles in “Silent Roar.”
“I dance to show that I can,” Lyons said. “The whole point has always been to show that anyone can do
anything they put their minds to.”
Bethune, who started “Infinite Dreams,” a dance program for disabled children, is no stranger to
disabilities herself, having had scoliosis, lymphedema as well as numerous surgeries on her dysplastic
hips.
She is already working hard to place programs within Glendale schools, similar to what she has already
done in Pasadena, she said.
With a tight budget and a dance program already in place for disabled students, the GCC Center for
Disabled Students doesn’t necessarily have room for another, according to Associate Dean Joy Cook,
who called the inclusion of disabled and diverse students of Bethune Theatredanse commendable.
“I think when a person with disabilities can be involved, it’s a wonderful experience both for the dancer
and the audience,” said Cook, who added that the company’s establishment in Glendale would give
students another option.
http://www.glendalenewspress.com/articles/2010/01/26/entertainment/gnp-bethune012710.txt
Breast Center at Baylor Dallas Recognized for Commitment to Fighting Breast Disease
Read more: http://www.earthtimes.org/articles/show/breast-center-at-baylor-dallas,1141437.
shtml#ixzz0iI35vs07 DALLAS, Jan. 28 /PRNewswire-USNewswire/ -- Baylor Sammons Breast
Center at Baylor University Medical Center at Dallas has been recognized by the National Accreditation
Program for Breast Centers (NAPBC) for its "firm commitment to offer its patients every significant
advantage in their battle against breast disease." The center has now received a three-year, full
accreditation from the NAPBC. Accreditation by the NAPBC is only given to those centers that have
voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous
evaluation and review of their performance.
"We are committed to joining with women to fight breast cancer with every tool, technique and
treatment available," said John Pippin, M.D., chairman of the Breast Site Committee at Baylor Charles
A. Sammons Cancer Center at Baylor Dallas. "Accreditation validates that commitment." Baylor
Sammons Breast Center is only the second program in Texas to achieve this accreditation.
Advantages of Accreditation
Receiving care at a NAPBC-accredited center ensures that a patient will have access to:
•Comprehensive care, including a full range of advanced technological services
•A multidisciplinary team approach to coordinate the best treatment options
•Information about ongoing clinical trials and new treatment options
•Quality breast care close to home
---------
http://www.sfgate.com/cgi-bin/blogs/gurley/detail?&entry_id=56625
Haiti journey improv
10 days and counting to Haiti. My mind is whizzing and my days are packed with to-do lists that
overflow into the next day. I keep trying to project myself into that moment when I return, and stare at
my desk and try to figure out where I was and what I was doing before I left. It seems impossible to
emotionally transport myself from these moments now, to there, and, then back.
My kids - as kids are wont to do - vibrate like tuning forks to the emotional environment around them,
even when they're not aware of it. The home front has evolved from teens who lean into me more than
usual, to teens who blow like landmines along a disputed border.
My work has been lovely beyond belief. In retrospect, it should be no surprise that people who work,
by choice, in a clinic for the homeless, are likely to possess levels of compassion that, if scored on Iowa
standardized tests, would put them into the "gifted" category. We had an all-staff meeting, where I was
asked to stand - so that I could hear the gratitude from those who feel that I am representing them
personally on this trip.
I got superb tips from a skilled rehab nurse as we worked together, comments and instructions about
what to do in Haiti, between seeing patients here - she pointed out that I should bring ACE bandages for
wrapping stumps for all those amputees who got life-saving surgery, but minimal-to-no aftercare, the
ones who now have wide-spread infections. "They can wash and re-use ACE bandages, and it'll help
season the stump and control lymphedema. Oh, and felt for padding, and you'll need to teach them to
cut off the arms of long-sleeve t-shirts, and knot the end to use as a stump-sock. God, I wish you could
take a few straight-caths. I'm betting there will be some spinal-injury patients. What would they do
without a cath?" She walked off, shaking her head in disbelief at the horror of that prospect: dying in
agony because you could not pee.
But I could not help, walking through the Civic Center BART station, but notice the huddled humps of
two homeless men lying against the wall. They lay on cardboard strips, bunched blankets iglooed around
them. In their own form of hell.
Our first team meeting was last Sunday. It was a lovely group of people, men, women, some in their
twenties, most in their forties, a couple of women maybe early sixties, all sitting around a living room,
while Dr. Enoch Choi updated everyone on the outstanding issues in his calm, soothing voice. He began
by saying that he knows many of us are in-charge when we're in our own environments - but that the
point of going as a team is to work together, to accomplish more than any of us could do alone. That we
will each be asked to step outside our pre-defined roles, to be more flexible, to work cooperatively.
And he reminded us that any of us, who didn't feel comfortable with that situation, could always head to
Haiti on our own - there are no barriers to doing that. At all. You or I or anyone else could get a flight
over there and walk right in.
In a way, it was chilling reminder of the breakdown of government and regulation there. And we are still
definitely going the weekend of February 14 - the only questions are around the flight destination. If the
security situation deteriorates further, we'll fly into the Dominican Republic and travel by truck overland
(6 hours to the border, then another 1 hour to PAP), and stay at the border, driving in to PAP each day.
An apartment and driver, plus guards, have been arranged at the border. Not one single hotel room is
available (otherwise all 15 of us would be sleeping in that one room).
However, in order to serve more people (and not waste time going back and forth to PAP), we may
still, if security allows, fly directly into PAP and work on the grounds of a large, indigenous
church/orphanage two blocks from the American Embassy, giving care from that home base and
sleeping in tents or on the ground.
Which means we have, so far, two flight options - one is to fly commercial to Miami, then take military
cargo from Miami to PAP (the military cargo plane space is arranged, the commercial flight to Miami not
so much - that decision is awaiting security developments). If we go by way of Dominican Republic, we
have been generously donated 1 million miles by Alaska Air for our team's flights.
I looked around the room and realized that, for people who would soon be sleeping packed like
sardines head-to-toe (even in an apartment bedroom), without bathing for 8 or so days, no one felt
comfortable asking the gritty questions. Is there functional sewer systems in Port au Prince? I've been to
part of Africa where la toilette is a pair of concrete footprints shaped like Dr. Scholl's inserts (and not
large, six 6 men's shoes, max) positioned beside an ominous hole in the ground. That might seem like an
upgrade from the prospects in Haiti. We're bringing our own lunch for each day, but what about the
infection risk of other meals?
Tent city without toilets or tents
On the personal front, I started my malaria medicine last weekend. I got the weird dreams, the ones I
remembered and I dreaded - it's something about how my brain is wired (I once tried a tiny dose of
Ambien for jet-lag and spent the evening seeing writhing nightmarish ulcers sprout on dream-people who
were talking mutely, pleading with me soundlessly). This time I awoke with the distinct memory of my
daughters' bass teacher swelling and swelling, elephant-man-like, his seeping split-skin explosion
inevitable. Luckily I only get these dreams on the once-a-week night I take chloroquine.
My Mama called (yes, I'm Southern, and, hence, she will always stay my Mama). She reminded me that
I'm "not as young as you think," as well as several other choice, sweet, and incisive reminders that I
should perhaps re-think this whole idea. I do have two children, after all.
I feel my stomach knot and I get quiet and after I hang up, I take the time to think about it. My Mama is
not the kind whose advice a wise person ignores easily. But I think back to those sleeping homeless
men, and how dangerous the area where I work, Civic Center, can be. And how careful Dr. Choi is
being when making plans for the group. And while the situation (and stories) in Haiti are horrific, all the
outpouring of compassion and support (a lot of which I've personally seen or heard) has been a
testament to the vast goodness of humanity. And then my uber-efficient friend, Pam, calls to say the
Wells Fargo trust fund for the trip "Share the Wellth" is up and working, and that, more importantly, she
has something she thinks I might be interested in taking with me, from her Eagle Scout son's camping
supplies - super-compact, teensy tiny rolls of toilet paper. Yes! Yes! I have my portable shower ready
(a packet of Handy Wipes) and I splurge on a tiny battery-powered SpongeBob toothbrush. Doc
Gurley motto: Hey, if your teeth feel good, you can even do without coffee.
I downloaded the free Gideon 321 page e-textbook, Infectious Diseases of Haiti, as well as both the
free Haitian Creole Byki app (rushed to market with a specially-created medical section - two
stethoscopes up to these folks!), as well as the Pimsleur free course of Haitian Creole lessons (two
stethoscopes up AGAIN - you rock, Simon & Shuster). I spent the day speaking Creole out loud to
myself in my home, narrating my life and interviewing myself about imaginary health problems - an out-of-
body experience if there ever was one.
My dining table is an Everest of supplies. I read an article forwarded by Medscape, a reminder that
Haitian women now are particularly vulnerable to reproductive neglect and violence. I'm thinking I may
pack a giant pile of condoms. Surely they'll fit too. Ah, but one crucial element remains to sort out - how
to get connected while I'm there, so I can bring along all of you who are going with me. There has to be
an affordable solution somewhere. So I'm heading out with my iPhone to the AT&T store tomorrow.
Which may be the most confusing part of this whole trip - wish me luck!
Share in the comments section - and tune in for the next in the series to get details about the Haiti trip
(and, oh yeah, jury duty? That old thing? I was in and out of there in a DAY!). If you want to donate for
supplies or transport, head over to www.docgurleycom for details underlined at the end of this same
article. But if you're feeling a tad Haiti-ed out and overwhelmed, never fear, there will be OTHER, non-
Haiti, fun health topics in the next few days! Keep up on the latest health issues in the news by signing up
for a Doc Gurley RSS feed by clicking here. Look for future pics and other articles at Doc Gurley! Also
check out Doc Gurley's joyhabit and iwellth twitter feeds - so you can get topic-specific fun, effective,
affordable tips on how to nurture your joy and grow your wellth this coming year.
Read more: http://www.sfgate.com/cgi-bin/blogs/gurley/detail?&entry_id=56625#ixzz0ecDo8cEu
Read more: http://www.sfgate.com/cgi-bin/blogs/gurley/detail?&entry_id=56625#ixzz0ecDoGwSE
-----------------
Administered by the American College of Surgeons, the NAPBC is a consortium of professional
organizations dedicated to the improvement of the quality of care and monitoring of outcomes of patients
with diseases of the breast. This mission is pursued through standard-setting, scientific validation, and
patient and professional education.
On the Frontlines of Breast Care
Baylor Sammons Breast Center provides a broad range of breast care services, from prevention and
detection to treatment and recovery. The center provides clinical coordinators to help patients navigate
their care and recovery process every step of the way. These coordinators help patients by providing
referrals to a wide range of experienced specialists; answering questions; and scheduling appointments.
The Center's focus on education includes community programs, as well as the Virginia R. Cvetko Patient
Education Center. The education center is designed to help cancer patients and their families understand
and manage the physical, emotional and spiritual challenges of cancer. The center's staff includes a
medical director, nurse educators, genetics nurse, chaplains, social workers and trained cancer survivor
volunteers.
Understanding that early diagnosis is often the key to successful breast cancer treatment, Baylor
Sammons Breast Center provides computerized breast cancer risk assessments, a Hereditary Cancer
Risk Program (including genetic testing and counseling) and screening and diagnostic services. Screening
and diagnostic services are provided through the Baylor University Medical Center at Dallas Darlene G.
Cass Women's Imaging Center.
Baylor Sammons Breast Center also participates in several breast cancer prevention and treatment trials;
provides lymphedema treatment and education; and operates Ernie's Appearance Center, featuring
products and services that minimize the visible effects of cancer therapy.
About Baylor Dallas
Baylor University Medical Center at Dallas, a 1025-bed not-for-profit academic hospital, is a major
patient care and research center in the southwest. The nationally acclaimed medical center serves as
flagship hospital for Baylor Health Care System and has earned Magnet status for "Excellence in
Nursing Services" from the American Nurses Credentialing Center -- the organization's highest level of
recognition. In addition to its Level 1 trauma center, Baylor Dallas is also home to many nationally
ranked centers of excellence including transplantation, cardiovascular services, orthopaedics, oncology
services, digestive diseases, neurosciences and gynecology. In 2009, U.S. News & World Report
recognized Baylor Dallas for the 17th consecutive year in its "America's Best Hospitals" guide.
SOURCE Baylor Health Care System
http://www.earthtimes.org/articles/show/breast-center-at-baylor-dallas,1141437.shtml
FIRST REPORT THAT LESSER USED BIOPSY TELLS MORE
Sentinel Lymph Node biopsy less commonly used in cervical cancer, yields three fold higher lymph node
metastases detection over standard method, and offers proven reduced complications for patients.
Attention: Assignment Editor, Health/Medical Editor, Lifestyle Editor, News Editor, Science Editor
TORONTO, ONTARIO, NEWS RELEASE--(Marketwire - Jan. 29, 2010) - For the first time ever
reported in cervical cancer, Sunnybrook researchers have shown higher detection of lymph node
metastases, one of the most telling factors about the course of disease, using Sentinel Lymph Node
biopsy compared to complete pelvic lymphadenectomy, in a study published in Gynecologic Oncology.
"These findings inform a newer way of thinking about the management of cervical cancer," says Dr. Allan
Covens, surgical oncologist and head, Gynecology Cancer Care Team, Sunnybrook's Odette Cancer
Centre. "In our view, complete lymphadenectomy as a gold standard for lymph node assessment in
cervical cancer is cogently challenged. More frequent use of Sentinel Lymph Node biopsy in cervical
cancer detects more lymph node metastases, which may have a positive overall impact on survival."
Sentinel Lymph Node biopsy reduces a patient's complications such as pain and lymphedema (chronic
swelling) of limbs and or soft tissue, and is used widely in melanoma, breast and vulva cancers. Sentinel
Lymph Node biopsy removes one to two sentinel lymph nodes (the first lymph nodes to drain from the
primary tumour, hence the first to harbour metastases) compared to pelvic lymphadenectomy involving
the removal of ten to 30 lymph nodes, and increased complications.
"Our findings of higher lymph node metastases (including micrometastases) detection using Sentinel
Lymph Node biopsy together with known reduced complications for patients and low false-negative
rates, suggest a strong efficacy advantage of this procedure over the standard complete pelvic
lymphadenectomy procedure in early stage cervical cancer," says Dr. Covens, Professor, Obstetrics and
Gynecology, and director Gynecologic Oncology Fellowship, University of Toronto.
Findings indicate a lymph node metastases detection rate almost 3 fold higher with Sentinel Lymph
Node biopsy compared to pelvic lymphadenectomy. All sentinel lymph node metastases were smaller
than one centimetre. The higher detection rate the researchers suggest may be due to the extensive
sectioning performed on Sentinel Lymph Node biopsy. Another possible explanation may be related to
the unusual locations of sentinel lymph nodes in cervical cancer. Over 21 per cent of the cohort of 87
patients who underwent Sentinel Lymph Node biopsy, had sentinel lymph nodes located either in the
common iliacs or paraaortics. These nodes would not be typically removed in a standard pelvic
lymphadenectomy.
The researchers compared 81 of the 87 patients who underwent Sentinel Lymph Node biopsy, to 218
matched patients who had complete pelvic lymphadenectomy. Both groups subsequently underwent
radical hysterectomy or radical trachelectomy.
Despite continued yearly declines in mortality rates for cervical cancer, in 2009 an estimated 1,300
Canadian women were diagnosed with cervical cancer and an estimated 380 women died from the
disease.
For further information: www.sunnybrook.ca/
http://www.marketwire.com/press-release/FIRST-REPORT-THAT-LESSER-USED-BIOPSY-
TELLS-MORE-1109402.htm
-----------------------------
The American Physical Therapy Association (APTA) is seeking to gather input from a variety of
stakeholders, including:
• Physical therapy patients/clients,
• Non-PT Health care providers, and
• Product/Service Vendors who serve the physical therapy profession
If you know someone who fits in one or more of these categories, please feel free to pass the survey link
on so they can contribute their views.
See the link below to participate in this very important survey.
Thank you for your input!
Nicole
Nicole L. Stout MPT, CLT-LANA
Survery was deactivated in January this post is fyi only.
Hello – The American Physical Therapy Association (APTA) requests your assistance in completing its
Environmental Scan Survey. This Environmental Scan Survey is being provided to you and other valued
stakeholders to gather your views about the physical therapy profession’s current and future
environment. Your response to this invitation on or before January 20th is greatly appreciated!
The analysis of the collected data will help APTA identify current trends and possible changes that are
occurring, or will occur, in the next one to three years that could affect the nature, direction, or viability
of the physical therapy profession. Responses will be summarized and the data used to inform APTA’s
strategic planning process. Your individual responses will remain strictly confidential and results will be
reported in aggregate form only.
To complete this survey, please click the link below and follow the instructions provided. Please answer
the questions in this survey from your individual perspective. We understand that some questions may
not be applicable you. In such instances, please skip the question and move on.
Click here to begin the Environmental Scan Survey.
If you have any questions, or if you would like additional information about this survey, please contact
Marc Goldstein, EdD, APTA’s Senior Director of Research at research-dept@ apta.org.
Finally, APTA is seeking to gather input from a variety of stakeholders, including:
• Physical therapy patients/clients,
• Non-PT Health care providers, and
• Product/Service Vendors who serve the physical therapy profession
If you know someone who fits in one or more of these categories, please feel free to pass the survey link
on so they can contribute their views.
Thank you,
R. Scott Ward, PT, PhD
President, American Physical Therapy Association
----------------------
Measuring the Cost of a Lymphedema Treatment Mandate -
3 Years of Experience in the Commonwealth of Virginia
BACKGROUND: One of the most urgent of problems today is our inability to afford quality healthcare.
Lymphedema, once acquired, is a lifelong disease with no currently known cure. However, the quality of
that treatment is greatly to be questioned, and often does not meet the recommended standards of
knowledgeable lymphedema specialty groups. These standards include the treatment by specially
qualified therapists, a course of treatment limited only by medical necessity, patient instruction in self
treatment and the provision and daily use of compression bandages, garments and devices. It can be
shown that lymphedema treatment in accordance with these protocols, with high patient adherence, is an
effective way to REDUCE healthcare costs by reducing the periodic infections for which the
lymphedema patient is at risk.
Lymphedema mandates are being considered in a number of states similar to the lymphedema treatment
mandate passed by the Commonwealth of Virginia in 2003. Virginia also has in place a rule that requires
every insurer, health services plan and health maintenance organization (HMO) to report to the State
Corporation Commissioner the yearly cost and utilization information for each of the 30 mandates
currently in effect.
This document is an abstract of the costs of the Virginia lymphedema treatment mandate for the year
2006, with comparisons with the two prior years the mandate has been in effect. It contains claims and
utilization data, and estimates by the healthcare providers of the insurance premium impact of each
mandate. These impacts are spending impacts only, and do not consider the beneficial effects of
lymphedema treatment on reducing medical and hospital costs by the inevitable reduction of
lymphedema-related cellulitis.
DATA SOURCE: The source of data for this document is the “Report of the State Corporation
Commission on The Financial Impact of Mandated Health Insurance Benefits and Providers Pursuant to
Section 38.2-3419.1 of the Code of Virginia: 2006 Reporting Period to the Governor and the General
Assembly of Virginia” Report RD289, October 25, 2007 available at the Virginia Department of
Insurance website at URL: http://leg2.state.va.us/DLS/H&SDocs.NSF/Published%20by%20Year?
The cost data for the lymphedema mandate is abstracted and presented with a discussion of other states'
lymphedema mandate analyses. This Virginia report is the only comprehensive and authoritative report
to date of the cost of lymphedema care, and covers 28 major insurance companies and 14 HMOs
representing 77.26% of the Virginia insurance market, and 1,482,863 units of coverage.
VIRGINIA LYMPHEDEMA MANDATE: Section 38.2-3418.14 of the Code of Virginia requires that
insurers, health service plans and HMOs provide coverage that shall include benefits for equipment,
supplies, complex decongestive therapy, and outpatient self-management training and education for the
treatment of lymphedema.
CPT AND ICD-9-CM CODES COLLECTED: The codes collected and costed in the company
claims reports included ICD Codes 457.0 Postmastectomy lymphedema syndrome, 457.1 Other
lymphedema, 757.0 Hereditary edema of legs, CPT Codes, 97124 Massage, compression, 97140
Manual therapy techniques, manipulation, 97535 Self-care/home management training
CLAIM EXPERIENCE: Claim experience provides the most direct measure of the cost of a
lymphedema treatment mandate. The lymphedema claims filed as a percentage of the total claims for
individual contracts was 0.05%, and for group contracts was 0.06%. The average lymphedema claim
cost per individual contract was $1.15 and for group contract $2.64. [Tables 5 & 6]. Since most
insurance contracts included lymphedema treatment prior to the mandate and separate claim data for
lymphedema treatment were not required to be reported, it is not possible to determine what portion of
these claim costs result from the mandate.
UTILIZATION OF SERVICE: Data are provided on the number of visits and the number of days
attributable to each mandated benefit for the year. The group data was held to be more reliable than the
individual contract data. The average number of visits per contract for lymphedema treatment was 0.09,
and the average number of days per contract was 0.01. [Table 7]
PREMIUM IMPACT: Companies are required to use actual claim experience and other relevant
actuarial information to determine the premium impact of each mandated benefit. The estimated premium
impact or the lymphedema mandate ranged 0.25% to 0.56% of the overall average contract premium on
individual contracts, and 0.13% to 0.25% on HMO contracts. It is not possible to explain why the
estimated premium impacts are so much greater than the actual claims experience.
MANDATE ANALYSES IN OTHER STATES: A 2004 analysis of a similar Massachusetts bill
estimated per member per month costs of $0.03 for coverage of lymphedema treatment. In 2005 the
California Health Benefits Review Program estimated an increase of 0.0003% or $0.01 per person per
year for implementing AB-213 Liu. None of these analyses accounted for significant avoided costs due
to reduced infection that could be passed on to the customer as REDUCED premiums.
CONCLUSIONS: An upper bound on the costs of implementing a lymphedema treatment mandate can
be estimated using the actual claims data in Virginia, where a lymphedema mandate has been law since
January 1, 2004. It is an upper bound since: 1) the estimated premium increases are many times the
actual claims experience for the years analyzed; 2) the reported claims experience represents the total
lymphedema treatment claims instead of the incremental increase due to the mandate, and; 3) the
reduction in total claim costs due to resulting lower cellulitis rates are not used to reduce estimated
premiums.
Prepared by Robert Weiss, M.S.
Lymphedema Treatment Advocate
National Lymphedema Network
LymphActivist@aol.com
====================================================================
REFERENCES
1. “Report of the State Corporation Commission on The Financial Impact of Mandated Health
Insurance Benefits and Providers Pursuant to Section 38.2-3419.1 of the Code of Virginia: 2006
Reporting Period to the Governor and the General Assembly of Virginia” Report RD289, October 25,
2007 available at the Virginia Department of Insurance website at URL: http://leg2.state.va.
us/DLS/H&SDocs.NSF/Published%20by%20Year?
2. California Health Benefits Review Program, "Analysis of Assembly Bill 213 Health Care Coverage
for Lymphedema" A Report to the 2005-2006 California Legislature, April 7, 2005.
3. Commonwealth of Massachusetts Mandated Benefit Review - "Review and Evaluation of Proposed
Legislation Entitled: “An Act Providing Coverage for Lymphedema Treatments” Companion bills:
Senate Bill No. 848 & House Bill No. 1309, Provided for: The Joint Committee on Insurance Division
of Health Care Finance and Policy Commonwealth of Massachusetts.
Potential saving through proper LE management.doc
An Estimate of Healthcare Savings which could be achieved through Proper Lymphedema Management
The underlying principle behind the analysis is the assumption that management of lymphedema results in
an immediate and significant reduction in the incidence of lymphedema-related infection. The ongoing
cost of treatment of lymphedema is balanced out by the savings due to avoidance of the necessity of
treating recurring cellulitis, frequently on an emergency basis.
A number of separate approaches have been taken to arrive at a credible estimate of the potential
savings to be achieved. The first approach (Appendix A) was to postulate two lymphedema treatment
scenarios for a woman diagnosed with and treated for breast cancer. The first scenario postulates that
she receives early and continued treatment of her lymphedema according to the recommended
guidelines. The second scenario postulates that she receives no treatment for her lymphedema, but does
receive medical treatment for her recurrent lymphedema-related infections. Data to support both
scenarios are derived from statistics taken from recent scientific journals. The results of this study
establishes, for this hypothetical case, a significant saving to her medical provider when the lymphedema
is treated and managed.
Infection of the skin and lymphatic system (cellulitis/lymphangitis) is a major cause of lymphedema. It is
also a major result of lymphedema. (Stoberl & Partsch 1987). Some 10-15% of lymphedema patients
experience infections each year (Swenson et. al. 2002, Kasseroller 1998). Therefore one might expect
30,000-45,000 cellulitis cases yearly from 300,000 lymphedema patients in California (Appendix C).
Hospital discharges for 2003 involving cellulitis of all sites and from all causes were 111,438. The
average hospital stay for cellulitis was 5 days (Hospital Discharge Data 2002). At an average hospital
stay cost per patient per day in California of $1763 (2003 AHA Annual Survey) this places the yearly
burden for treatment of cellulitis in California at almost 1 Billion dollars, with $264-397 million estimated
as related to lymphedema. If the incidence of cellulitis is reduced by 50% through the treatment of
lymphedema (Ko et. al. 1998, Foeldi 1996) a $132-200 million saving would result, not accounting for
medication cost savings or savings due to reduced disability.
Another approach taken was an attempt to extend this principle to a large population by examining
actual hospital admissions data to attempt to size the burden of unmanaged lymphedema and the savings
to be achieved for a larger population by treating the lymphedema. This study utilized the Patient
Discharge Data for Calendar Year 2003 maintained by the California Office of Statewide Health
Planning and Development. Total number of patient discharges in 2003 involving cellulitis of the arm or
hand (ICD-9-CM Codes 682.3 and 682.4) were 18,876. Of this total, 307 cases involved upper limb
lymphedema or swelling. These 307 cases involved an average hospital stay of 5.6 days for a total cost
of $8,271,398. The total number of patient discharges in 2003 involving cellulitis of the leg and foot
(ICD-9-CM Codes 682.6 and 682.7) were 62,056. Of this total, 1851 cases involved lower limb
lymphedema or swelling. These 1851 cases involved an average hospital stay of 10.4 days for a total
cost of $62,814,399. Similar relationships are shown between discharges with cellulitis of the lower
limbs and various surgical procedures e.g.: hip and knee replacement and hysterectomy 224 cases at
$25,262,301 cost; and coronary artery by-pass grafts 265 cases at $66,224,482 cost. Each of these
infections is a lymphedema risk factor. Adding up the costs of only the cases of cellulitis documented as
being related to lymphedema or swelling, yields a total of $162,571,000 in treatment of lymphedema-
related cellulitis, well within the $132-200 million range of savings calculated using a different analysis
using different data sets.
An estimate was made as to the cost of providing lymphedema treatment to the estimated lymphedema
patients in California. Hinrichs found that the distribution of severities was 75% mild (Stage 1), 22%
moderate (Stage 2) and 3% severe (Stage 3). Yearly costs of treatment developed in the hypothetical
breast cancer scenario (Appendix A) were $200 for Stage 1, $1550 for Stage 2 and $5500 for Stage
3. Applying the observed distribution of severity of lymphedema [Hinrichs 2004] to the estimated
300,000 California lymphedema patients and using the estimated costs of treatment, yields an annual
cost of lymphedema treatment if all patients were to be diagnosed and treated of $197 million. These
estimated costs are in the range of estimated savings using statistics in scientific journals and hospital
databases.
So the bottom line is that treatment of lymphedema is cost neutral and has the potential of saving money,
providing a significantly improved quality of life for lymphedema patients and reducing the burden of
disabilities resulting from late-stage lymphedema. Further references to the cost-efficacy of lymphedema
treatment are found in the annotated references of Appendix B.
Prepared by Robert Weiss, M.S.
Lymphedema Treatment Advocate
National Lymphedema Network
LymphActivist@aol.com
======================================================================
=
APPENDIX A
STRUCTURE FOR A COST-EFFICACY STUDY OF LYMPHEDEMA TREATMENT
ASSUMPTIONS:
•Patient diagnosed and treated for breast cancer at 40 years of age
•Patient lives to 80 years of age
•Assume two different scenarios for post-mastectomy lymphedema treatment:
-Patient receives early and continual lymphedema treatment
-Patient does not treat lymphedema, but treats lymphedema-related infections
DEVELOPMENT OF TREATMENT COSTS:
•Costs postulated for Phase I (clinical) and Phase II (home) Treatment.
-Phase I costs include 2-week course of CDT @ $1000, 1 compression sleeve @ $100, 1
bandaging kit @$150 = $1250.
-Phase II annual costs depend on Stage of LE.
+Stage 1 (less than 2cm) costs include 4 Medi or Juzo compression sleeves per
year @ $50 = $200/year.
+Stage 2 (between 2-10cm) costs include 4 Elvarex compression sleeves @ $150,
1-week CDT course @ $500, 3 bandaging kits @ $150 = $600+500+450= $1550/year.
+Stage 3 (greater than 10cm) costs include 6 Elvarex compression sleeves @
$150, 6-weeks of CDT @ $500 / week, 4 bandaging kits @ $150, Pneumatic compression pump
$5000/5 years = $900+3000+600+1000=$5500/year.
•Assumed cost of treatment of an infection in emergency room setting including intravenous antibiotic, 2-
week course of oral antibiotic, followup office visits, physical therapist = $5000.
LYMPHEDEMA PROGRESSION SCENARIOS:
•Incidence of infection (cellulitis/lymphangitis) depends on stage and treatment. Each infection further
scars the lymphatic system and advances the stage of the lymphedema.
-Untreated
+Stage 1: 1 infection which ends Stage 1 and initiates Stage 2;
+Stage 2: 1 infection every 2 years;
+Stage 3: 2 infections per year.
-Treated
+Stage 1: 1 infection which ends Stage 1 and initiates Stage 2;
+Stage 2: 1 infection every 5 years;
+Stage 3: 1 infection every 2 years
SCENARIOS COSTED FOR 40 YEARS OF SURVIVAL:
•SCENARIO #1- Lymphedema after breast cancer is NOT TREATED:
-Stage 1 (less than 2cm) for 2 years, followed by;
-Stage 2 (between 2-10cm) for 6 years, followed by;
-Stage 3 (greater than 10cm) for remaining 32 years.
•SCENARIO #2- Lymphedema after breast cancer IS TREATED:
-Stage 1 (less than 2cm) for 5 years, followed by;
-Stage 2 (between 2-10cm) for remaining 35 years.
COST SUMMATIONS
•Cost for Scenario #1:
-2 years @ Stage 1, 1 infection: $5000 = $5,000
-6 years @ Stage 2, 3 infections: 3x$5000 = $15,000
-32 years @ Stage 3, 64x$5000 = $320,000
Total cost for 40 years $340,000
•Cost for Scenario #2:
-5 years @ Stage 1, 1 infection: $5000 + 5x$200 = $6,000
-35 years @ Stage 2, 7 infections: 7x$5000 + 35x$1,550 = $89,250
Total cost for 40 years $95,250
•Net Cost of Lymphedema Treatment over 40-year Breast Cancer Survivor's survival lifetime:
$95,250 minus $340,000 equals NEGATIVE $244,750 (Savings for illustrative patient)
Cost Ratio = 3.57 (no LE treatment / LE treatment)
The estimates for the cost of treating one infection are low, perhaps by a factor of two or three. The cost
differentials would be much more dramatic if these higher figures were to be used. The above analysis
does not include the disability and loss of wages or the pharmaceutical costs for pain management due to
not treating or under-treating lymphedema.
LYMPHEDEMA TREATMENT IS GOOD BUSINESS AS WELL AS GOOD MEDICINE.
=================================================================
APPENDIX B
LYMPHEDEMA TREATMENT COST-EFFECTIVITY REFERENCES
Compiled by Robert Weiss 10/8/03
Updated 2/22/04
Boris, MD, M., Weindorf, MD, S., Lasinski, M.A., P.T., B.: “Persistence of Lymphedema Reduction
After Complex Lymphedema Therapy”, (1997)Oncology, Vol. 11, No. 1, January 1997, pp. 99-109,
discussion pp. 110, 113-114. Three case reports document dramatic decreases in incidence of
hospitalizations for treatment of cellulitis for three patients treated by CDT.
Campisi C, Boccardo F, Zilli A, Maccio A, Napoli F: "The use of vein grafts in the treatment of
peripheral lymphedemas: long-term results", Microsurgery. 2001;21(4):143-7. Study of 665 patients
with microsurgical lymphatic-venous anastomoses for obstructive lymphedema with 446 patients
available for long-term follow-up. Average follow-up of greater than 7 years showed average reduction
in excess volume of 69%. There was an 87% reduction in the incidence of cellulitis.
Campisi C, Boccardo F, Zilli A, Maccio A, Napoli F.: "Long-term results after lymphatic-venous
anastomoses for the treatment of obstructive lymphedema". Microsurgery 2001;21(4):135-9. Over the
past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical
lymphatic-venous anastomoses; of these, 446 patients were available for long-term follow-up study.
Objective assessment was undertaken by water volumetry and lymphoscintigraphy.
Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo-
Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%).
Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average
reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been
able to discontinue the use of conservative measures, with an average follow-up of more than 7 years
and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis
after microsurgery.
Casley-Smith, J. R. PhD, MD, Boris, M., MD, Weindorf, S. MD, Lasinski, B. MA, PT: "Treatment for
Lymphedema of the Arm—The Casley-Smith Method, A Noninvasive Method Produces Continued
Reduction", (1998) Cancer (Supplement) Vol. 83, No. 12, Dec 15, 1998, pp. 2843-2860. Costs per
year and effectivities of a 4-week course of CDT treatment was presented, including costs of bandages
and garments (Figure 9). Average costs for different treatments ranged from $2000-3000 per year with
40% to over 100% reductions of initial edema. Cost ranges from savings (negative costs) to $7000 per
year for various alternative treatment protocols.
Daane, S. MD, Poltoratszy, P. RPT, CPT, Rockwell, W. B. MD: "Post-mastectomy Lymphedema
Management: Evolution of the Complex Decongestive Therapy Technique", Ann Plast Surg, Feb 1998,
Vol 40, No. 2, pp. 128-134. Treatment was an average of 15.3 visits per patient over a period of 3-4
weeks, with an average cost of $1513. The duration of each treatment session was from 45 minutes to 1
hour. The goals of therapy are to control edema, to prevent infection and to improve function. Each
inflammatory episode can exacerbate lymphatic fibrosis.
Földi MD, E.: "Prevention of Dermatolymphangioadenitis by Combined Physiotherapy of the Swollen
Arm after Treatment of Breast Cancer", Lymphology, 1996, Vol. 29, pp. 91-94. Study of medical
records of 150 breast cancer patients with arm lymphedema in the years 1990-1994. Conclusion were
that in women with arm lymphedema after treatment of breast cancer, recurrent
Dermatolymphangioadenitis (DLA) attacks [cellulitis/lymphangitis infections] can nearly be eliminated by
improvement in arm swelling by combined physiotherapy (CPT) Phase I. If these women are free of skin
risk factors [unrelated to the lymphedema] such as psoriasis, neurodermatitis, vericose lymphatics,
lymph fistulae and/or fungal overgrowth, continued CPT (Phase II) maintains reduction of edema and
prevents further DLA episodes.
Ko, MD, D. S. C., Lerner, MD, R., Klose, CCDPI, G.; Cosimi, MD, A. B.: “Effective Treatment of
Lymphedema of the Extremities”, Arch of Surgery, April 1998; Vol. 133, pp. 452-458. 299 patients
referred for evaluation of lymphedema of the upper or lower extrematies were treated with CDT for an
average duration of 15.7 days. Lymphedema reduction was measured following treatment and at 6- and
12-month follow-up visits. The incidence of infections decreased from 1.10 infections per patient year to
0.65 infections per patient year after a complete course of CDP [Phase I and Phase II] (Table 2).
Krishnamoorthy K: "Estimated costs of acute adenolymphangitis to patients with chronic manifestations
of bancroftian filariasis in India."Indian J Public Health 1999 Apr-Jun;43(2):58-63.
In India, lymphatic filariasis persists as a major cause of clinical morbidity and as an impediment to socio-
economic development. The direct costs incurred for the treatment of adeno-lymphangitis (ADL)
episodes and the consequent indirect costs due to loss of income were determined from selected
agricultural labour-intensive rural endemic pockets in Tamil Nadu. Information on the occurrence of
ADL, its frequency and duration were collected using semi-structured questionnaire from randomly
selected patients afflicted with chronic manifestations of bancroftian filariasis. Direct (treatment) cost per
year per patient was found to range from Rs. 30 to 101 among patients with different manifestations.
Income foregone (indirect cost) annually by each patient, which is a function of frequency and duration
of ADL ranged from Rs. 182 to 702. ADL episodes among filarial patients alone cost a minimum of Rs.
4515 million for the nation every year. Cost benefit analysis of filariasis control programme in India
showed that the benefits in terms of savings on treatment and work lost due ADL alone exceeded the
cost by 24%. The per capita cost of the National Filaria Control Programme was calculated to be Rs.
2.6 per annuam.
Lerner, R. MD: "Complete Decongestive Pysiotherapy and the Lerner Lymphedema Services Academy
of Lymphatic Studies (the Lerner School)", (1998) Cancer (Supplement) Vol. 83, No. 12, Dec 15,
1998, pp. 2861-2863. "By employing [the Foeldi] method of CDP we have been given a treatment
modality that achieves a greater than 80% long term success rate without morbidity or mortality and
without disfigurement of any kind. We have been able to do this for a reasonable cost, and, by
transferring the future care of the lymphedema patient away from the doctor/hospital setting, we have
produced a very cost effective method of caring for this long-term, chronic disease."
Miller SR, Mondry T, Reed JS, Findley A, Johnstone PA.Delayed cellulitis associated with conservative
therapy for breast cancer. J Surg Oncol. 1998 Apr;67(4):242-5.
Delayed breast cellulitis is an infrequently reported entity after conservation therapy for breast cancer.
We describe our experience with this entity at Naval Medical Center, San Diego. Eight patients who
presented with delayed cellulitis after wide local excision/axillary dissection and breast radiotherapy (RT)
are presented. Their clinical characteristics and therapy are described and possible causative factors are
analyzed. The latency of breast cellulitis is variable after breast conservation therapy, although most
cases in our experience and in the literature occur within a year post-RT. These infections are frequently
refractory to a single course of antibiotics (n = 4 cases in our experience). Some patients suffer multiple
episodes separated by months. Breast cancer patients are at risk for delayed cellulitis after conservative
surgery and RT. The mechanism of such events probably involves lymph stasis, however, therapy is no
different from the more frequently occurring cases of cellulitis presenting perioperatively.
O'Brien BM, Mellow CG, Khazanchi RK, Dvir E, Kumar V, Pederson WC.: "Long-Term Results after
Microlymphaticovenous Anastomoses for the Treatment of Obstructive Lymphedema," J Plastic and
Reconstr Surg, 1990, Vol. 85, No. 4, pp. 562-72. Over the last 14 years, 134 patients with obstructive
lymphedema have been treated with microlymphaticovenous anastomoses. Ninety patients were
available for long-term follow-up study. Of these, 52 patients were treated by microlymphatic surgery
only and 38 of them also had segmental or radical reduction surgery, either at the same time or
secondarily. Objective assessment was undertaken by volume and circumferential measurements.
Initially, lymphangiography was used, but a study demonstrated increased edema immediately following
the investigation in one-third of the patients and it was abandoned, both preoperatively and
postoperatively. In the microlymphaticovenous anastomoses only group (N = 52), subjective
improvement occurred in 38 patients (73 percent). Objectively, volume changes showed a significant
improvement in 22 patients (42 percent), with an average reduction of 44 percent of the excess volume.
In the microlymphaticovenous anastomoses and reduction surgery, usually segmental, group (N = 38),
subjective improvement occurred in 30 patients (78 percent) and objective improvement occurred in 23
patients (60 percent), with an average reduction of 44 percent of the excess volume. Of those followed
up, 67 patients (74 percent) have been able to discontinue the use of conservative measures, with an
average follow-up of 4.0 years and average reduction in excess volume of 26 percent. There was a 58
percent reduction in the incidence of cellulitis following surgery. In those patients who were improved,
drainage resulted in increased softness of the limbs. Edema of the hand diminished considerably in most
patients, although this was difficult to measure. These long-term results indicate that
microlymphaticovenous anastomoses have a valuable place in the treatment of obstructive lymphedema
and should be the treatment of choice in these patients. Reduction surgery can be used as an adjunct in
some of these patients, especially in the posteromedial aspect of the upper arm. Liposuction has been
used in failed cases or in patients in whom no lymphatics could be found. Improved results can be
expected with earlier operations because patients referred earlier usually have less lymphatic disruption.
Reid T: "Treatment of Lymphedema and Recurrent Cellulitis", Case Report presented at the Second
National Lymphedema Network Conference, Sept 1996. 31 year old patient with lymphedema due to
multiple knee injuries and surgeries spent 152 days in hospital between May 1994 and November 1995.
After 5 months of treatment with Reid manually-adjustable compression sleeve, she had no further
events of cellulitis and was able to be taken off antibiotics. Cost effectiveness analysis showed savings
over 5 months to exceed $90,000-$130-000 based on hospital cost of $2-3,000/day.
Thiadens SRJ, Rooke TW, Cooke JP: "Lymphedema" in Current Management of Hypertensive and
Vascular Diseases (1992) Mosby Yearbeck, Inc., St. Louis, MO. pp. 314-319. In a retrospective
study of 304 lymphedema patients, over 25 percent had incurred an episode of cellulitis over a period of
3 years.
======================================================================
=
APPENDIX C
PREVALENCE OF LYMPHEDEMA IN CALIFORNIA
Authoritative estimates of the prevalence of lymphedema in California do not currently exist. An estimate
of 300,000 has been made based on the following rationale and sources.
The process starts with American Cancer Society data on the prevalence of the most common cancers
based on SEER data. A best estimate of the incidence of lymphedema from treatment of the various
types of cancer was developed from a systematic analysis of scientific journal data to obtain an estimate
of the prevalence of lymphedema among cancer survivors. An estimate of the prevalence of
lymphedema as sequelae of various other non-cancer-related surgeries and radiotherapy was added
based on hospital discharge statistics.
The basic starting point is the American Cancer Society's "California Cancer Facts & Figures, 2003,
specifically page 3 table entitled "Expected Incidence, Mortality, and Prevalence of Common Cancers in
California, 2003" This reference shows the prevalence of the top 5 cancers for men and women in
California as 698,600, which represents 77% of all cancers. The total of all cases would be 906,300
excluding DCIS cases.
An estimate of the DCIS cases is derived from the ACS “Cancer Facts and Figures 2004”. Carcinoma
in situ of the breast accounts for about 59,390 new cases annually. During this same year the estimated
number of new cases of invasive breast cancer was 217,440. Using the number for invasive breast
cancer to estimate lymphedema would yield an estimate 21.5% low, since the treatment protocols are
the same for DCIS as for early-stage invasive breast carcinoma. The estimate California prevalence was
therefore adjusted by 121.5%, giving a prevalence of all cancers including DCIS of 1,101,155.
A systematic study of the scientific literature on lymphedema resulted in an estimate of the incidence of
lymphedema. Consulting a list of over 2,000 journal references to lymphedema, over 250 contain data
on incidence of lymphedema as sequalae of various surgical and radiative therapies and on the
prevalence of primary lymphedema.
This systematic analysis was presented as a plenary session presentation entitled "Incidence of
Lymphedema –A Literature Review" at the 6th International NLN Conference for Professionals, "New
Frontiers in Lymphedema Research & Therapy" held in Reno in October 2004. A summary of the
findings was published in the NLN quarterly journal LYMPHLink Jan-Mar 2005;17(1):12,27.
The incidence of lymphedema from the various cancer therapies ranges from 10 to 40 percent. A
weighted average for the various cancers of 25% applied to the 1 million+ cancer survivors in California
in 2003 yielding an estimate of the prevalence of lymphedema in California from cancer therapies as
275,289.
To the above cancer-related population is added an estimate of the lymphedema resulting from other
surgical procedures. For example, in Damberg CL, Danielson B et. al.:"The California Report on
Coronary Artery Bypass Graft Surgery 1999 Hospital Data Summary Report" dated August 2003 the
authors state "Each year approximately 26,000 Californians with advanced heart disease undergo
Coronary Artery Bypass Graft." An estimated 25% of these patients, who have a section of their
saphenous vein and associated lymph vessels harvested to perform the CABG, will develop
lymphedema in the lower limb from which the vein was removed, yielding an additional 6,500
lymphedema patients each year.
Other surgical procedures known to be related to lymphedema are hip and knee replacements. There is
no California data on the frequency of these procedures, or the prevalence of the survivors. National
hospital discharge data from 2002 suggest that the number of total hip replacements (165,000) and total
knee replacements (326,000) are on the same order as coronary artery bypass grafts (516,000). One
can guess therefore that another 6,500 lymphedema cases can be added each year from these
procedures.
Another cause of lymphedema is repeated skin infections (cellulitis or lymphangitis). It is not known what
percentage of the 111,438 cases of cellulitis treated in California in 2003 were the result of lymphedema
and what percentage were the primary cause of lymphedema.[Stoberl C & Partsch H: “Erysipel und
Lymphodém: Ei oder henne?” (Erysipelas and lymphedema: egg or hen?) in German, Z Hautkr. 1987;
62:56-62.]
At this point, and until more definitive data mining can be done, it would be prudent to limit the estimate
of lymphedema from all causes to 300,000, with 275,000 from cancer treatment. Dr. Szuba of Stanford
University states "In our (lymphedema) clinic, about 75% of the patients have lymphedema because of
malignancy or its therapy, with about half of these related to breast cancer surgery." [Szuba A, Shin WS,
Strauss HW & Rockson S.: "The third circulation: radionuclide lymphoscintigraphy in the evaluation of
lymphedema", J Nucl Med Jan 1,2003;44 (1):43-57]. Using that ratio would increase the estimate to
367,000 based on the 275,000 cancer-related estimate.
NLN rational for a 2010 bill.doc
The National Lymphedema Network’s rationale for a
Lymphedema Diagnosis & Treatment Cost Saving Bill of 2010
LYMPHEDEMA is a medical condition affecting an estimated 1.5 to 3 million Medicare Beneficiaries
who are not receiving treatment from Medicare according to the current medical standard of care. But
what is worse is that Medicare is spending billions of dollars every year treating a largely preventable
lymphedema-related CELLULITIS.
The NLN hopes that you will consider introducing a lymphedema diagnosis and treatment cost-saving
bill to correct many of the deficiencies in Medicare coverage of lymphedema treatment. We can provide
you with a proposed draft if you are interested in sponsoring this quality of care bill. There is no conflict
with current Congressional efforts to pass a Medicare access bill since this is a quality of care bill. The
bill also does not conflict with any CMS policies, but instead it removes ambiguities and clarifies
coverage issues.
Lymphedema is incurable and progressive, and if left untreated, the swollen area can become fibrous
and prone to serious, debilitating infections. Over time, untreated lymphedema results in disfigurement,
disability and even death. The recognized standard of treatment of lymphedema is Complete
Decongestive Therapy (CDT). CDT comprises four interacting protocols applied in two phases (acute
and ongoing): manual lymph drainage (MLD); compression therapy; lymph drainage exercises; and skin
care. [Refs: ACS 1998, ISL 2003, NLN 2006]. The initial intensive phase is performed by medical
professionals, but ongoing care is patient self-provided using techniques taught the patient by the
healthcare provider.
Medicare does not cover lymphedema treatment materials or treatment by lymphedema- qualified
professionals other than Physical Therapists and Occupational Therapists, nor does Medicare require
that the provider of lymphedema treatment services be qualified in the specialized techniques. While
Medicare does cover and pay for statutorily-limited therapy and sequential compression pumps, many
patients suffer recurrent infections, progressive degradation in their condition and eventual disability
because they cannot afford the compression bandages and garments required for their everyday self-
care.
Denials of coverage for lymphedema compression bandage systems, compression garments and devices
and supplies are based on inconsistent interpretations of Federal statutes and the Medicare publication
system, and CMS has stated repeatedly that a change in the law will be necessary in order for them to
change their policies to cover these medically necessary items. We would like to request that you pursue
such a change.
Please understand that this is NOT a new health mandate. The staff, equipment and facilities are already
in place in most medical providers. Most providers already cover lymphedema treatment, and there are
no exclusions in any medical policies that we are aware of. The Women’s Health and Cancer Rights Act
of 1998 already mandates the treatment of lymphedema resulting from breast cancer treatment.
It can be shown to result in medical savings which exceed ongoing costs by factors of 2-5. A
lymphedema coverage mandate has been in effect in Virginia since 2004, and a similar law was passed
in North Carolina this year, to become effective in 2010. Data from the first five years of operation in
Virginia show claim costs of $1.12-2.82 per year per contract (0.04-0.09% of total claims) not
accounting for the expected savings due to reduced cellulitis rates.
The National Lymphedema Network urges you to consider sponsoring the proposed “Lymphedema
Diagnosis and Treatment Cost Saving Bill of 2010” which has the backing of the National Lymphedema
Network. Please contact us with any questions or with requests for further information, medical
evidence, cost efficacy data or detailed legislative details.
Prepared by Robert Weiss, M.S. with the NLN
Lymphedema Treatment Advocate
LymphActivist@aol.com
National Lymphedema Network
Latham Square, 1611 Telegraph Avenue, Suite 1111
Oakland, CA 94612-2138
Hotline: 1-800-541-3259 or 510-208-3200
Fax: 510-208-3110
www.lymphnet.org
nln@lymphnet.org
This one had pictures that didnt come thru, if you want them tell me how to get them to you and I can
Lymphedema Overview -.doc
Lymphedema Overview
What Is Lymphedema: Lymphedema is a condition caused by injury, trauma or congenital defects
involving the lymph system. When the impairment becomes so great that the lymphatic fluid exceeds the
lymphatic transport capacity, an abnormal amount of protein-rich fluid collects in the tissues of the
affected area. There are two types of lymphedema. Primary lymphedema, which can be present at
birth (congenital), develop at the onset of puberty (praecox) or in adulthood (tarda). Secondary
Lymphedema can be caused by surgeries or radiation treatments and is a common side effect of cancer
treatments that remove or damage lymph nodes resulting in the chronic swelling of a body area or part
nearest the damaged portion of the lymph system.
Stages of Lymphedema:
Stage 1: Tissue is still at the "pitting" stage, which means that when pressed by fingertips, the area
indents and holds the indentation. When lymphedema is diagnosed and treatment is begun in Stage1,
and received consistently, the disease in almost all cases cases will be prevented from progressing, there
will be few complications and the patient will live a long, healthy and virtually normal life.
Stage 2: The tissue now has a spongy consistency and is "non-pitting," meaning that when pressed by
fingertips, the tissue bounces back without any indentation forming. Fibrosis found in Stage 2
lymphedema marks the beginning of the hardening of the limbs and increasing size. When diagnosis and
treatment are received in Stage 2 it is possible that through treatment a patient will return to stage one,
and progression to Stage 3 can be prevented. In Stage 2 the patient will have more frequent
complications, the disease will have effected his/her ability to lead a normal life in some regards and
varying degrees of constant discomfort may be present.
Stage 3: At this stage the swelling is irreversible and usually the limb(s) is/are very large. The tissue is
hard (fibrotic) and unresponsive; at this stage some patients consider undergoing reconstructive surgery
called "debulking". The damage is now irreversible; there is potentially serious chronic pain and the
lymphedema patient faces recurring, difficult and expensive to treat complications. A person with Stage
3 lymphedema is often fully disabled by the disease.
In virtually all cases, lymphedema can be halted from progressing once diagnosis is made and treatment
is begun and continued consistently.
Typical examples of Stage 3 are below – this can be prevented!
PICTURES DELETED
Treatment for Lymphedema: The standard of lymphedema care is a multi-phasic, multi-modal protocol
called "complex decongestive therapy or CDT" consisting of manual lymph drainage, compression
therapy, exercises and skin care. It is administered in two phases; a clinical phase and a home care
phase, elements of which are prescribed by the patient's physician and qualified therapist. Initial
treatment by a qualified lymphedema therapist consists of 2-4 weeks of frequent manual lymph drainage
sessions and compression bandaging, specialized decongestion exercises, and instruction in self-care for
the second phase of treatment. After the initial swelling is reduced to a minimum by the professional
therapist, the patient is measured for a compression garment and continues self-treatment at home with
simplified self-lymph draining, self bandaging, exercises while under compression, wearing of
compression garments and meticulous skin care. The goal is to transfer responsibility for ongoing
treatment to the patient, thereby unburdening the healthcare system. But the provision of the materials
necessary for self-care remains the responsibility of the healthcare system, else the patient cannot be
adherent.
PICTURES DELETED
Complications: When lymphedema remains untreated, protein-rich fluid continues to accumulate, leading
to an increase of swelling and a hardening or fibrosis of the tissue. In this state, the swollen limb(s)
becomes a perfect culture medium for bacteria and subsequent recurrent infections (cellulitis and
lymphangitis). Moreover, untreated lymphedema can lead into a decrease or loss of functioning of the
limb(s), skin breakdown, chronic infections and, sometimes, irreversible complications. In the most
severe cases, untreated lymphedema can develop into a rare form of lymphatic cancer called
Lymphangiosarcoma (most often in secondary lymphedema). Since lymphedema is disfiguring, causes
difficulties in daily living and can lead to lifestyle becoming severely limited, it may also result in
psychological distress.
PICTURES DELETED
Cover Letter to legislatures re an LE mandate.doc
Why Legislation to ensure nation-wide Lymphedema Treatment Coverage is desperately needed
Dear Congressman Kissell,
My young son Dylan (DOB 9/29/06) was born with lymphedema, a life-long disease for which there is
currently no known cure. Lymphedema sufferers face great obstacles due to lack of insurance coverage
for their treatment. Despite the fact that this treatment does not fall under any of the categories for which
insurance companies typically justify denial of coverage, my appeals, and those of so many others, have
fallen on deaf ears.
Lymphedema (known many years ago as elephantiasis) has many causes, but most cases are the result
of treatment for cancer. Only one known course of treatment exists; it is used world-wide by the
medical community, it is not experimental and has decades of proven success. The treatment protocol is
low-tech, uses already available facilities and healthcare staff and requires no new expensive
pharmaceuticals or surgery. Yet lymphedema treatment is currently not covered by Medicare, Medicaid
and some private insurance companies.
Treatment for lymphedema is a medical necessity critical to the health and well-being of those who suffer
from the disease. With treatment, a patient can live a long, healthy and virtually normal life. But without
treatment, the disease grows progressively worse, causing severe deformity, disability and pain, and in
some cases even results in death. It has been proven in studies that the cost of treatment, in the long run,
is equal to or less than the cost of treating the ensuing and inevitable consequences which occur when
lymphedema is not properly managed.
The Federal Government has already mandated coverage for the treatment of lymphedema resulting
from breast cancer. However, the Federal Government cannot require private insurers to adhere to
their mandates as State’s can, which has resulted in only some companies voluntarily complying. Of
those companies which do embrace the Women's Health and Cancer Act, many still will not cover
treatment for lymphedema resulting from other causes, and those cases are often far more extensive and
severe. There is no possible justification for this double standard of covering treatment for some but not
for others. These companies only offer coverage to treat the serious, expensive and often chronic
complications, which are the inevitable result of their failure to cover the proper lymphedema treatment
in the first place.
Lymphedema treatment coverage will not increase costs for Medicare and private insurance company’s
or result in the need for an increase in their premiums; these statements are not speculative, but
documented fact. Mandated coverage for lymphedema has been in effect in Virginia since 2004. A
study conducted by the State of Virginia, which collected data during the first three years of the
mandate, proves that the required coverage is essentially cost neutral. Fiscal impact studies performed
in Massachusetts and California also showed the same results - and none of these studies took in to
account the further savings of reduced complications, reduced absenteeism from work, reduced
disability claims, etc. In short, covering lymphedema treatment is a win-win situation; it is good business
and it will bring to an end the needless human suffering resulting from lack of treatment.
For my insurance company to have denied my child coverage for the only known treatment for his
disease was unconscionable, and I could not sit idly by knowing that Dylan would face this struggle over
and over again for the rest of his life if nothing was done. Appeals to my insurance were futile, as is
consistently the case with lymphedema sufferers around the country, despite the fact that I provided
them the same evidence presented to the North Carolina legislature which resulted in the state mandate
being passed. Therefore, it has been proven that it is not possible for patients to right this wrong by
dealing directly with the insurance companies on an individual basis, and passing mandates state by state
will take decades to achieve lymphedema treatment coverage for all Americans.
This is a nation-wide problem and a nation-wide solution is needed without further delay. Please help
me ensure that no man, woman or child anywhere in the United States is ever denied treatment coverage
for their lymphedema again by sponsoring federal legislation to require nation-wide comprehensive
coverage for this disease.
Thank you for your time and consideration,
Heather Ferguson
------------------------------------------
http://www.timesnews.net/article.php?id=9019468
Fly fishing retreats inspire breast cancer survivors
Leigh Ann Laube
Published January 2nd, 2010
Nancy Puckett didn’t fully understand the connection between fly fishing and battling breast cancer until
she spent a peaceful weekend casting a line in the Great Smoky Mountains as part of the Casting for
Recovery program.
The White Pine, Tenn., resident came away from that weekend a changed woman.
“It’s a blessing to me because there’s nothing like it. It’s the closest thing to paradise I can describe on
Earth. It absolutely changed my desire to help others, to tell others about the ladies I met, how many
years some had been in remission, about the courage to get out there in the water and to use my arm,”
Puckett said.
Casting for Recovery (CFR), founded in 1996, is a national non-profit support and educational program
for breast cancer survivors. CFR offers free retreats tailored to promote and support mental and
physical healing through shared experiences and the learning of new skills. At the end of 2008, CFR had
had served 3,500 women in 269 retreats across the country.
During the two and a half day retreats, the sport of fly fishing is used to promote physical, emotional and
spiritual healing. The program allows women to get away from their cancer, but provides gentle exercise
through fly fishing as well as support from medical and psychosocial professionals.
Puckett was diagnosed with breast cancer in April 2005. She was later diagnosed with lung cancer. She
applied for Casting for Recovery, but wasn’t selected to participate that first year.
“So I just asked God to bless the person who was [selected] and that it would benefit them. The next
year [in 2008], I put my name in again, and I was selected to go. I had an opportunity with Casting for
Recovery to be with women who truly understood and continue to understand the battle that I’m
fighting. The concept of the fly fishing entails many things. It builds your self-esteem, makes you active
and use muscles and strength that I had forgotten I had,” she said.
“I had the privilege of having my own fly fisherman guide who was so kind and helpful. He never
became upset because he had helped with Casting for Recovery many times. His name was Charlie.
Casting for Recovery just changed my life. I love to fly fish. I do it in the winter. In November, I was
out. I had myself geared up, layered up and was tossing that rod. I do it just for the peace and the
therapy. To me, it’s an individual thing and it’s a talent or a gift or skill that can never be totally
mastered. The more you do it, the better you get at it.”
Puckett said fly fishing serves as a weekly date that she can do with her husband.
Puckett suffers from lymphedema — a swelling caused by a blockage in the lymphatic system — in her
left arm. Fly fishing taught her to use that arm again.
“It’s probably the most therapeutic activity that I have been able to do since I’ve been able to use my
arm. The fly fishing helps me relax and not think about the fact that I had cancer,” she said.
Mary Johnson, from Shady Valley, Tenn., has been a fly fishing instructor in the Tri-Cities area for more
than a decade, and she belongs to an all-women fly fishing chapter in the Smokies. She’ll serve as a
leader for the Casting for Recovery retreat scheduled for April 2010 in Gatlinburg.
“It’s just such an incredible thing, and I have seen women who have just blossomed. The rest of their life
has just spun out of control, and this one weekend they can be with other people who understand where
they are in their life. They’re outside. They learn to tie flies. They’re on a fabulous private trout stream
stocked with fish,” Johnson said.
Casting for Recovery relies on local volunteers and organizations to support its community-based
retreats.
“The retreat leaders and staff raise all the money. All these women get to come on full scholarship,”
Johnson said. “They get free lodging, meals and instruction. We get lots of donations, cash and door
prizes. The community supports this program, and it’s absolutely heartwarming.”
It might seem an odd combination — teaching breast cancer survivors to fly fish — but to Johnson, it’s
not only about providing a healing connection the natural world and relieving everyday stressors, but fly
fishing techniques provide gentle exercise for joint and soft tissue mobility.
“The actual surgery that these women have had to go through, the motion of casting helps them stretch
out those muscles,” Johnson said. “Because it’s an above-your-shoulder thing, your hand is up in the air.
It doesn’t compromise the lymphedema aspect. So there are physical reasons, but there are also women
instructors, so it makes the women more open to talk about what they’re going through. ... It gives them
such hope. It’s a beautiful thing to watch.”
Though the focus of the weekend is on fly fishing, Casting for Recovery does make available to the
women a psychotherapist, and a health-care professional, such as a physical therapist or nurse.
“It is all about fly fishing, but if someone wants to avail themselves of someone in those fields, they’re
available for free,” Johnson said.
Participants learn the fundamentals of fly casting, entomology, knot-tying and equipment basics, but most
importantly, they spend time on the water practicing catch-and-release fishing.
The Gatlinburg retreat is the closest retreat for women in the Tri-Cities. It will take place April 9-11 at
the Lodge at Buckberry Creek. A second retreat will be held March 19-21 at Tumbling Creek Lodge in
McEwen, Tenn. McEwen is located in Humphreys County, west of Nashville.
Tennessee retreats are for Tennessee residents, Johnson said, and the Gatlinburg retreat can
accommodate 15 women. To be eligible to attend a retreat, you must be a breast cancer survivor at any
stage. Participants for each of the scheduled 2010 retreats will be selected at random from all eligible
applications received by Casting for Recovery by the retreat deadline. There is no cost to participants to
attend, other than the expenses involved in traveling to and from the retreat location.
Although women can participate in a retreat only once, there are some reunion weekends being planned
for past participants, Johnson said.
The Gatlinburg retreat will go on regardless of the weather, she said. “We’ve done this in the snow, and
everybody loved it. Last year, we had a bear on the porches of the lodge. The year before it snowed.
Nothing stops this,” she said.
During their special weekend, participants are treated like queens, Puckett said. “When you go in, you’ll
find roses on your bed with mints, or someone knocks on your door with chocolate chip cookies. Prizes
are given each day that are donated just for these women for that weekend. It’s like you are a
celebrity,” she said.
Puckett caught a small native trout during her fishing adventure, and shared the joy with the others.
“Regardless of who caught what size, it was like someone won a million dollars,” she recalled. “The
unity among these ladies was just grand. Of course everybody wanted to catch the big one, but we were
so excited with whoever caught whatever.”
The deadline to apply for the Gatlinburg retreat is Jan. 20, 2010. The deadline to apply for the McEwen
retreat is Jan. 8, 2010. The only Virginia retreat will be May 19-21 in Orkney Springs. Application
deadline is March 12, 2010.
For more information about the Vermont-based Casting for Recovery, or for an application, call (802)
362-9181 or visit www.castingforrecovery.org.
http://www.news-press.com/article/20100105/COLUMNISTS40/100104060/1013
Melanie Payne
January 5, 2010
Melanie Payne: Another complication I certainly did not need
One reason I wanted to avoid the lymph node surgery was because of a possible complication called
lymphedema.
Before I had the surgery, I went to see a specialist, Ellen Poage, a certified lymphedema therapist.
Lymph nodes work as filters and help the body fight infection. They drain away proteins, salt, water and
white blood cells.
If the lymphatic system isn’t draining correctly, lymph fluid builds and causes swelling, or lymphedema.
Lymphedema is not uncommon in women who have had lymph nodes removed because of breast
cancer. But it’s much more common in women who have all or most of the lymph nodes removed than
those who have only one or a few removed in the sentinel node procedure.
Poage, who is also a registered nurse, took pre-operative measurements of my arms and gave me
exercises to do that would lessen the chances of me getting lymphedema.
Poage also told me what types of lifestyle changes I should expect, such as not lifting extremely heavy
objects and not get my blood pressure checked or injections in my right arm.
Because my type of breast cancer, Ductal carcinoma in situ, or DCIS, was slightly more aggressive and
had begun to break out of the milk duct, I had a sentinel lymph node biopsy in the very unlikely event the
cancer had spread.
The biopsy involves injecting a radioactive dye in the breast and then removing the primary lymph node
or nodes that drain fluid from the breast. The thought is these are the most likely to contain cancer cells if
the disease has spread.
Poage said women often believe that because they only had one or two lymph nodes removed in this
procedure — I had four — that they are not at risk for lymphedema.
This is not true, she said.
“By taking out a lymph node, the capacity (of the system) has been reduced,” Poage said when I
interviewed her recently. “That puts the person at risk. Everyone who has had a lymph node removed is
at risk for lymphedema.”
Also increasing the risk for lymphedema is the radiation treatments, Poage said.
Radiation causes inflammation and that can lead to lymphedema.
Lymphedema can develop years after the surgery, Poage said. So often physicians won’t recognize that
a woman has lymphedema when she comes into the office with swelling in her arm or hand.
Worse, some doctors tell women they simply need to “live with it,” Poage said. The swelling isn’t usually
painful, but it can cause numbness, an achy feeling from the tight stretched skin, and it is uncomfortable
and unsightly.
If lymphedema does develop, Poage said, see a certified lymphedema therapist right away.
A therapist can use massage to help drain the fluid, provide skin care, fit you with a compression sleeve
and help you develop exercises that will alleviate the swelling.
----------------------------------------
http://www.curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/1312
Pumping Iron
BY LACEY MEYER
In the past, doctors advised breast cancer survivors with lymphedema to avoid heavy lifting because of
the possibility of infection and symptom flare-ups. But a study, published in August 2009 in The New
England Journal of Medicine, shows that weight-lifting may actually be beneficial and help reduce
lymphedema symptoms, not exacerbate them.
According to lead author Kathryn Schmitz, PhD, of the University of Pennsylvania Abramson Cancer
Center, the study shows that participating in a safe, structured weight-lifting routine can help women with
lymphedema take control of their symptoms and reap the many rewards of weight-lifting on their overall
health as they begin life as a cancer survivor.
Removing lymph nodes alters the body’s ability to respond to inflammation, infection, trauma, and injury,
Schmitz says, and “exercise, apart from this study, has been known for a long time to improve the body’
s response to injury, infection, inflammation, and trauma.”
The year-long study involved 141 breast cancer survivors with lymphedema; half took part in a twice-a-
week, slowly progressive weight-lifting program and the other half did not. The weight-lifting program
included stretching, cardiovascular warm-up, abdominal and back exercises, and weight-lifting
exercises. Women in the weight-lifting program began with very light weights and gradually increased by
the smallest possible increments. During weight-lifting, participants wore a custom-fitted compression
garment on the affected arm and were monitored by a lymphedema specialist throughout the study.
Strength training (weight-lifting) exercises—specifically training the affected limb—reduced the risk of
aggravating the condition because these women had trained their arms in a way that they would be less
likely to hurt themselves during daily activities, such as carrying heavy groceries or lifting a child. Women
in the weight-lifting group also had greater improvements in self-reported severity of lymphedema
symptoms and upper- and lower-body strength. They also had a lower incidence of lymphedema
exacerbations as assessed by a certified lymphedema specialist (14 percent in the weight-lifting group
had flare-ups versus 29 percent in the control group). In each arm of the study, however, the proportion
of women who had an increase of 5 percent or more in limb swelling was similar: 11 percent in the
weight-lifting group, and 12 percent in the control group.
But these results don’t mean it’s OK to throw all lymphedema precautions and activity restrictions out
the window. Women with lymphedema should always be extra cautious when doing any strenuous
activity or heavy lifting with the affected arm because of the increased risk of injury and added stress.
When doing work where there may be injury to the skin, such as gardening, it is best to wear protective
gloves. Women with lymphedema should also avoid getting I.V. lines, shots, or blood drawn in the
affected arm and always be aware of any changes, such as heaviness, puffiness, fullness, achiness, or
redness in a certain area, and see a doctor immediately if any of these occur.
“Those [traditional] guidelines are real and should always be used,” Schmitz says, “but the likelihood that
[women with lymphedema] are going to hurt themselves with the occasional activities of life that require
a lot of the upper body will be reduced if they will engage in upper body strength training.”
Breast cancer survivor Sharon Cowden, MD, helped create an exercise DVD, Strength & Courage:
Exercises for Breast Cancer Survivors, for survivors with lymphedema to use at home. Cowden
underwent an axillary node dissection seven years ago, which put her at increased risk for lymphedema.
She credits exercise and weight-lifting with helping her regain upper body strength and flexibility.
“I’m a pediatrician, so I lift kids all day—a lot of kids,” Cowden says. “Also, I’m a golfer, and upper
strength and flexibility are necessary for a good game. My game has never been better. My handicap
has dropped 10 points since my surgery in large part because of these exercises.”
Because up to 62 percent of all breast cancer survivors have some kind of arm or shoulder problem
resulting from curative surgery, reconstructive surgery, or radiation therapy, Schmitz recommends
survivors have a physical therapist evaluate their shoulder and arm for general weakness or changes in
range of motion that may require treatment prior to starting an exercise program with the upper body.
“It would be a terrific safeguard to go see a physical therapist,” Schmitz says, “even if you don’t have
lymphedema, even if you had few lymph nodes removed, or no lymph nodes removed.”
For some women with lymphedema, however, weight-lifting and strength training may cause more harm
than benefit, Schmitz says. This includes women with a lot of symptoms and whose lymphedema is
“really reactive. She has a lot of flare-ups and fluctuations, her limbs get bigger and smaller over the
course of weeks, or she finds herself at the physical therapist often. She’s likely not going to do well with
strength training.”
Although several previous studies have suggested weight-lifting is safe for breast cancer survivors, the
recent NEJM study is the longest and largest to date.
Another strength of the study is its delivery in community fitness centers—primarily YMCAs that offer
the LIVESTRONG program, a collaboration between the Lance Armstrong Foundation and the
YMCA to develop programs specifically for cancer survivors—which will facilitate future dissemination
of the weight-lifting program. However, this study had only one year of follow-up and lymphedema can
sometimes develop 5 to 10 years after surgery.In addition to consulting a doctor and physical therapist,
Schmitz offers a few tips for women interested in embarking on a new weight-lifting routine:
1. Start low, and progress slowly. Start with the lowest possible resistance with the weight. If you are
using a dumbbell, it should be a 2-pound dumbbell or something very light. If using a machine, it should
be set on the top plate. Progressing slowly means that you should do a couple of sessions for each
upper body exercise before you increase the resistance. When you do increase the resistance, do so by
a small amount. Increases in weight should be made gradually, and only after a week or two of doing the
exercise at least twice a week to ensure you aren’t having any worsening of symptoms.
2. Listen to your body and respond to your symptoms. If you have a change in upper body symptoms
that would be consistent with the symptoms of lymphedema—a sense of heaviness, fullness, puffiness,
achiness, and/or redness in a particular area, that would be associated with a cellulitic infection, which
means you should stop immediately and see a physical therapist.
3. Learn and use perfect form. Find a trainer who can teach you how to do the exercises properly. For
example, back muscles are really big and wrist muscles are not, so if you try to finish a back exercise
with your wrist, you will create inflammation in your wrist from doing too much with the tiny wrist
muscles.
4. Ease back into it. If you take a break from exercise, either because you have a cold or are on
vacation for a week, you need to back off on the resistance and rebuild again.
5. Get the goods. Always wear a well-fitting compression garment during weight training. Consult with a
physical therapist or lymphedema specialist on how the compression band should fit and where to get
one.
6. Find help. Find a lymphedema therapist through the National Lymphedema Network or a specialized
trainer with the YMCA program to instruct you a few times before exercising on your own. If you can’t
find a trainer in your area, check out Cowden’s Strength & Courage DVD, available online at http:
//www.strengthandcourage.net/dvd/research.aspx
-------
http://www.herald-mail.com/?cmd=displaystory&story_id=238886&format=html
Robinwood series addresses women's health
By CRYSTAL SCHELLE
February 1, 2010
For years, it's been the embarrassing secret women didn't even want to talk about to other women.
A study by Kaiser Permanente in 2008 found that one-third of women suffered from urinary
incontinence, which is the accidental, unintentional release of urine.
Urinary incontinence can happen anytime and anywhere, making daily activities often difficult. That's why
physical therapists Andrea Rankin and Karla Trotta, with Total Rehab Care at Robinwood Medical
Center, want women to know that there is help.
Rankin and Trotta are leading the first in a weekly series of presentations during February on problems
that affect women. The series is called "Let's Talk, Ladies." Hosted by Total Rehab Care, the first one is
Friday, Feb. 5, and addresses urinary incontinence. Other topics will be pelvic pain, Lymphedema and
osteoporosis.
Although incontinence has often be thought of as an older woman's problem, Rankin said women of all
ages - including those in child-bearing years and even as young as 12 - could learn something from the
workshop.
"Urinary incontinence is not a disease," Trotta said, "it's really a symptom."
Urinary incontinence happens when the muscles that support the bladder become weak. Because it is
muscle-related, Trotta said, physical therapy helps.
Many things can cause a woman to develop urinary incontinence, she said. These include the stress of
childbirth, urinary tract infections or diet - such as drinking too much fluid, drinking too little fluid, or
consuming beverages that are too acidic.
Rankin said there are three main types of urinary incontinence:
• Stress - When muscles around the urethra are weak, sneezing, coughing or laughing increases pressure
on the muscles and causes leakage.
• Urge incontinence -This is the sudden feeling a woman has that she must go to the bathroom.
• Mixed incontinence - This includes symptoms of both stress and urge.
Rankin said physical therapists can help a woman strengthen her pelvic-floor muscles. One way is
through teaching women the proper way to do Kegel exercises. Trotta said the key is doing the simple
exercises properly.
"A lot of women bulge the pelvic floor, instead of lifting it," she said.
She said physical therapists can use a biofeedback unit to see if a patient contracts her muscles properly.
Rankin said therapy for urinary incontinence can include other exercises and sometimes surgery.
Both Rankin and Trotta said it's hard to predict how long a woman must participate in therapy. Rankin
said it's dependent, oftentimes, on the patient herself to make sure she is following through outside the
therapy room.
"We always say the ball's in their court," she said.
On average, Rankin said it will take about three months before a woman feels she can safely do her
regular activities without an extra maxi pad or Depends stuffed in her purse for emergencies.
"Gradually she'll gain the confidence when she can go out in public," she said.
Both therapists said they are excited about offering the Let's Talk Ladies presentation. They want to get
the word out about what can be done to help women with urinary incontinence.
Some men also have urinary incontinence issues, Trotta said, and they are welcome to attend the talks.
"We want to educate them and let them know that this isn't something normal that they have to tolerate,"
Trotta said. "And this is information that can take back to their sisters, mothers, aunts or adult children.
That's why it's called Let's Talk Ladies."
--------------------------------------------------------------------------------
If you go ...
What: Let's Talk Ladies
When: 8 to 9 a.m. Fridays, Feb. 5 through 26
Where: Robinwood Medical Center, room 122 (yellow entrance by the waterfall), east of Hagerstown
Cost: Free
Contact: Contact Mendy Bishop at 301-790-8649 or mendy.bishop@wchsys.org
Topics:
Feb. 5 - Incontinence
Feb. 12 - Pelvic pain
Feb. 19 - Lymphedema
Feb. 26 - Osteoporosis
------
Medical Center opens in Scottsdale
Staff Report ~ 2/3/2010
Desert Springs Cancer Care Center, the first medical oncology practice located north of Loop 101 in
Scottsdale and first green-built facility in Arizona, is now open. The 5,000 square-foot outpatient clinic’s
traditional patient services include: medical oncology and hematology consultations; chemotherapy and
all therapeutic infusions; and on-site pharmacy and laboratory. The practice will also offer lymphedema
therapy, organic manicures and pedicures, classes on patient nutrition and skin care, yoga, on-site wig
and prosthetic services and a boutique with vitamins, jewelry, fashion, make-up and more.
Some of the sustainable properties include: automatic lighting and CFLs; tinted and shaded windows;
low water usage plumbing and 100 percent copper piping; low odor/zero VOC paint and more.
Desert Springs Cancer Care Center is located on the northeast corner of Scottsdale and Deer Valley
Roads. The address is 21803 N. Scottsdale Road in Scottsdale, and the clinic is open from 7 a.m. to 7
p.m. seven days a week. Desert Springs Cancer Care Center accepts most forms of insurance. For
information, visit www.desertspringscc.com.
http://www.thefoothillsfocus.com/020310-medical.asp
-----
Tummy Solutions - Lypossage
February 3, 2010
Comments (0) Recommend Print this page E-mail this article Share
Del.icio.us Facebook Digg Reddit Newsvine
Buzz up!Twitter FarkIt Type Size A A A Q. Why Do I Have Cellulite, Lumps, and Bulges?
A. The fatty tissue of your body acts as its "toxic waste disposal site," where substances that it cannot
metabolize are dumped. This congested tissue has poor blood circulation (you'll notice that cellulite-
prone areas are cool to the touch.) Lymphatic flow may also be restricted by tight undergarments and
pantyhose. Lypossage cleanses the body of stagnant, stalled lymphatic fluid (lymphedema) that can
create the lumps and bulges we know as figure imbalance. The deeper Lypossage strokes break up
adhesions under the skin that can contribute to the dimpled, uneven appearance of cellulite. Lypossage
also tones the muscles, lifting and firming sagging tissue.
http://www.theleafchronicle.com/article/20100203/ASKEXPERT/100202006
----------------
http://savannahnow.com/sports/2010-02-05/grandmother-walk-tybee-half-marathon
Grandmother to walk Tybee half-marathon
68-year-old raising money for lymphatic research
Posted: February 5, 2010 - 12:16am
Advertisement
By Noell Barnidge
The idea came to Wanda Glass in the middle of the night.
The 68-year-old resident of Sun City Hilton Head, a retirement community in Bluffton, S.C., had been
searching for a way to raise money for lymphatic research. Her grandson, 12-year-old Will Miles, was
born with primary lymphedema, a disease in which excess lymphatic fluid collects in tissues and causes
them to swell.
Glass flirted with the idea of securing sponsors and walking from her home to Miles' home on Hilton
Head Island.
"But that wasn't a practical situation because it's dangerous," she said Thursday night. "Then (the Critz
Tybee Run Half-Marathon and 5K on Tybee Island) came up and I thought, 'This is what I'm going to
do.' "
Glass is registered to walk 13.1 miles in Saturday's half-marathon. She is accepting sponsors for her
walk via a per-mile basis or flat donation to the Community Foundation of the Lowcountry to benefit the
Will Miles Lymphatic Research Foundation.
"I'm praying that there will be lots of interest," Glass said. "All this money will go to research. Every
penny."
To sponsor Glass or to make a donation, visit www.cf-lowcountry.org. Scroll over the "give" banner,
click on "Donate Online," click "Field of Interest Funds" and select the Will Miles Lymphatic Research
Fund.
"It's been my passion to make people aware of this disease so that money can be raised for research,"
Glass said. "I want to see him cured. A lot of cancer patients have this, too, as adults; especially breast
cancer patients.
"The lymphatic system is probably one of the most important systems in your body because it transports
the toxins out of your body. When that doesn't work, then you've got issues."
Glass has been training for the Tybee Run at her Sun City home.
"Last Friday, I tried to do the 13-mile," she said. "I walked for three hours and did 12.7 miles, so I
shouldn't have any trouble. They give you 3? hours Saturday to accomplish it. I should be able to do it.
I'll pick up the pace a little bit."
Today is the deadline to register for the Critz Tybee Run Half-Marathon and 5K on Tybee Island. The
event will be capped at 3,000 participants: 1,500 runners in the half-marathon, 1,500 runners in the 5K.
The cost is $45 for the half-marathon and $35 for the 5K. Participants cannot register the day of the
race. To register, visit www.active.com. For more information, and to download a registration form and
route maps, visit www.critztybeerun.com.
The 5K will start at 8 a.m. at the north end of the island, near the lighthouse. The half-marathon will
begin at 8:30 a.m. at Butler Avenue and 15th Street. Both races will end on Tybrisa Street near the pier.
CRITZ TYBEE RUN
What: Half-marathon and 5K
When: Saturday, 5K at 8 a.m.; half-marathon at 8:30 a.m.
Where: Tybee Island
Registration: www.active.com
Info: call 912-355-3527.
------------------------
http://professional.cancerconsultants.com/oncology_main_news.aspx?id=44589
Early Physiotherapy May Prevent Lymphedema After Axillary Lymph Node Dissection
Researchers from Spain have reported that women who undergo axillary lymph node dissection for
early-stage breast cancer and receive physiotherapy for one year after surgery have less lymphedema
than women not receiving such therapy. The details of this study appeared in the January 16, 2010 issue
of the British Medical Journal.[1]
Lymphedema refers to swelling of the arm due to an accumulation of lymph fluid. It commonly affects
women who have had axillary lymph nodes removed for the staging of early breast cancer. The most
common chronic side effect of axillary lymph node dissection is lymphedema. Early postsurgical
rehabilitation improves mobility and shoulder function but has no effect on lymphedema. Researchers
from the University of Pennsylvania have recently reported that a program of twice weekly, slowly
progressive weight lifting increased strength and reduced lymphedema symptoms without affecting arm
and hand swelling in breast cancer survivors with stable lymphedema.
The current study involved 116 women who had lymph node dissection for early-stage breast cancer
between 2005 and 2006. All women in the study received an educational status, and half were randomly
allocated to receive early physiotherapy by a physiotherapist. The physiotherapy program included
“manual lymph drainage, massage of scar tissue, and progressive active and action assisted shoulder
exercises.” The study period was one year.
Lymphedema developed in 14 women (25%) in the control group and four (7%) in the physiotherapy
group.
Lymphedema developed four times earlier in the control group compared with the treated group.
Comments: These authors concluded: “Early physiotherapy could be an effective intervention in the
prevention of secondary lymphedema in women for at least one year after surgery for breast cancer
involving dissection of axillary lymph nodes.”
Reference:
[1] Lacomba MT, Sanchez MJY, Goni AZ, et al. Effectiveness of early physiotherapy to prevent
lymphoedema after surgery for breast cancer : randomised, single blinded, clinical trial. British Medical
Journal. 2010;340:
----------------------
http://www.wireservice.ca/index.php?name=News&file=article&sid=2152
News by LymphedemaDepot
--------------------------------------------------------------------------------
Most-read story in Health:
100% CERTIFIED ORGANIC POMEGRANATE FACIAL OIL
Lymphedema Depot brings Solaris Products to British Columbia
Published on Monday, February 08, 2010
Lymphedema Depot is bringing Solaris compression products for lymphedema and other chronic
swelling conditions to presentations in Burnaby and Victoria, BC.
Lymphedema Depot, the exclusive Canadian distributor of Solaris compression products for the
treatment of lymphedema and other chronic edemas will be appearing at a conference in Burnnaby, BC,
near Vancouver, and will also be hosting an open house and product demonstration in Victoria, BC for
all interested parties.
The Victoria event will take place on Friday, March 5, from 12:30 in the afternoon to 5:30 pm. It will be
held at The Emily Carr Branch of the Greater Victoria Library, 3500 Blanshard Street, Victoria. John
Mulligan will present the Solaris compression products including the Solaris Tribute, Caresia bandage
liners, Swell Spots edema and fibrosis pads and ReadyWrap inelastic medical binders for chronic
venous insufficiency and other conditions.
"This will be our first opportunity to present the Solaris products to the Vancouver Island health care
community and patient population," says Mulligan. "We are looking forward to meeting the fitters,
therapists and medical garment retailers on the Island, as well as interested patients who want the best in
medical compression devices." There is no charge for this event. For more information, contact
Lymphedema Depot at 905-687-8500.
On Saturday, March 6, 2010, Lymphedema Depot will be presenting and talking about Solaris
compression products at the British Columbia Lymphedema Association's first Lymphedema Awareness
Day in Burnaby, BC. The event will be held at Bonsor Recreation Complex, 6550 Bonsor Ave,
Burnaby, BC, from 8:30 am to noon. The event is free but registration is required. For more information
please contact the BCLA at 866-991-2252 or visit their website at www.bclymph.org.
"We are very excited to partner with the BCLA on this first Lymphedema Awareness Day event. They
have lined up an excellent program of speakers and product vendors. This will be a wonderful
opportunity for the lymphedema care community and patient population to come out and find out more
about lymphedema and the care of this condition," states Mulligan. "They will also get a rare opportunity
to see the finest in lymphedema care products first hand and get to ask questions and obtain valuable
information from the vendors. I will be there to showcase the Solaris compression products which I
believe are the finest compression products on the market and make living with lymphedema and other
chronic swelling conditions easier, bringing simplicity, elegance and effectiveness to a self-care regimen
that formerly was frustrating, difficult and time-consuming."
"Breast cancer survivors and survivors of other cancers, often experience chronic swelling as a result of
damage to the lymphatic system," according to Mulligan. "Solaris compression products are designed to
address swelling resulting from lymph node removal, cancer treatments, mastectomy and lumpectomy.
The same products can also be used to address swelling from chronic venous insufficiency, lipedema,
dependent swelling, post-surgical swelling, primary lymphedema and other disorders of the lymph
system."
For more information about these events or about Solaris compression garments in Canada, visit www.
LymphedemaDepot.com, or call us at 905-687-8500.
----------------------------------------------
By DR. PAUL DONOHUE
Dear Dr. Donohue: My mother-in-law is 71 and does not like going to the doctor. For the past two
years, her right leg swells up every day. She says that when she wakes up, she is fine and the leg doesn't
hurt. She refuses to see a doctor. My husband said, "I'm taking you," and she started crying. Is there
anything you can say to encourage her to see a doctor?
- Anon.
A: I can assure your mother-in-law that doctors aren't such bad people. She might be surprised and
actually like the one she sees. She has to find out the cause of her swelling and the appropriate treatment
for it. Delaying treatment can lead to changes that are close to impossible to undo.
Our bodies are supplied with lymph vessels, tiny hoses that suction up tissue fluid and return it to the
circulation. When something obstructs those lymph vessels, fluid remains in that part of the body. Most
likely, this is what's wrong with your mother's leg. She has a lymph-vessel obstruction that causes her leg
to swell. It goes down at night because the leg is elevated and gravity stops pulling fluid into the leg.
Or she could have trouble with the veins in her legs. Their valves might not be working well. In that case,
blood stays in the leg veins and fluid oozes into the tissues.
If your mother-in-law is adamant about not consulting a doctor, she can do some things that will help her
leg. She must elevate her leg as often as she can and for as long as she can during the day. By
"elevation," I mean her leg has to be higher than her heart. She can attain that position only by lying
down with her leg propped up on pillows. She should never cross her legs when she's sitting. A swollen
leg encourages infections, so she should never go barefoot or wear sandals. Compression hose (elastic
hose), preferably fitted for her leg, squeeze fluid out of the leg and back into the circulation.
The booklet on edema and lymphedema (swelling) discusses these matters and their treatment in detail.
To obtain a copy, write: Dr. Donohue - No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a
check or money order for $4.75 with the recipient's printed name and address. Allow four weeks for
delivery.
Cure for dry mouth
Dear Dr. Donohue: I take high blood pressure medicine, and it gives me a dry mouth. It keeps me
awake all night. I gargle with Biotene, but that doesn't last long. Can you suggest something else?
- G.J.
A: Have you asked your doctor for a different blood pressure medicine?
I can give you the names of a number of products that might keep your mouth moistened longer.
Numoisyn Lozenges and Numoisyn Liquid require a doctor's prescription. OraMoist, a time-release
disc that sticks to the roof of the mouth, can keep the mouth from drying out for many hours. You can
find it in most drugstores. MouthKote Oral Moisturizer and spray work well. Biotene also comes as a
gel, and that might last longer than the gargle preparation you're using.
Medicines that promote saliva production include pilocarpine, Salagen and Evoxac. You need a
prescription for these.
Best time for flu shot?
Dear Dr. Donohue: When is the best time to get a regular flu shot? I read that the shot is effective for
only four months. Getting it in September or October will leave you unprotected from January on.
- R.H.
A: Vaccines promote the production of antibodies, ammunition against germs. Within two weeks of the
flu shot, antibodies to the flu virus are at a level high enough to afford protection. Peak antibody levels
are reached in two to four months. They remain high for some time. By the next flu season, however,
their level has waned and protection is gone.
Influenza most often hits its high attack rate in January and February. Vaccine administered as early as
September still affords good protection in those months and later. October is the usual month for
vaccination, but it can be effectively given in November and December, and even into January.
Dr. Paul Donohue writes for North America Syndicate. Send letters to Box 536475, Orlando, FL
32853-6475.
http://www.herald-review.com/news/opinion/editorial/columnists/dr_donohue/article_f9976174-b521-
5c37-9d21-9f6e10bfd175.html
Possible state cuts worry Tri-City seniors
By John Trumbo, Herald staff writer
KENNEWICK — Elderly and disabled senior citizens in the Tri-Cities are speaking out to prevent
billions of dollars worth of services from being cut from the state budget later this year.
From $2 billion to $3 billion could be lost from the $31 billion state budget under proposed cuts from
Gov. Chris Gregoire's budget , said Virginia A. Janin, a coordinator with Southeast Washington's Aging
and Long Term Care office in Kennewick.
Janin and several senior citizens held a news conference Wednesday at the agency's offices in
Kennewick to explain the importance of fully funding the programs.
"I am very grateful for the services I've received through aging and long term care," said Denise Brown
of Richland.
Brown, who suffers from lymphedema and cerebral palsy, said the in-home care she receives is the only
way she can continue to stay in her home. "Please keep these services available and make the cuts
elsewhere," she said.
In-home care, the Meals on Wheels program and reductions of other services for seniors could affect
dozens of clients in the Tri-Cities, said John Rupp, CEO for the Kennewick nonprofit Senior Life
Resources Northwest, which administers several programs, including Meals on Wheels, in Benton and
Franklin counties.
Rupp said state budget cuts in 2009 already trimmed 15 percent in funding affecting the number of hours
of service to seniors, and that health, dental and insurance reductions would come in 2010 unless the
governor and legislators find a way to buy back the proposed cuts.
Larry Gettman, one of 30 volunteers who take Meals on Wheels door to door weekly, said clients
eagerly await the deliveries and visits.
"I go to homes three days a week and see people who are ready to meet someone at the door. It helps
them get up and going for the day," he said.
Dorothy Stone, 87, of Kennewick, said she depends on the services provided through the Aging and
Long Term Care office.
"I really appreciate the Meals on Wheels and I go to the senior center twice a week, and the day care
on Wednesdays. I really appreciate them," said Stone, who is blind, hard of hearing and has heart
trouble.
Stone's son, Ed, who is her care provider, said his mother would not be able to remain in her own home
without the state's assistance.
"They really do a good job. These services help keep a family together. I believe it costs (the state) less
than if she had to be placed in a care home," Ed Stone said.
Dorothy Stone's husband died in 1986, and she lived alone without state help for 20 years. But when
she started two fires trying to cook her own meals about five years ago, her son decided he needed to
do something to get her the help she needed.
"This program allows me to stay with her," said Ed Stone, who also was taking care of his grandparents
in Toppenish until they died a few years ago.
Janin said the governor's proposed cuts in seniors services and people with disabilities can be reduced if
legislators are willing to make cuts elsewhere.
"This is not a good time to receive cuts. It will be very difficult to gain the funds back," said Marcee
Woffinden, Meals on Wheels program director at Senior Life Resources Northwest.
-- John Trumbo: 582-1529
Inimitable Mary Ann
Even out of her checkstand for two years, customers still care about Mary Ann Corbin
By Rodger Nichols
The Chronicle
Some people are perfectly fitted to what they do. It’s hard to imagine them doing anything else. And
when they fit so well, you miss them when they’ve gone.
For the past two years, Safeway customers in The Dalles have been missing Mary Ann Corbin.
Even if you didn’t know her name, you knew who she was — the feisty lady with the short dark hair
who had a word or a smile or a horrible pun for everyone who came through her line.
Many customers automatically headed for her checkstand, no matter if it meant waiting in a longer
line, sometimes even if there were other checkstands open.
“Safeway had a policy that you shouldn’t have to stand in line and they’d drag you to another line,”
Corbin said. “The people in my line wouldn’t go and the manager said ‘You’re ruining my policy!’ I said
‘It’s not me; it’s those guys [the customers]. You want to kick them out?’”
Corbin has kept the scrappy attitude she learned growing up in Kentucky. It’s a quality she would
need over the years.
“My dad had a bar, and I didn’t like living in a bar. All I wanted was out,” said Corbin. “I graduated
on Tuesday; I started working in Cincinnati on Wednesday and on Sunday I moved there.”
The 20-mile trip from her home town to the bright lights was a much longer move in lifestyle.
“I lived in a town the size of Mosier and I went to a town bigger than Portland,” she said.
In Cincinnati, she met her future husband, Donald. They were married in 1969. He talked her into
moving to Oregon; first to Woodburn then The Dalles.
Sons Kevin and Sean arrived in 1971 and 1972.
Corbin worked at the old Jantzen swim suit plant in Hood River until the plant closed down. She
started at Safeway in November 1979.
That led to the end of her marriage.
“When I started selling groceries, I didn’t realize he was living another life, because I was in Hood
River all the time,” she said. “When I filed for a divorce, Ron Somers said ‘What took you so long?’”
She never remarried. “I didn’t have patience to find another one,” she said. “I was taking care of
these two boys. I don’t need another one to raise.”
Being a single mom had its problems, but she said there was help as well.
Both her sons were heavily involved with baseball at all levels, which she said brought her into contact
with a number of people she wouldn’t have met otherwise.
“If you can keep kids busy in the fields and off the streets, you’ve got it made,” she said. “And in a
small town, people tell you what’s going on.”
Corbin started on the swing shift at Safeway.
“I’m not a night person,” she said. “That was hard on me. And with boys in the house, you don’t
want to be gone at night.”
In two months she earned her way to the 10 a.m. to 7 p.m. shift. That’s where she stayed until breast
cancer forced her off the job in 2007.
For 28 years, she worked at brightening people’s days.
“When you go into a grocery store you don’t want to be there,” she said. “It’s a bad mood to begin
with. So I tried to know what was on sale, where it was at, if we were out, what we would substitute. I
was the mother-in-law, you know. Nag, nag, nag. That’s what you need.”
Most of that “nagging” was directed at helping customers
“John Wolf, the lawyer would come into the store and I’d yell ‘John, get an Oregonian. Open up the
Living section; there’s a $10 coupon.’ They’d just come back from church and hadn’t seen it yet.
“Or I’d tell him to buy five Coca-Colas and when he’d come through the line, I’d tell him that if you
buy two, you get three free. He would always thank me.
“Randy [Dodd, the store manager] hated it when I did that.”
She loved steering people to better deals and would send a “courtesy clerk” running down the aisle to
swap out something in the customer’s grocery cart for something better once she’d talked them into it.
Over the years, she rang up sales for orchardists, aluminum plant workers — who would buy steak
dinners in good times — and once, a couple of very tall black guys who turned out to be members of
the Portland Trailblazers.
She sold panty hose to guys when Mt. St. Helens blew its top, so they could cover the air filters in
their cars against the volcanic ash.
She sold expensive imported beer and gourmet items to Rajneesh followers and food to the Salvation
Army the day the commune dumped busloads of homeless people from Portland at the Salvation Army
just across the street.
Then there was the time the store was robbed during Cherry Festival in the 1980s.
“The guy with the gun is behind me. I’m thinking ‘Oh, sweet Jesus, I’m raising kids and this guy’s got
a gun. Down. That’s where you want to go, Mary Ann.’
“And pretty soon, all hell broke lose. City cops showed up. [Wasco County Sheriff’s Deputy]
Scattergood came running across. He had something — a rifle, a sawed-off-shotgun. They tackled the
guy in the office.”
Nobody was hurt in the incident, though Corbin said it gave her the shakes.
What really shook her was when her health started to deteriorate in late 2007.
“I got a call from Dr. Moon and he said ‘You have cancer. I’m doing a mastectomy tomorrow
morning at eight o’clock.’ That’s how much notice I had.”
The surgery also removed lymph nodes, giving her lymphedema in her left arm.
That was eight o’clock in the morning.
At eight o’clock that night, they operated again, telling her she had bleeders.
“It feels like there’s a real tight cinch here to this day,” she said, touching her chest, “because they
stitched it up twice; they short-sheeted it.”
Corbin said she is especially sensitive to drugs
“They tried one chemo,” she said. “After a week, Dr. Fu called me and said ‘That almost killed you. I’
m going to cut it in half.’ And I’m thinking, ‘You’re going to just half kill me.’”
After the half dose, the oncologist told her any more chemo definitely would kill her.
That meant radiation and Herceptin, a drug which suppresses a protein that causes breast cells to
reproduce uncontrollably, causing cancer.
Her body didn’t take it well.
“I either threw it up or passed it the other way,” she said. “It was a contest to see which end it would
come out. It got to the point where people would invite you to dinner and you’d look at it and think ‘Is it
worth it?’”
Corbin calls that time her “year on Elm Street,” referring to the movie “Nightmare on Elm Street.”
She was so weak, she had difficulty in holding her 9-pound granddaughter.
She said she had “chemo head,” and would read a book and be unable to remember it.
Corbin, who habitually walks a mile each day with Nigel, her golden retriever, was also affected by
retained liquid
“I had to stop and sit down on the transformers when I did my walk because it was smothering my
heart,” she said. “I would lose my breath. I would say ‘Nigel, stay with mommy, OK? I can’t go any
farther.’ She’d put her head on my knee. We’d sit on the transformer over here at the little Head Start.
Then we’d sit on the wall down at Rite Aid and then coming up by Dr. Alleman’s I’d sit on that
transformer because that little grade would just kill me. But we kept going.”
By August 2008 her kidneys had failed.
After her first dialysis treatment removed 22 pounds of water, she weighed 119 pounds.
When they stopped the Herceptin at the end of 2008, she said, it took until May 2009 until her body
settled down.
“That took a lot of pressure off,” she said. “I didn’t have to fight the diarrhea or the throwing up any
more.
“When you’re on the [dialysis] machine, you’re on for three and a half hours straight. If they have to
take you off, it throws you way back. So they didn’t like me the first five months, but I had no control
over it. They finally came around and realized how bad I was.”
Corbin says this without any hint of a whine or expecting any pity. She just reports how it is.
That includes a union pension she hadn’t expected. But the second check came with a notice that the
union’s solvency was in “catastrophic status” and there may be no more checks.
But all those years of being kind to customers have led to a lot of support in the community.
“I got a stack of get well cards,” she said.
“The guys from the store came over on three or four occasions and did my yardwork and cleaned my
house. I sat out in the front yard like a zombie.”
Dialysis takes her to the Ray Yasui Center in Hood River every Tuesday, Thursday and Saturday.
Michael Kennedy drives her every Tuesday, and Janet Block every Thursday. Saturdays, she drives
herself. She says she’s about 60 percent of where she was, but couldn’t check groceries anymore
because of the shunt in her right arm and because she couldn’t stand for the hours needed.
Though she hasn’t worked at the store for two years, she still gets Christmas cards from customers.
And Safeway awarded her a 30-year pin last November.
Corbin doesn’t believe in just sitting around, even with serious medical conditions.
When her children left home, she taught herself how to crochet from a library book, and a customer
donated 17 boxes of yarn. She makes lap robes, stocking caps and ear warmers for residents of the
Oregon Veterans Home and for the gift shop.
She has a garden and last year grew 21 tomato plants, even though she can no longer eat the
tomatoes, due to the dialysis.
“I like to give,” she said
Her neighbor, Fran King, worked for many years for Hospice. One particualr patient used to tell her
he had to go get some groceries and his “daily dose of Corbin.”
King said Corbin “kept a lot of senior citizens going and happy. She was always cheerful and people
miss her greatly.”
Corbin said her philosophy was “Just be kind to everybody. Because what goes around, comes
around two and threefold. Some people just love getting in a hole and feeling sorry for themselves. Pity-
partying isn’t going to get them anything. When you feel like that, get a dog. Get somebody to talk to.”
And her reaction to her illnesses?
“You have to treat it like baseball; walk it off. Even when it hurts, you got to keep going. Because if
you don’t go, you’re going to stop. And if you stop, they’ll bury you — so I try to keep moving as much
as possible.”
http://www.thedalleschronicle.com/news/2010/01/news01-10-10-01.shtml
Therapeutic approach can help relieve lymphedema
In the United States, the most common cause of lymphedema is breast cancer. Approximately 25 to 35
percent of women who have had mastectomies develop this condition. Andi Garris, lymphedema
therapist and a doctor of physical therapy with Blount Memorial Total Rehabilitation, says the sooner a
lymphedema diagnosis is made and therapeutic help is received, the better the outcomes are to try and
normalize the affected area.
Lymphedema is a condition where the lymphatic pathways are unable to transport lymphatic fluid out of
an area of the body. "The area then becomes congested with lymph fluid, and the skin swells causing
discomfort," Garris says. Mild swelling occurs in the first stage, which comes and goes and can be
alleviated in the arms and legs with elevation. Some people feel tightness, heaviness or aching, but may
not see any swelling, she says. Stage two begins when the swelling no longer leaves the area. After a
period of time, some people may experience fibrous and tough skin, as the protein and waste materials
in the lymph fluid accumulate and pack in around the skin cells. When these changes begin to take place,
it has progressed to stage three.
Primary lymphedema occurs when lymph vessels and nodes are unable to transport lymph because of
congenital problems, or from no known cause. Secondary lymphedema occurs when the vessels are
damaged as a result of another event including burns, trauma, cancer treatment and removal of lymph
nodes. Secondary lymphedema is more common in women, Garris says. "One of the most common
causes of lymphedema in the arm is due to the treatment of breast cancer. In the legs, other medical
conditions common to both men and women can cause lymphedema, and the prevalence among men is
higher, but still not equal to women."
Symptoms of lymphedema include fullness, tingling, heaviness, tightness, aching and pain. "Some people
do not experience any of these symptoms and only know there is a problem once swelling begins,"
Garris says. If you recently had medical treatment for breast cancer and have any of these symptoms, a
one-time visit to a therapist (with physician recommendation) can determine the status of lymphedema,
provide education for management of the condition, and equip you to head off chronic swelling and pain
that comes with fully-developed lymphedema.
Complete Decongestive Therapy is a therapeutic approach that can reduce lymph congestion and bring
a more-normal fluid balance to the affected area. A therapist uses his or her hands to stimulate the lymph
pathways and open up lymph nodes, so the area can begin to work the fluid out and drain the area. The
massage is followed by a four-layer wrapping that continues the flow of fluid out of the area until the
treatment is repeated the next day, Garris says.
If left untreated, lymphedema begins to change skin into fibrous, hard tissue, causing loss of mobility in
the arms. Fluid can start backing up into adjacent areas leading to bouts of infection in the arms. This
also can occur in the legs, but with the added problem of wound development on the shins and difficulty
walking due to heaviness and leg pain."
Call 640-0517 to speak to a therapist at Blount Memorial Total Rehabilitation, who is available to
answer any questions on lymphedema.
The Women's Health column is provided by the staff and associates of Blount Memorial Hospital. It
appears every Sunday in Women's Times. For more information on this column call 983-7211.
This story was edited for presentation on the Web. Additional information and details are available for
subscribers only. If you want every word of Blount County's best news and information source you can
get home delivery and e-edition subscriptions here. Nobody knows Blount better than The Daily Times,
your hometown newspaper for 125 years and counting.
http://www.thedailytimes.com/article/20100110/WOMEN/301109980
Breast Cancer, Physical Therapy & Lymphedema
By Robert A. Wascher, MD, FACS
Weekly Health Update:
Breast Cancer, Physical Therapy & Lymphedema
Arm lymphedema, or chronic swelling of the arm, occurs in 10 to 30 percent of women following
treatment for breast cancer. When the lymphatic drainage network in the arm and hand has been
disrupted by the surgical removal of axillary (armpit) lymph nodes, or by radiation therapy to the axilla
(or, sometimes, following both types of treatment), the delicate network of lymphatic vessels that return
excess tissue fluid back to the heart can become obstructed. This lymphatic obstruction can then result in
chronic swelling of the hand and arm. Patients with significant lymphedema of the arm following breast
cancer treatment may experience considerable swelling (edema), heaviness, stiffness and discomfort of
the affected hand and arm.
Unfortunately, there are no known effective methods available to prevent lymphedema, and once
significant lymphedema does develop, compression sleeves and soft tissue massage are the primary
treatment modalities currently available. Unfortunately, currently available lymphedema treatments are
often not highly effective for many patients, and there is no known cure for lymphedema once it develops.
Now, a newly published research study, in the British Medical Journal, suggests that physical therapy,
when initiated early after breast cancer surgery, can significantly decrease the risk of arm and hand
lymphedema. In this prospective randomized clinical research study, 120 women who underwent
removal of their axillary lymph nodes for breast cancer were randomized to one of two groups. Women
assigned to the experimental group underwent physical therapy 3 times per week, for a total of 3 weeks.
Physical therapy techniques used in this group included manual lymph drainage and soft tissue massage
techniques, as well as progressive shoulder exercises. Both groups of women also underwent the same
lymphedema management educational course, but the control group of women did not receive any
physical therapy interventions.
Among the 116 women who completed at least one year of follow-up, 18 women (16 percent) went on
to develop lymphedema. Fourteen of the women who developed lymphedema were in the control
group, while the remaining 4 women were in the experimental group. Thus, in this clinical study, early
physical therapy following axillary lymph node dissection (ALND) was associated with a very significant
72 percent reduction in the risk of developing lymphedema, at least within the first year following breast
cancer surgery.
Whether or not the use of early postoperative physical therapy can reduce the incidence of arm
lymphedema over periods longer than one year is unknown at this time, and additional follow-up of the
patients who participated in this clinical research study will be required to answer this very important
question. However, this is one of the very few studies available that suggests a role for physical therapy
in the actual prevention of arm and hand lymphedema following ALND for breast cancer. If additional,
mature follow-up of these patients confirms a long-term benefit from early postoperative physical
therapy in preventing arm lymphedema, then a strong case could be made for the routine use of early
physical therapy in women who undergo ALND, and perhaps, as well, women who undergo sentinel
lymph node biopsy with subsequent radiation therapy to the breast and armpit (axilla) area.
For additional information and resources related to cancer-associated lymphedema, please click on the
links below:
http://www.cancersupportivecare.com/Abstracts/asbdpbtps.html
http://meeting.ascopubs.org/cgi/content/abstract/23/16_suppl/8185
http://www.annalssurgicaloncology.org/cgi/content/abstract/15/7/1996
http://www.cancerlynx.com/sln.html
http://doctorwascher.com/Archives/11-23-08.htm
http://doctorwascher.com/Archives/8-16-09.htm
--------------------------------------------------------------------------------
Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any
significant changes in medications, diet, or level of physical activity
--------------------------------------------------------------------------------
Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and
a widely published author
http://mensnewsdaily.com/2010/01/16/breast-cancer-physical-therapy-lymphedema/
At Marysville YMCA, cancer survivors grow stronger
By Sharon Salyer, Herald WriterAfter the hair loss from chemotherapy, after the fatigue of radiation,
even after doctors say that cancer has been blasted from their bodies, a whole new round of healing
must take place: overcoming the physical and emotional toll of a cancer fight.
Cancer survivors, who have survived the ravages of treatment, are left with muscle deficits.
Even 10 to 20 years later, scientists have found, the muscle mass of cancer survivors often lags far
behind people of the same age. Their endurance isn't as great. They have less cardiovascular strength to
power them through activities.
And psychologically, they often feel that the body they thought they knew and trusted has failed them.
“Surviving… dealing with it, it's very emotional,” said Rick Lawson, 49, of Marysville, who has battled
leukemia and a baseball-sized brain tumor.
Cancer patients first must endure the chaotic swirl of seemingly nonstop medical appointments,
treatments and assessments only to be dumped at the “finish line” into the emotional void of discharge.
“First it's, ‘Am I going to survive this?'” Lawson said. “When you're done with treatment, it's like, ‘What
do I do now?' ”
Local YMCAs, working with the Fred Hutchinson Cancer Research Center in Seattle and the Lance
Armstrong Foundation, are trying to provide answers.
A new free program called Exercise and Thrive is being offered at YMCAs in Marysville and Monroe,
designed to meet the special physical and psychological needs of cancer survivors.
The classes include strength training; cardio workouts; flexibility, balance and deep-breathing routines;
and diet and nutrition tips.
Word spread fast about the first classes offered this fall in Snohomish County. Many slots were filled by
word of mouth and referrals from the Providence Regional Cancer Partnership in Everett. The next
classes begin Feb. 23 in Marysville and Monroe.
Scientists aren't sure why cancer survivors have less muscle mass than their peers up to two decades
after their treatment ends, said Karen Syrjala, co- director of the survivorship program at the Fred
Hutchinson Cancer Research Center in Seattle.
Studies are now under way to see if it's the treatment itself that's damaging muscle cells or caused by
patients' inactivity during treatment, she said.
Regardless of the cause, loss of strength from cancer treatments means survivors have a much greater
potential for injuries and flare-ups with lymphedema, which can cause swelling and problems with range
of motion, she said.
YMCA exercise instructors who teach cancer survivors get training on their special needs — how to
slowly build muscle strength and how to avoid strains and injuries that can come with attempting too
much too soon.
“We think it's important to have people who really understand the limits,” Syrjala said.
“One of the things we've learned with cancer survivors is from a long period of inactivity, they do lose
cardiovascular ability, endurance and at the same time they lose muscle mass.”
Cancer survivors, some of whom were participating in marathons before their treatments, have to learn a
whole new way to approach exercise and fitness, she said.
“It's very hard not to push and build as fast as you can,” she said. “Sometimes, we have to help people
slow down.”
Fourteen people signed up for the initial 10-week course in Marysville. Only one — Lawson — was a
man.
While other men said they didn't want to join a class with a female-dominated roster, Lawson took it in
stride.
“I grew up with three older sisters,” he said. “I get along quite well with women.”
The combination of his leukemia treatments and the aftermath of fighting a brain tumor left him blinded in
his right eye, with decreased coordination and stamina, and with body aches in his left hip and leg.
He had previously sought out physical therapy to help him rebuild his strength. But to make progress, he
needed to go about three times a week. His insurance was charging him $50 out of pocket for each visit.
“I couldn't afford PT anymore,” he said.
The twice weekly, 90- minute YMCA classes are customized for cancer patients, he said, and slowly
built up his strength.
There were other benefits, too: a better outlook, more energy, less depression and fatigue.
“My wife has noticed I'm happier,” he said. “My muscles have some sort of definition now.”
Even after the class ended in early December, he has continued his workouts, often going to the Y three
times a week for water aerobics, treadmill workouts and strengthening regimens.
“I'll make the Y my second home – a place for me to go,” he said.
The program has benefits beyond improvements in fitness and tips on stretching and nutrition, class
members say. Among them is spending time with people who know firsthand the ups and downs of a
cancer battle.
“Everybody has gone through the same thing: the diagnosis and response of family and friends,” said
class member Renate Whitcomb of Marysville.
Whitcomb, 44, was diagnosed with breast cancer in October 2006.
A cancer diagnosis often leaves patients feeling alienated, she said. “Most people don't know what to
say.
“I've never been part of a support group,” Whitcomb said, but class members “have really been my
support.
“It helped me deal with my stress,” she added. “It was such a godsend.”
About 200 people have participated in Exercise and Thrive programs, offered at Puget Sound area
YMCAs, including Northshore, West Seattle, Auburn, Bellevue, Marysville and Monroe. Harborview
Medical Center in Seattle has joined hospitals in Spokane and Alaska in offering the program, too.
Cancer centers have offered similar strength and resistance training programs for patients, Syrjala said.
What makes this program different is that they're offered in the community where the patients live.
For people in Snohomish County, that means saving hours of commuting time on I-5 to get to Seattle. “I
hope for most people, it takes 20 minutes or less to get to their local Y,” she said.
Reports on 158 of the 200 people who have participated so far showed improvements in flexibility,
strength, waist measurements and blood pressure.
“It's one of our most positive programs in terms of impact on lives,” Syrjala said.
“People said they felt better physically, had more stamina and less fatigue,” she said. “In a relatively
short time… that's a lot of change.”
Sharon Salyer: 425-339-3486, salyer@heraldnet.com.
http://www.heraldnet.com/article/20100117/NEWS01/701179891&news01ad=1
AtlantiCare Cancer Care Institute offers CyberKnife® Technology targets hard-toreach tumors non-
invasively
TheAtlantiCare Cancer CareInstitute, a Fox Chase Cancer Center Partner, in Egg Harbor Township,
New Jersey, offers CyberKnife® Robotic Radiosurgery – the world’s only robotic radiosurgery system
designed to treat tumors anywhere in the bodynon- invasively.
CyberKnife compares X- ray images to the patient’s original CT scan before each treatment to ensure
unparalleled targeting accuracy. It continually tracks, detects and corrects for any patient or
tumormovement.
“Through this technology our experienced team delivers high-dose radiation with pinpoint precision,
while minimizing damage to surrounding healthy tissue,” said Lauren Ochs, executive director,
AtlantiCare Oncology Services, AtlantiCare. “ We are pleased to offer patients this advanced
technology as a non- invasive alternativetosurgeryforthetreatmentof both cancerous and non-cancerous
tumorsanywhereinthebody.”
“ We can now treat previously hard to reach cancers, includingthoseofthe lung, brain, spine, liver,
pancreas and kidney – non- invasively,” said Jonathan Law, MS, DABR, DABMP, director, Medical
Physics AtlantiCare Regional Medical Center. “Side effects are minimal and there is littleor no recovery
time.”
The AtlantiCare Cancer Care Institute offersCyberknife® surgeryasanoutpatient procedure. It also
offers radiation therapy, chemotherapy/infusion treatments, diagnostic services, as well as access to the
latest clinical trials as a Fox Chase Cancer Center Partner. The AtlantiCare Cancer Care Institute has
on-site laboratory, pharmacy, social work, nutrition and lymphedema therapy services.
“ The CyberKnife’s flexible robotics allows us to treat tumors from nearly any direction and in nearly
any location in the body,” said Law. “At the AtlantiCare Cancer Care Institute, tumors have nowhere to
hide,”saidLaw.
http://www.jewishtimes-sj.com/news/2010-01-
22/Health_and_Nutrition/AtlantiCare_Cancer_Care_Institute_offers_CyberKnif.html
TOMBALL REGIONAL MEDICAL CENTER RANKED TOP FIVE PERCENT IN NATION
Recognized by HealthGrades as a Distinguished Hospital for Clinical Excellence
Tomball, TX – HealthGrades has announced that Tomball Regional Medical Center ranks among the
top 5% in the nation for clinical excellence. A study by HealthGrades, the leading independent
healthcare ratings organization, analyzed patient outcomes at each of the nation’s 5,000 nonfederal
hospitals over the years 2006, 2007 and 2008.
“This ranking is an outside affirmation that attests to the excellence of our physicians and entire team,”
said Lynn LeBouef, President/CEO of TRMC.
According to the eighth annual HealthGrades Hospital Quality and Clinical Excellence study, Tomball
Regional Medical Center and the other hospitals in the top 5% demonstrated patient outcomes that far
exceeded those of other hospitals. Patients admitted to these hospitals had risk-adjusted mortality rates
that were, on average, 29% lower than all other hospitals and complication rates 9% lower than all other
hospitals.
Tomball Regional Medical Center is one of only 269 hospitals that received this distinction from
HealthGrades.
“Our data show that only a select few hospitals achieve high-quality patient outcomes not just in a few
categories of care, but across the board and over time,” said Rick May, MD, a vice president with
HealthGrades and an author of the study. “Patients in communities with a Distinguished Hospital for
Clinical Excellence should feel proud of the hospital’s accomplishments, and confident that the level of
care there is among the very best in the nation.”
The study states: “Patients who choose to receive their care at a Distinguished Hospital for Clinical
Excellence certainly will have a lower risk for an adverse clinical outcome relative to all other hospitals.”
Methodology
This is the eighth year that HealthGrades has independently analyzed the clinical quality performance of
all non-federal hospitals across the country in 27 procedures and diagnoses. In the study, the company
reviewed approximately 40 million hospitalization records from the Centers for Medicare and Medicaid
Services, part of the U.S. Department of Health and Human Services, over the years 2006, 2007 and
2008. All hospitals that participate in the Medicare program were part of the independent study.
Hospitals that receive the HealthGrades Distinguished Hospital Award for Clinical Excellence are those
hospitals that rank in the top 5% when all 26 individual scores are aggregated into an overall score.
About Tomball Regional Medical Center
Recognized for its full continuum of services and remarkable growth over the years, Tomball Regional
Medical Center (TRMC) serves a population of 330,000 area residents. TRMC has earned specialty
accreditation for both stroke care and cardiac care and has been ranked by HealthGrades as among
America’s top 5% of all hospitals for clinical excellence. Through exceptional technology and a
specialized medical staff, area residents receive a full range of medical services close to home. Services
provided include open-heart surgery, neurosurgery, a new maternity floor and level III neonatal intensive
care unit, inpatient rehabilitation, skilled nursing, and home health care. The 150-acre campus also
includes designated specialty centers: the Robert F. Schaper Heart Center, the Texas Wound and
Lymphedema Center, the Texas Sports Medicine Center, a Cancer Treatment Center, and the Heritage
Retirement Community. To learn more, call 281-401-7500.
----------------------------------------------------
LdB mom on a mission
Posted By Jill Winzoski
Lymphedema. Never heard of it? Neither had Lac du Bonnet mother-of-three Kim Avanthay.
Four-and-a-half years ago, doctors informed Kim that her son Austin was born with lymphedema, a
disease that affects the lymphatic system, causing extreme swelling and hardening of the tissues. He has it
in his right arm and leg.
The first type, known as primary lymphedema (the kind Kim's son has) can be present at birth or
develop at any time, and is the result of inherent defects in the lymphatic system.
Secondary lymphedema, which is more common, is the result of a damaged lymphatic system. Anyone
who's had certain kinds of cancer treatment like radiation therapy or had lymph nodes removed is at a
significantly greater risk for acquiring the disease. Other traumas like an accident, surgery, or severe
infection can also increase the risk of getting lymphedema.
"People need to know about this. You can lower your risks of getting it if you know what to be aware
of," said Avanthay. "Although there's no cure, it can be managed through a combination of things, like
draining the limb, or wearing compression garments."
She also said that those who are at higher risk for developing the disease, like breast cancer survivors,
might think twice about air travel without compression garments, as this can help prevent lymphedema.
Considering as many as one-in-four breast cancer survivors develops the disease, it is presently getting
relatively little attention.
"There is as of yet no support group in Manitoba for lymphedema sufferers," says Avanthay, who is
currently spearheading a Manitoba contact for the Canada-wide lymphedema association.
On Jan. 3, Avanthay sent out requests to various Manitoba municipalities, cities, businesses and to the
Province itself to proclaim March 6th starting this year to be Lymphedema Awareness Day. So far, the
towns and RMs of Beausejour, Lac du Bonnet, Whitemouth, Shoal Lake, St. Francis Xavier, Coldwell,
Neepawa and La Broquerie have agreed to uphold the pledge. More municipalities have yet to respond,
but Avanthay is grateful that the municipalities have been "very supportive."
Although The City of Winnipeg has denied her request, she has yet to hear from the province, which is
currently "looking into it," said Avanthay.
The Lymphovenous Association of Ontario says the condition is "under the medical radar screen," and
that government health officials need pressure put on them by patients, their family members, health care
professionals and lymphedema associations. They say that public health policy needs to be changed
because currently the need for standardized and accessible treatment is not being addressed.
Avanthay, who also works full time in Pinawa, is preparing to attend an international conference in
Brighton, U.K., where she seeks the tools that will help her start a support group here in Manitoba. A
Bud, Spud and Steak fundraiser will be held on Feb. 6 from 7 p.m. – 10 p.m. at the Norvilla Hotel on
north Henderson to help with travel expenses. Anyone wishing to buy tickets for this event (or to
otherwise help with the cause) should call Kim at 345-0441, or e-mail her at kimavant@mts.met.
http://www.beausejourreview.com/ArticleDisplay.aspx?e=2273708
Keller certified as clinical specialist
Victoria Keller, PT, MS, WCS, was certified as a clinical specialist in women’s health physical therapy
by the American Board of Physical Therapy Specialists. Keller is one of 61 physical therapists certified
in women’s health in the U.S., one of two in the state of Texas.
Keller specializes in the treatment of pelvic floor disorders that can result in incontinence, pelvic pain and
constipation in both women and men. She is a certified lymphedema therapist through the Lymphology
Association of North America. She has also worked with women with osteoporosis and has taught pre-
and post-natal exercise.
Keller graduated from Mineral Wells High School and received a bachelor of science degree in physical
therapy from the University of Texas Medical Branch in Galveston. She received a master of science
degree in physical therapy from Texas Woman’s University in 2006. She worked for 10 years at Baylor
Medical Center in Irving prior to moving to Graham. She is employed with Young County Home Health
and will soon be opening a practice called Thrive Physical Therapy.
The ABPTS of the American Physical Therapy Association awards certificates to physical therapists
meeting approved requirements. To obtain board certification, candidates must submit evidence of
required clinical practice in a specialty area and successfully complete a rigorous written examination,
which demonstrates specialized knowledge in advance clinical proficiency in a specialty area of physical
therapy practice.
http://www.grahamleader.com/index.asp?Story=17996
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Everyday people do have a voice in the government
by Larry Kissell
We hear a lot about the people not having a role in their government. There is a feeling that laws aren’t
written with the average person in mind.
I want to share the stories behind three pieces of legislation I have or will introduce in the coming weeks.
Each one of these bills was born out of ideas presented by constituents right here at home. I am proud
to introduce the legislation and even prouder to represent the folks who brought these issues to my
attention.
The first bill would have an impact on veterans across this country. My staff and I were contacted by a
100 percent permanently disabled American veteran who voiced his concerns about the vast difference
in benefits offered by states to 100 percent permanently disabled veterans. While some states provide a
very robust package of benefits, demonstrating its commitment and appreciation for its disabled
veterans, other states’ benefits packages are lacking in comparison.
The most bothersome is that despite North Carolina’s large veteran population, our state’s benefit
package is far from what our veterans deserve. Our veterans have answered our nation’s call for duty
and served this country with honor and distinction. They deserve the very best benefit package we can
offer.
After hearing this concern, I am sponsoring a bill to create a commission to review each state’s current
disabled veterans benefits package, compare the packages and rank each state based on the benefits it
offers to 100 percent permanently disabled veterans. This commission will provide recommendations to
Congress and each state on how to make each state’s package comparable across the country.
The second bill came about when a constituent visited our office to voice her concerns about
lymphedema and the denial of coverage for treatment of this devastating disease. Her son suffers from
the disease, and she had fought to see that he receives the treatment he needs.
Lymphedema is a chronic disease caused by a weakened lymphatic system, and can be hereditary or
caused by a secondary reason such as injury to the lymph nodes. Many cancer patients suffer from
lymphedema which causes lymphatic fluid to collect in the limbs and cause swelling. The swelling can
become permanent if not treated.
Yet, coverage for treatment is routinely denied by insurance companies as well as Medicare and
Medicaid. Complications from the disease if left untreated can range from severe deformity, disability,
pain and can even lead to death. Luckily, treatment is covered for breast cancer patients under the
Women’s Health and Cancer Act, but others suffering from the disease fight an uphill battle just to get
coverage for treatment.
Our constituent has already worked with the state to mandate insurance companies to provide coverage
for lymphedema treatment in North Carolina with the help of Representative Tricia Cotham, but her
concern is the thousands of people across the country that fight on a daily basis to get their insurance
companies to cover this badly-needed treatment. States which have mandated the coverage have
proven that covering the treatment leads to lower medical expenses caused by complications of the
disease.
We must right that wrong, and make sure that people living with this disease are granted access to the
treatments they need. We hope to introduce this important legislation to mandate coverage for
lymphedema treatment in the coming weeks.
The third piece of legislation came straight from a couple in Stanly County. This couple trains service
dogs, and they wanted to voice their concerns about allowing service dogs in training access to the areas
where normally only service dogs at work would be allowed. This would allow service dogs to receive
the best training in the areas where they will actually be working.
Service dogs provide invaluable help to those they serve, allowing individuals freedoms that their
disability might not afford them otherwise. It is critical that these animals receive the best training in any
and all areas they will go while working.
I introduced H.R. 4378 which would amend the Americans with Disabilities Act to require that the
access to transportation and public accommodations be afforded to trainers and handlers of service
animals as is afforded under the ADA to individuals with disabilities who use such service animals. This
gives the trainers and handlers the ability to better train and prepares service dogs for their future uses.
These extraordinary folks saw a need and petitioned their government and I am doing all I can to make
sure that their idea becomes law. Their causes aren’t just about what they need, but about helping
thousands of others who are living with the same problem or facing the same challenges.
I am making sure their voices and yours are heard in Washington.
Congressman Larry Kissell (D-N.C. -8) offices include Rockingham: 230 East Franklin St.,
Rockingham, NC 28379, Phone: 997-2070; Concord number (704) 786-1612; Fayetteville number
(910) 920-2070; Washington office: 512 Cannon House Office Building, Washington, DC 20515;
phone (202) 225-3715. Web site, kissell.house.gov
http://www.yourdailyjournal.com/view/full_story/5638548/article-Everyday-people-do-have-a-voice-in-
the-government?instance=secondary_opinion_left_column
Out of the blue
Dance company creates diverse platform to celebrate nature’s beauty.
By Liana Aghajanian
Bethune Theatredanse is celebrating the company’s 30th anniversary in a new city with a tip of the hat to
nature.
“Silent Roar” was inspired by the marine environmental artist who goes by one name, Wyland, said
Artistic Director Zina Bethune, who wrote, directed and choreographed the production coming Feb. 5
to 7 to Glendale Community College Theatre.
The performance relays the plight of whales as they travel from Alaska to Baja California with the help
of original music, graphics, film and other digital elements, she said.
Bethune plans on making the area a permanent home for her company, saying its collective cultural
mentality is conducive to forming a relationship with the city.
“Glendale wears a kind of cultural signature,” she said. “I think we can be part of that cultural signature
in a very positive way.”
After having done research on the city, Bethune believes the tight-knit and supportive nature it offers will
be a great fit for her company, which comprises diverse dancers, she said.
Although Bethune Theatredanse might not be the only dance group fusing dancing, digital arts and
storytelling, it was a trailblazer in the field when it began 30 years ago, when defined lines separated the
worlds of dance, theater and media, Bethune said.
Because of her story-oriented nature and background in dance, theater and film, Bethune found it natural
to blur the lines and provide audiences with an experience that is difficult to categorize, she said.
She hopes that by forming a solid relationship with the college, she can create an exchange between the
company and students on campus, she said.
“We can really provide an opportunity for students to work alongside seasoned professionals in a
multitude of departments, including dance, drama, graphics and media,” Bethune said.
Glendale resident Marc McCall, a video game programmer by day and the multimedia production
designer for “Silent Roar,” calls Bethune’s unconventional methods admirable.
A former GCC student, McCall thinks the company’s presence in Glendale will be nothing but positive.
With a head start, Bethune Theatredanse already has a few dancers from the Glendale and Burbank
area who are performing in “Silent Roar,” including Ciny Ricalde, who has trained with the National
Academy of Arts and the Joffrey Ballet.
After taking time off to raise her daughter, this production is Ricalde’s comeback into dancing. She has
nothing but praise for Bethune and credits her openness to casting diverse dancers.
“The diversity brings a different look and different qualities, like a canvas and textures on a painting,”
Ricalde said. Different textures is what Bethune is all about, like giving those with disabilities a chance to
explore and showcase their dancing abilities, including break-dancer and aerialist Jacob “Kujo” Lyons,
who is severely hard of hearing. He has about five roles in “Silent Roar.”
“I dance to show that I can,” Lyons said. “The whole point has always been to show that anyone can do
anything they put their minds to.”
Bethune, who started “Infinite Dreams,” a dance program for disabled children, is no stranger to
disabilities herself, having had scoliosis, lymphedema as well as numerous surgeries on her dysplastic
hips.
She is already working hard to place programs within Glendale schools, similar to what she has already
done in Pasadena, she said.
With a tight budget and a dance program already in place for disabled students, the GCC Center for
Disabled Students doesn’t necessarily have room for another, according to Associate Dean Joy Cook,
who called the inclusion of disabled and diverse students of Bethune Theatredanse commendable.
“I think when a person with disabilities can be involved, it’s a wonderful experience both for the dancer
and the audience,” said Cook, who added that the company’s establishment in Glendale would give
students another option.
http://www.glendalenewspress.com/articles/2010/01/26/entertainment/gnp-bethune012710.txt
Breast Center at Baylor Dallas Recognized for Commitment to Fighting Breast Disease
Read more: http://www.earthtimes.org/articles/show/breast-center-at-baylor-dallas,1141437.
shtml#ixzz0iI35vs07 DALLAS, Jan. 28 /PRNewswire-USNewswire/ -- Baylor Sammons Breast
Center at Baylor University Medical Center at Dallas has been recognized by the National Accreditation
Program for Breast Centers (NAPBC) for its "firm commitment to offer its patients every significant
advantage in their battle against breast disease." The center has now received a three-year, full
accreditation from the NAPBC. Accreditation by the NAPBC is only given to those centers that have
voluntarily committed to provide the highest level of quality breast care and that undergo a rigorous
evaluation and review of their performance.
"We are committed to joining with women to fight breast cancer with every tool, technique and
treatment available," said John Pippin, M.D., chairman of the Breast Site Committee at Baylor Charles
A. Sammons Cancer Center at Baylor Dallas. "Accreditation validates that commitment." Baylor
Sammons Breast Center is only the second program in Texas to achieve this accreditation.
Advantages of Accreditation
Receiving care at a NAPBC-accredited center ensures that a patient will have access to:
•Comprehensive care, including a full range of advanced technological services
•A multidisciplinary team approach to coordinate the best treatment options
•Information about ongoing clinical trials and new treatment options
•Quality breast care close to home
---------
http://www.sfgate.com/cgi-bin/blogs/gurley/detail?&entry_id=56625
Haiti journey improv
10 days and counting to Haiti. My mind is whizzing and my days are packed with to-do lists that
overflow into the next day. I keep trying to project myself into that moment when I return, and stare at
my desk and try to figure out where I was and what I was doing before I left. It seems impossible to
emotionally transport myself from these moments now, to there, and, then back.
My kids - as kids are wont to do - vibrate like tuning forks to the emotional environment around them,
even when they're not aware of it. The home front has evolved from teens who lean into me more than
usual, to teens who blow like landmines along a disputed border.
My work has been lovely beyond belief. In retrospect, it should be no surprise that people who work,
by choice, in a clinic for the homeless, are likely to possess levels of compassion that, if scored on Iowa
standardized tests, would put them into the "gifted" category. We had an all-staff meeting, where I was
asked to stand - so that I could hear the gratitude from those who feel that I am representing them
personally on this trip.
I got superb tips from a skilled rehab nurse as we worked together, comments and instructions about
what to do in Haiti, between seeing patients here - she pointed out that I should bring ACE bandages for
wrapping stumps for all those amputees who got life-saving surgery, but minimal-to-no aftercare, the
ones who now have wide-spread infections. "They can wash and re-use ACE bandages, and it'll help
season the stump and control lymphedema. Oh, and felt for padding, and you'll need to teach them to
cut off the arms of long-sleeve t-shirts, and knot the end to use as a stump-sock. God, I wish you could
take a few straight-caths. I'm betting there will be some spinal-injury patients. What would they do
without a cath?" She walked off, shaking her head in disbelief at the horror of that prospect: dying in
agony because you could not pee.
But I could not help, walking through the Civic Center BART station, but notice the huddled humps of
two homeless men lying against the wall. They lay on cardboard strips, bunched blankets iglooed around
them. In their own form of hell.
Our first team meeting was last Sunday. It was a lovely group of people, men, women, some in their
twenties, most in their forties, a couple of women maybe early sixties, all sitting around a living room,
while Dr. Enoch Choi updated everyone on the outstanding issues in his calm, soothing voice. He began
by saying that he knows many of us are in-charge when we're in our own environments - but that the
point of going as a team is to work together, to accomplish more than any of us could do alone. That we
will each be asked to step outside our pre-defined roles, to be more flexible, to work cooperatively.
And he reminded us that any of us, who didn't feel comfortable with that situation, could always head to
Haiti on our own - there are no barriers to doing that. At all. You or I or anyone else could get a flight
over there and walk right in.
In a way, it was chilling reminder of the breakdown of government and regulation there. And we are still
definitely going the weekend of February 14 - the only questions are around the flight destination. If the
security situation deteriorates further, we'll fly into the Dominican Republic and travel by truck overland
(6 hours to the border, then another 1 hour to PAP), and stay at the border, driving in to PAP each day.
An apartment and driver, plus guards, have been arranged at the border. Not one single hotel room is
available (otherwise all 15 of us would be sleeping in that one room).
However, in order to serve more people (and not waste time going back and forth to PAP), we may
still, if security allows, fly directly into PAP and work on the grounds of a large, indigenous
church/orphanage two blocks from the American Embassy, giving care from that home base and
sleeping in tents or on the ground.
Which means we have, so far, two flight options - one is to fly commercial to Miami, then take military
cargo from Miami to PAP (the military cargo plane space is arranged, the commercial flight to Miami not
so much - that decision is awaiting security developments). If we go by way of Dominican Republic, we
have been generously donated 1 million miles by Alaska Air for our team's flights.
I looked around the room and realized that, for people who would soon be sleeping packed like
sardines head-to-toe (even in an apartment bedroom), without bathing for 8 or so days, no one felt
comfortable asking the gritty questions. Is there functional sewer systems in Port au Prince? I've been to
part of Africa where la toilette is a pair of concrete footprints shaped like Dr. Scholl's inserts (and not
large, six 6 men's shoes, max) positioned beside an ominous hole in the ground. That might seem like an
upgrade from the prospects in Haiti. We're bringing our own lunch for each day, but what about the
infection risk of other meals?
Tent city without toilets or tents
On the personal front, I started my malaria medicine last weekend. I got the weird dreams, the ones I
remembered and I dreaded - it's something about how my brain is wired (I once tried a tiny dose of
Ambien for jet-lag and spent the evening seeing writhing nightmarish ulcers sprout on dream-people who
were talking mutely, pleading with me soundlessly). This time I awoke with the distinct memory of my
daughters' bass teacher swelling and swelling, elephant-man-like, his seeping split-skin explosion
inevitable. Luckily I only get these dreams on the once-a-week night I take chloroquine.
My Mama called (yes, I'm Southern, and, hence, she will always stay my Mama). She reminded me that
I'm "not as young as you think," as well as several other choice, sweet, and incisive reminders that I
should perhaps re-think this whole idea. I do have two children, after all.
I feel my stomach knot and I get quiet and after I hang up, I take the time to think about it. My Mama is
not the kind whose advice a wise person ignores easily. But I think back to those sleeping homeless
men, and how dangerous the area where I work, Civic Center, can be. And how careful Dr. Choi is
being when making plans for the group. And while the situation (and stories) in Haiti are horrific, all the
outpouring of compassion and support (a lot of which I've personally seen or heard) has been a
testament to the vast goodness of humanity. And then my uber-efficient friend, Pam, calls to say the
Wells Fargo trust fund for the trip "Share the Wellth" is up and working, and that, more importantly, she
has something she thinks I might be interested in taking with me, from her Eagle Scout son's camping
supplies - super-compact, teensy tiny rolls of toilet paper. Yes! Yes! I have my portable shower ready
(a packet of Handy Wipes) and I splurge on a tiny battery-powered SpongeBob toothbrush. Doc
Gurley motto: Hey, if your teeth feel good, you can even do without coffee.
I downloaded the free Gideon 321 page e-textbook, Infectious Diseases of Haiti, as well as both the
free Haitian Creole Byki app (rushed to market with a specially-created medical section - two
stethoscopes up to these folks!), as well as the Pimsleur free course of Haitian Creole lessons (two
stethoscopes up AGAIN - you rock, Simon & Shuster). I spent the day speaking Creole out loud to
myself in my home, narrating my life and interviewing myself about imaginary health problems - an out-of-
body experience if there ever was one.
My dining table is an Everest of supplies. I read an article forwarded by Medscape, a reminder that
Haitian women now are particularly vulnerable to reproductive neglect and violence. I'm thinking I may
pack a giant pile of condoms. Surely they'll fit too. Ah, but one crucial element remains to sort out - how
to get connected while I'm there, so I can bring along all of you who are going with me. There has to be
an affordable solution somewhere. So I'm heading out with my iPhone to the AT&T store tomorrow.
Which may be the most confusing part of this whole trip - wish me luck!
Share in the comments section - and tune in for the next in the series to get details about the Haiti trip
(and, oh yeah, jury duty? That old thing? I was in and out of there in a DAY!). If you want to donate for
supplies or transport, head over to www.docgurleycom for details underlined at the end of this same
article. But if you're feeling a tad Haiti-ed out and overwhelmed, never fear, there will be OTHER, non-
Haiti, fun health topics in the next few days! Keep up on the latest health issues in the news by signing up
for a Doc Gurley RSS feed by clicking here. Look for future pics and other articles at Doc Gurley! Also
check out Doc Gurley's joyhabit and iwellth twitter feeds - so you can get topic-specific fun, effective,
affordable tips on how to nurture your joy and grow your wellth this coming year.
Read more: http://www.sfgate.com/cgi-bin/blogs/gurley/detail?&entry_id=56625#ixzz0ecDo8cEu
Read more: http://www.sfgate.com/cgi-bin/blogs/gurley/detail?&entry_id=56625#ixzz0ecDoGwSE
-----------------
Administered by the American College of Surgeons, the NAPBC is a consortium of professional
organizations dedicated to the improvement of the quality of care and monitoring of outcomes of patients
with diseases of the breast. This mission is pursued through standard-setting, scientific validation, and
patient and professional education.
On the Frontlines of Breast Care
Baylor Sammons Breast Center provides a broad range of breast care services, from prevention and
detection to treatment and recovery. The center provides clinical coordinators to help patients navigate
their care and recovery process every step of the way. These coordinators help patients by providing
referrals to a wide range of experienced specialists; answering questions; and scheduling appointments.
The Center's focus on education includes community programs, as well as the Virginia R. Cvetko Patient
Education Center. The education center is designed to help cancer patients and their families understand
and manage the physical, emotional and spiritual challenges of cancer. The center's staff includes a
medical director, nurse educators, genetics nurse, chaplains, social workers and trained cancer survivor
volunteers.
Understanding that early diagnosis is often the key to successful breast cancer treatment, Baylor
Sammons Breast Center provides computerized breast cancer risk assessments, a Hereditary Cancer
Risk Program (including genetic testing and counseling) and screening and diagnostic services. Screening
and diagnostic services are provided through the Baylor University Medical Center at Dallas Darlene G.
Cass Women's Imaging Center.
Baylor Sammons Breast Center also participates in several breast cancer prevention and treatment trials;
provides lymphedema treatment and education; and operates Ernie's Appearance Center, featuring
products and services that minimize the visible effects of cancer therapy.
About Baylor Dallas
Baylor University Medical Center at Dallas, a 1025-bed not-for-profit academic hospital, is a major
patient care and research center in the southwest. The nationally acclaimed medical center serves as
flagship hospital for Baylor Health Care System and has earned Magnet status for "Excellence in
Nursing Services" from the American Nurses Credentialing Center -- the organization's highest level of
recognition. In addition to its Level 1 trauma center, Baylor Dallas is also home to many nationally
ranked centers of excellence including transplantation, cardiovascular services, orthopaedics, oncology
services, digestive diseases, neurosciences and gynecology. In 2009, U.S. News & World Report
recognized Baylor Dallas for the 17th consecutive year in its "America's Best Hospitals" guide.
SOURCE Baylor Health Care System
http://www.earthtimes.org/articles/show/breast-center-at-baylor-dallas,1141437.shtml
FIRST REPORT THAT LESSER USED BIOPSY TELLS MORE
Sentinel Lymph Node biopsy less commonly used in cervical cancer, yields three fold higher lymph node
metastases detection over standard method, and offers proven reduced complications for patients.
Attention: Assignment Editor, Health/Medical Editor, Lifestyle Editor, News Editor, Science Editor
TORONTO, ONTARIO, NEWS RELEASE--(Marketwire - Jan. 29, 2010) - For the first time ever
reported in cervical cancer, Sunnybrook researchers have shown higher detection of lymph node
metastases, one of the most telling factors about the course of disease, using Sentinel Lymph Node
biopsy compared to complete pelvic lymphadenectomy, in a study published in Gynecologic Oncology.
"These findings inform a newer way of thinking about the management of cervical cancer," says Dr. Allan
Covens, surgical oncologist and head, Gynecology Cancer Care Team, Sunnybrook's Odette Cancer
Centre. "In our view, complete lymphadenectomy as a gold standard for lymph node assessment in
cervical cancer is cogently challenged. More frequent use of Sentinel Lymph Node biopsy in cervical
cancer detects more lymph node metastases, which may have a positive overall impact on survival."
Sentinel Lymph Node biopsy reduces a patient's complications such as pain and lymphedema (chronic
swelling) of limbs and or soft tissue, and is used widely in melanoma, breast and vulva cancers. Sentinel
Lymph Node biopsy removes one to two sentinel lymph nodes (the first lymph nodes to drain from the
primary tumour, hence the first to harbour metastases) compared to pelvic lymphadenectomy involving
the removal of ten to 30 lymph nodes, and increased complications.
"Our findings of higher lymph node metastases (including micrometastases) detection using Sentinel
Lymph Node biopsy together with known reduced complications for patients and low false-negative
rates, suggest a strong efficacy advantage of this procedure over the standard complete pelvic
lymphadenectomy procedure in early stage cervical cancer," says Dr. Covens, Professor, Obstetrics and
Gynecology, and director Gynecologic Oncology Fellowship, University of Toronto.
Findings indicate a lymph node metastases detection rate almost 3 fold higher with Sentinel Lymph
Node biopsy compared to pelvic lymphadenectomy. All sentinel lymph node metastases were smaller
than one centimetre. The higher detection rate the researchers suggest may be due to the extensive
sectioning performed on Sentinel Lymph Node biopsy. Another possible explanation may be related to
the unusual locations of sentinel lymph nodes in cervical cancer. Over 21 per cent of the cohort of 87
patients who underwent Sentinel Lymph Node biopsy, had sentinel lymph nodes located either in the
common iliacs or paraaortics. These nodes would not be typically removed in a standard pelvic
lymphadenectomy.
The researchers compared 81 of the 87 patients who underwent Sentinel Lymph Node biopsy, to 218
matched patients who had complete pelvic lymphadenectomy. Both groups subsequently underwent
radical hysterectomy or radical trachelectomy.
Despite continued yearly declines in mortality rates for cervical cancer, in 2009 an estimated 1,300
Canadian women were diagnosed with cervical cancer and an estimated 380 women died from the
disease.
For further information: www.sunnybrook.ca/
http://www.marketwire.com/press-release/FIRST-REPORT-THAT-LESSER-USED-BIOPSY-
TELLS-MORE-1109402.htm
-----------------------------
The American Physical Therapy Association (APTA) is seeking to gather input from a variety of
stakeholders, including:
• Physical therapy patients/clients,
• Non-PT Health care providers, and
• Product/Service Vendors who serve the physical therapy profession
If you know someone who fits in one or more of these categories, please feel free to pass the survey link
on so they can contribute their views.
See the link below to participate in this very important survey.
Thank you for your input!
Nicole
Nicole L. Stout MPT, CLT-LANA
Survery was deactivated in January this post is fyi only.
Hello – The American Physical Therapy Association (APTA) requests your assistance in completing its
Environmental Scan Survey. This Environmental Scan Survey is being provided to you and other valued
stakeholders to gather your views about the physical therapy profession’s current and future
environment. Your response to this invitation on or before January 20th is greatly appreciated!
The analysis of the collected data will help APTA identify current trends and possible changes that are
occurring, or will occur, in the next one to three years that could affect the nature, direction, or viability
of the physical therapy profession. Responses will be summarized and the data used to inform APTA’s
strategic planning process. Your individual responses will remain strictly confidential and results will be
reported in aggregate form only.
To complete this survey, please click the link below and follow the instructions provided. Please answer
the questions in this survey from your individual perspective. We understand that some questions may
not be applicable you. In such instances, please skip the question and move on.
Click here to begin the Environmental Scan Survey.
If you have any questions, or if you would like additional information about this survey, please contact
Marc Goldstein, EdD, APTA’s Senior Director of Research at research-dept@ apta.org.
Finally, APTA is seeking to gather input from a variety of stakeholders, including:
• Physical therapy patients/clients,
• Non-PT Health care providers, and
• Product/Service Vendors who serve the physical therapy profession
If you know someone who fits in one or more of these categories, please feel free to pass the survey link
on so they can contribute their views.
Thank you,
R. Scott Ward, PT, PhD
President, American Physical Therapy Association
----------------------
Measuring the Cost of a Lymphedema Treatment Mandate -
3 Years of Experience in the Commonwealth of Virginia
BACKGROUND: One of the most urgent of problems today is our inability to afford quality healthcare.
Lymphedema, once acquired, is a lifelong disease with no currently known cure. However, the quality of
that treatment is greatly to be questioned, and often does not meet the recommended standards of
knowledgeable lymphedema specialty groups. These standards include the treatment by specially
qualified therapists, a course of treatment limited only by medical necessity, patient instruction in self
treatment and the provision and daily use of compression bandages, garments and devices. It can be
shown that lymphedema treatment in accordance with these protocols, with high patient adherence, is an
effective way to REDUCE healthcare costs by reducing the periodic infections for which the
lymphedema patient is at risk.
Lymphedema mandates are being considered in a number of states similar to the lymphedema treatment
mandate passed by the Commonwealth of Virginia in 2003. Virginia also has in place a rule that requires
every insurer, health services plan and health maintenance organization (HMO) to report to the State
Corporation Commissioner the yearly cost and utilization information for each of the 30 mandates
currently in effect.
This document is an abstract of the costs of the Virginia lymphedema treatment mandate for the year
2006, with comparisons with the two prior years the mandate has been in effect. It contains claims and
utilization data, and estimates by the healthcare providers of the insurance premium impact of each
mandate. These impacts are spending impacts only, and do not consider the beneficial effects of
lymphedema treatment on reducing medical and hospital costs by the inevitable reduction of
lymphedema-related cellulitis.
DATA SOURCE: The source of data for this document is the “Report of the State Corporation
Commission on The Financial Impact of Mandated Health Insurance Benefits and Providers Pursuant to
Section 38.2-3419.1 of the Code of Virginia: 2006 Reporting Period to the Governor and the General
Assembly of Virginia” Report RD289, October 25, 2007 available at the Virginia Department of
Insurance website at URL: http://leg2.state.va.us/DLS/H&SDocs.NSF/Published%20by%20Year?
The cost data for the lymphedema mandate is abstracted and presented with a discussion of other states'
lymphedema mandate analyses. This Virginia report is the only comprehensive and authoritative report
to date of the cost of lymphedema care, and covers 28 major insurance companies and 14 HMOs
representing 77.26% of the Virginia insurance market, and 1,482,863 units of coverage.
VIRGINIA LYMPHEDEMA MANDATE: Section 38.2-3418.14 of the Code of Virginia requires that
insurers, health service plans and HMOs provide coverage that shall include benefits for equipment,
supplies, complex decongestive therapy, and outpatient self-management training and education for the
treatment of lymphedema.
CPT AND ICD-9-CM CODES COLLECTED: The codes collected and costed in the company
claims reports included ICD Codes 457.0 Postmastectomy lymphedema syndrome, 457.1 Other
lymphedema, 757.0 Hereditary edema of legs, CPT Codes, 97124 Massage, compression, 97140
Manual therapy techniques, manipulation, 97535 Self-care/home management training
CLAIM EXPERIENCE: Claim experience provides the most direct measure of the cost of a
lymphedema treatment mandate. The lymphedema claims filed as a percentage of the total claims for
individual contracts was 0.05%, and for group contracts was 0.06%. The average lymphedema claim
cost per individual contract was $1.15 and for group contract $2.64. [Tables 5 & 6]. Since most
insurance contracts included lymphedema treatment prior to the mandate and separate claim data for
lymphedema treatment were not required to be reported, it is not possible to determine what portion of
these claim costs result from the mandate.
UTILIZATION OF SERVICE: Data are provided on the number of visits and the number of days
attributable to each mandated benefit for the year. The group data was held to be more reliable than the
individual contract data. The average number of visits per contract for lymphedema treatment was 0.09,
and the average number of days per contract was 0.01. [Table 7]
PREMIUM IMPACT: Companies are required to use actual claim experience and other relevant
actuarial information to determine the premium impact of each mandated benefit. The estimated premium
impact or the lymphedema mandate ranged 0.25% to 0.56% of the overall average contract premium on
individual contracts, and 0.13% to 0.25% on HMO contracts. It is not possible to explain why the
estimated premium impacts are so much greater than the actual claims experience.
MANDATE ANALYSES IN OTHER STATES: A 2004 analysis of a similar Massachusetts bill
estimated per member per month costs of $0.03 for coverage of lymphedema treatment. In 2005 the
California Health Benefits Review Program estimated an increase of 0.0003% or $0.01 per person per
year for implementing AB-213 Liu. None of these analyses accounted for significant avoided costs due
to reduced infection that could be passed on to the customer as REDUCED premiums.
CONCLUSIONS: An upper bound on the costs of implementing a lymphedema treatment mandate can
be estimated using the actual claims data in Virginia, where a lymphedema mandate has been law since
January 1, 2004. It is an upper bound since: 1) the estimated premium increases are many times the
actual claims experience for the years analyzed; 2) the reported claims experience represents the total
lymphedema treatment claims instead of the incremental increase due to the mandate, and; 3) the
reduction in total claim costs due to resulting lower cellulitis rates are not used to reduce estimated
premiums.
Prepared by Robert Weiss, M.S.
Lymphedema Treatment Advocate
National Lymphedema Network
LymphActivist@aol.com
====================================================================
REFERENCES
1. “Report of the State Corporation Commission on The Financial Impact of Mandated Health
Insurance Benefits and Providers Pursuant to Section 38.2-3419.1 of the Code of Virginia: 2006
Reporting Period to the Governor and the General Assembly of Virginia” Report RD289, October 25,
2007 available at the Virginia Department of Insurance website at URL: http://leg2.state.va.
us/DLS/H&SDocs.NSF/Published%20by%20Year?
2. California Health Benefits Review Program, "Analysis of Assembly Bill 213 Health Care Coverage
for Lymphedema" A Report to the 2005-2006 California Legislature, April 7, 2005.
3. Commonwealth of Massachusetts Mandated Benefit Review - "Review and Evaluation of Proposed
Legislation Entitled: “An Act Providing Coverage for Lymphedema Treatments” Companion bills:
Senate Bill No. 848 & House Bill No. 1309, Provided for: The Joint Committee on Insurance Division
of Health Care Finance and Policy Commonwealth of Massachusetts.
Potential saving through proper LE management.doc
An Estimate of Healthcare Savings which could be achieved through Proper Lymphedema Management
The underlying principle behind the analysis is the assumption that management of lymphedema results in
an immediate and significant reduction in the incidence of lymphedema-related infection. The ongoing
cost of treatment of lymphedema is balanced out by the savings due to avoidance of the necessity of
treating recurring cellulitis, frequently on an emergency basis.
A number of separate approaches have been taken to arrive at a credible estimate of the potential
savings to be achieved. The first approach (Appendix A) was to postulate two lymphedema treatment
scenarios for a woman diagnosed with and treated for breast cancer. The first scenario postulates that
she receives early and continued treatment of her lymphedema according to the recommended
guidelines. The second scenario postulates that she receives no treatment for her lymphedema, but does
receive medical treatment for her recurrent lymphedema-related infections. Data to support both
scenarios are derived from statistics taken from recent scientific journals. The results of this study
establishes, for this hypothetical case, a significant saving to her medical provider when the lymphedema
is treated and managed.
Infection of the skin and lymphatic system (cellulitis/lymphangitis) is a major cause of lymphedema. It is
also a major result of lymphedema. (Stoberl & Partsch 1987). Some 10-15% of lymphedema patients
experience infections each year (Swenson et. al. 2002, Kasseroller 1998). Therefore one might expect
30,000-45,000 cellulitis cases yearly from 300,000 lymphedema patients in California (Appendix C).
Hospital discharges for 2003 involving cellulitis of all sites and from all causes were 111,438. The
average hospital stay for cellulitis was 5 days (Hospital Discharge Data 2002). At an average hospital
stay cost per patient per day in California of $1763 (2003 AHA Annual Survey) this places the yearly
burden for treatment of cellulitis in California at almost 1 Billion dollars, with $264-397 million estimated
as related to lymphedema. If the incidence of cellulitis is reduced by 50% through the treatment of
lymphedema (Ko et. al. 1998, Foeldi 1996) a $132-200 million saving would result, not accounting for
medication cost savings or savings due to reduced disability.
Another approach taken was an attempt to extend this principle to a large population by examining
actual hospital admissions data to attempt to size the burden of unmanaged lymphedema and the savings
to be achieved for a larger population by treating the lymphedema. This study utilized the Patient
Discharge Data for Calendar Year 2003 maintained by the California Office of Statewide Health
Planning and Development. Total number of patient discharges in 2003 involving cellulitis of the arm or
hand (ICD-9-CM Codes 682.3 and 682.4) were 18,876. Of this total, 307 cases involved upper limb
lymphedema or swelling. These 307 cases involved an average hospital stay of 5.6 days for a total cost
of $8,271,398. The total number of patient discharges in 2003 involving cellulitis of the leg and foot
(ICD-9-CM Codes 682.6 and 682.7) were 62,056. Of this total, 1851 cases involved lower limb
lymphedema or swelling. These 1851 cases involved an average hospital stay of 10.4 days for a total
cost of $62,814,399. Similar relationships are shown between discharges with cellulitis of the lower
limbs and various surgical procedures e.g.: hip and knee replacement and hysterectomy 224 cases at
$25,262,301 cost; and coronary artery by-pass grafts 265 cases at $66,224,482 cost. Each of these
infections is a lymphedema risk factor. Adding up the costs of only the cases of cellulitis documented as
being related to lymphedema or swelling, yields a total of $162,571,000 in treatment of lymphedema-
related cellulitis, well within the $132-200 million range of savings calculated using a different analysis
using different data sets.
An estimate was made as to the cost of providing lymphedema treatment to the estimated lymphedema
patients in California. Hinrichs found that the distribution of severities was 75% mild (Stage 1), 22%
moderate (Stage 2) and 3% severe (Stage 3). Yearly costs of treatment developed in the hypothetical
breast cancer scenario (Appendix A) were $200 for Stage 1, $1550 for Stage 2 and $5500 for Stage
3. Applying the observed distribution of severity of lymphedema [Hinrichs 2004] to the estimated
300,000 California lymphedema patients and using the estimated costs of treatment, yields an annual
cost of lymphedema treatment if all patients were to be diagnosed and treated of $197 million. These
estimated costs are in the range of estimated savings using statistics in scientific journals and hospital
databases.
So the bottom line is that treatment of lymphedema is cost neutral and has the potential of saving money,
providing a significantly improved quality of life for lymphedema patients and reducing the burden of
disabilities resulting from late-stage lymphedema. Further references to the cost-efficacy of lymphedema
treatment are found in the annotated references of Appendix B.
Prepared by Robert Weiss, M.S.
Lymphedema Treatment Advocate
National Lymphedema Network
LymphActivist@aol.com
======================================================================
=
APPENDIX A
STRUCTURE FOR A COST-EFFICACY STUDY OF LYMPHEDEMA TREATMENT
ASSUMPTIONS:
•Patient diagnosed and treated for breast cancer at 40 years of age
•Patient lives to 80 years of age
•Assume two different scenarios for post-mastectomy lymphedema treatment:
-Patient receives early and continual lymphedema treatment
-Patient does not treat lymphedema, but treats lymphedema-related infections
DEVELOPMENT OF TREATMENT COSTS:
•Costs postulated for Phase I (clinical) and Phase II (home) Treatment.
-Phase I costs include 2-week course of CDT @ $1000, 1 compression sleeve @ $100, 1
bandaging kit @$150 = $1250.
-Phase II annual costs depend on Stage of LE.
+Stage 1 (less than 2cm) costs include 4 Medi or Juzo compression sleeves per
year @ $50 = $200/year.
+Stage 2 (between 2-10cm) costs include 4 Elvarex compression sleeves @ $150,
1-week CDT course @ $500, 3 bandaging kits @ $150 = $600+500+450= $1550/year.
+Stage 3 (greater than 10cm) costs include 6 Elvarex compression sleeves @
$150, 6-weeks of CDT @ $500 / week, 4 bandaging kits @ $150, Pneumatic compression pump
$5000/5 years = $900+3000+600+1000=$5500/year.
•Assumed cost of treatment of an infection in emergency room setting including intravenous antibiotic, 2-
week course of oral antibiotic, followup office visits, physical therapist = $5000.
LYMPHEDEMA PROGRESSION SCENARIOS:
•Incidence of infection (cellulitis/lymphangitis) depends on stage and treatment. Each infection further
scars the lymphatic system and advances the stage of the lymphedema.
-Untreated
+Stage 1: 1 infection which ends Stage 1 and initiates Stage 2;
+Stage 2: 1 infection every 2 years;
+Stage 3: 2 infections per year.
-Treated
+Stage 1: 1 infection which ends Stage 1 and initiates Stage 2;
+Stage 2: 1 infection every 5 years;
+Stage 3: 1 infection every 2 years
SCENARIOS COSTED FOR 40 YEARS OF SURVIVAL:
•SCENARIO #1- Lymphedema after breast cancer is NOT TREATED:
-Stage 1 (less than 2cm) for 2 years, followed by;
-Stage 2 (between 2-10cm) for 6 years, followed by;
-Stage 3 (greater than 10cm) for remaining 32 years.
•SCENARIO #2- Lymphedema after breast cancer IS TREATED:
-Stage 1 (less than 2cm) for 5 years, followed by;
-Stage 2 (between 2-10cm) for remaining 35 years.
COST SUMMATIONS
•Cost for Scenario #1:
-2 years @ Stage 1, 1 infection: $5000 = $5,000
-6 years @ Stage 2, 3 infections: 3x$5000 = $15,000
-32 years @ Stage 3, 64x$5000 = $320,000
Total cost for 40 years $340,000
•Cost for Scenario #2:
-5 years @ Stage 1, 1 infection: $5000 + 5x$200 = $6,000
-35 years @ Stage 2, 7 infections: 7x$5000 + 35x$1,550 = $89,250
Total cost for 40 years $95,250
•Net Cost of Lymphedema Treatment over 40-year Breast Cancer Survivor's survival lifetime:
$95,250 minus $340,000 equals NEGATIVE $244,750 (Savings for illustrative patient)
Cost Ratio = 3.57 (no LE treatment / LE treatment)
The estimates for the cost of treating one infection are low, perhaps by a factor of two or three. The cost
differentials would be much more dramatic if these higher figures were to be used. The above analysis
does not include the disability and loss of wages or the pharmaceutical costs for pain management due to
not treating or under-treating lymphedema.
LYMPHEDEMA TREATMENT IS GOOD BUSINESS AS WELL AS GOOD MEDICINE.
=================================================================
APPENDIX B
LYMPHEDEMA TREATMENT COST-EFFECTIVITY REFERENCES
Compiled by Robert Weiss 10/8/03
Updated 2/22/04
Boris, MD, M., Weindorf, MD, S., Lasinski, M.A., P.T., B.: “Persistence of Lymphedema Reduction
After Complex Lymphedema Therapy”, (1997)Oncology, Vol. 11, No. 1, January 1997, pp. 99-109,
discussion pp. 110, 113-114. Three case reports document dramatic decreases in incidence of
hospitalizations for treatment of cellulitis for three patients treated by CDT.
Campisi C, Boccardo F, Zilli A, Maccio A, Napoli F: "The use of vein grafts in the treatment of
peripheral lymphedemas: long-term results", Microsurgery. 2001;21(4):143-7. Study of 665 patients
with microsurgical lymphatic-venous anastomoses for obstructive lymphedema with 446 patients
available for long-term follow-up. Average follow-up of greater than 7 years showed average reduction
in excess volume of 69%. There was an 87% reduction in the incidence of cellulitis.
Campisi C, Boccardo F, Zilli A, Maccio A, Napoli F.: "Long-term results after lymphatic-venous
anastomoses for the treatment of obstructive lymphedema". Microsurgery 2001;21(4):135-9. Over the
past 25 years, 665 patients with obstructive lymphedema have been treated with microsurgical
lymphatic-venous anastomoses; of these, 446 patients were available for long-term follow-up study.
Objective assessment was undertaken by water volumetry and lymphoscintigraphy.
Lymphangioscintigraphy, lymphangiography (in patients with gravitational reflux pathology), and echo-
Doppler were used preoperatively. Subjective improvement was noted in 578 patients (87%).
Objectively, volume changes showed a significant improvement in 552 patients (83%), with an average
reduction of 67% of the excess volume. Of those patients followed up, 379 patients (85%) have been
able to discontinue the use of conservative measures, with an average follow-up of more than 7 years
and average reduction in excess volume of 69%. There was a 87% reduction in the incidence of cellulitis
after microsurgery.
Casley-Smith, J. R. PhD, MD, Boris, M., MD, Weindorf, S. MD, Lasinski, B. MA, PT: "Treatment for
Lymphedema of the Arm—The Casley-Smith Method, A Noninvasive Method Produces Continued
Reduction", (1998) Cancer (Supplement) Vol. 83, No. 12, Dec 15, 1998, pp. 2843-2860. Costs per
year and effectivities of a 4-week course of CDT treatment was presented, including costs of bandages
and garments (Figure 9). Average costs for different treatments ranged from $2000-3000 per year with
40% to over 100% reductions of initial edema. Cost ranges from savings (negative costs) to $7000 per
year for various alternative treatment protocols.
Daane, S. MD, Poltoratszy, P. RPT, CPT, Rockwell, W. B. MD: "Post-mastectomy Lymphedema
Management: Evolution of the Complex Decongestive Therapy Technique", Ann Plast Surg, Feb 1998,
Vol 40, No. 2, pp. 128-134. Treatment was an average of 15.3 visits per patient over a period of 3-4
weeks, with an average cost of $1513. The duration of each treatment session was from 45 minutes to 1
hour. The goals of therapy are to control edema, to prevent infection and to improve function. Each
inflammatory episode can exacerbate lymphatic fibrosis.
Földi MD, E.: "Prevention of Dermatolymphangioadenitis by Combined Physiotherapy of the Swollen
Arm after Treatment of Breast Cancer", Lymphology, 1996, Vol. 29, pp. 91-94. Study of medical
records of 150 breast cancer patients with arm lymphedema in the years 1990-1994. Conclusion were
that in women with arm lymphedema after treatment of breast cancer, recurrent
Dermatolymphangioadenitis (DLA) attacks [cellulitis/lymphangitis infections] can nearly be eliminated by
improvement in arm swelling by combined physiotherapy (CPT) Phase I. If these women are free of skin
risk factors [unrelated to the lymphedema] such as psoriasis, neurodermatitis, vericose lymphatics,
lymph fistulae and/or fungal overgrowth, continued CPT (Phase II) maintains reduction of edema and
prevents further DLA episodes.
Ko, MD, D. S. C., Lerner, MD, R., Klose, CCDPI, G.; Cosimi, MD, A. B.: “Effective Treatment of
Lymphedema of the Extremities”, Arch of Surgery, April 1998; Vol. 133, pp. 452-458. 299 patients
referred for evaluation of lymphedema of the upper or lower extrematies were treated with CDT for an
average duration of 15.7 days. Lymphedema reduction was measured following treatment and at 6- and
12-month follow-up visits. The incidence of infections decreased from 1.10 infections per patient year to
0.65 infections per patient year after a complete course of CDP [Phase I and Phase II] (Table 2).
Krishnamoorthy K: "Estimated costs of acute adenolymphangitis to patients with chronic manifestations
of bancroftian filariasis in India."Indian J Public Health 1999 Apr-Jun;43(2):58-63.
In India, lymphatic filariasis persists as a major cause of clinical morbidity and as an impediment to socio-
economic development. The direct costs incurred for the treatment of adeno-lymphangitis (ADL)
episodes and the consequent indirect costs due to loss of income were determined from selected
agricultural labour-intensive rural endemic pockets in Tamil Nadu. Information on the occurrence of
ADL, its frequency and duration were collected using semi-structured questionnaire from randomly
selected patients afflicted with chronic manifestations of bancroftian filariasis. Direct (treatment) cost per
year per patient was found to range from Rs. 30 to 101 among patients with different manifestations.
Income foregone (indirect cost) annually by each patient, which is a function of frequency and duration
of ADL ranged from Rs. 182 to 702. ADL episodes among filarial patients alone cost a minimum of Rs.
4515 million for the nation every year. Cost benefit analysis of filariasis control programme in India
showed that the benefits in terms of savings on treatment and work lost due ADL alone exceeded the
cost by 24%. The per capita cost of the National Filaria Control Programme was calculated to be Rs.
2.6 per annuam.
Lerner, R. MD: "Complete Decongestive Pysiotherapy and the Lerner Lymphedema Services Academy
of Lymphatic Studies (the Lerner School)", (1998) Cancer (Supplement) Vol. 83, No. 12, Dec 15,
1998, pp. 2861-2863. "By employing [the Foeldi] method of CDP we have been given a treatment
modality that achieves a greater than 80% long term success rate without morbidity or mortality and
without disfigurement of any kind. We have been able to do this for a reasonable cost, and, by
transferring the future care of the lymphedema patient away from the doctor/hospital setting, we have
produced a very cost effective method of caring for this long-term, chronic disease."
Miller SR, Mondry T, Reed JS, Findley A, Johnstone PA.Delayed cellulitis associated with conservative
therapy for breast cancer. J Surg Oncol. 1998 Apr;67(4):242-5.
Delayed breast cellulitis is an infrequently reported entity after conservation therapy for breast cancer.
We describe our experience with this entity at Naval Medical Center, San Diego. Eight patients who
presented with delayed cellulitis after wide local excision/axillary dissection and breast radiotherapy (RT)
are presented. Their clinical characteristics and therapy are described and possible causative factors are
analyzed. The latency of breast cellulitis is variable after breast conservation therapy, although most
cases in our experience and in the literature occur within a year post-RT. These infections are frequently
refractory to a single course of antibiotics (n = 4 cases in our experience). Some patients suffer multiple
episodes separated by months. Breast cancer patients are at risk for delayed cellulitis after conservative
surgery and RT. The mechanism of such events probably involves lymph stasis, however, therapy is no
different from the more frequently occurring cases of cellulitis presenting perioperatively.
O'Brien BM, Mellow CG, Khazanchi RK, Dvir E, Kumar V, Pederson WC.: "Long-Term Results after
Microlymphaticovenous Anastomoses for the Treatment of Obstructive Lymphedema," J Plastic and
Reconstr Surg, 1990, Vol. 85, No. 4, pp. 562-72. Over the last 14 years, 134 patients with obstructive
lymphedema have been treated with microlymphaticovenous anastomoses. Ninety patients were
available for long-term follow-up study. Of these, 52 patients were treated by microlymphatic surgery
only and 38 of them also had segmental or radical reduction surgery, either at the same time or
secondarily. Objective assessment was undertaken by volume and circumferential measurements.
Initially, lymphangiography was used, but a study demonstrated increased edema immediately following
the investigation in one-third of the patients and it was abandoned, both preoperatively and
postoperatively. In the microlymphaticovenous anastomoses only group (N = 52), subjective
improvement occurred in 38 patients (73 percent). Objectively, volume changes showed a significant
improvement in 22 patients (42 percent), with an average reduction of 44 percent of the excess volume.
In the microlymphaticovenous anastomoses and reduction surgery, usually segmental, group (N = 38),
subjective improvement occurred in 30 patients (78 percent) and objective improvement occurred in 23
patients (60 percent), with an average reduction of 44 percent of the excess volume. Of those followed
up, 67 patients (74 percent) have been able to discontinue the use of conservative measures, with an
average follow-up of 4.0 years and average reduction in excess volume of 26 percent. There was a 58
percent reduction in the incidence of cellulitis following surgery. In those patients who were improved,
drainage resulted in increased softness of the limbs. Edema of the hand diminished considerably in most
patients, although this was difficult to measure. These long-term results indicate that
microlymphaticovenous anastomoses have a valuable place in the treatment of obstructive lymphedema
and should be the treatment of choice in these patients. Reduction surgery can be used as an adjunct in
some of these patients, especially in the posteromedial aspect of the upper arm. Liposuction has been
used in failed cases or in patients in whom no lymphatics could be found. Improved results can be
expected with earlier operations because patients referred earlier usually have less lymphatic disruption.
Reid T: "Treatment of Lymphedema and Recurrent Cellulitis", Case Report presented at the Second
National Lymphedema Network Conference, Sept 1996. 31 year old patient with lymphedema due to
multiple knee injuries and surgeries spent 152 days in hospital between May 1994 and November 1995.
After 5 months of treatment with Reid manually-adjustable compression sleeve, she had no further
events of cellulitis and was able to be taken off antibiotics. Cost effectiveness analysis showed savings
over 5 months to exceed $90,000-$130-000 based on hospital cost of $2-3,000/day.
Thiadens SRJ, Rooke TW, Cooke JP: "Lymphedema" in Current Management of Hypertensive and
Vascular Diseases (1992) Mosby Yearbeck, Inc., St. Louis, MO. pp. 314-319. In a retrospective
study of 304 lymphedema patients, over 25 percent had incurred an episode of cellulitis over a period of
3 years.
======================================================================
=
APPENDIX C
PREVALENCE OF LYMPHEDEMA IN CALIFORNIA
Authoritative estimates of the prevalence of lymphedema in California do not currently exist. An estimate
of 300,000 has been made based on the following rationale and sources.
The process starts with American Cancer Society data on the prevalence of the most common cancers
based on SEER data. A best estimate of the incidence of lymphedema from treatment of the various
types of cancer was developed from a systematic analysis of scientific journal data to obtain an estimate
of the prevalence of lymphedema among cancer survivors. An estimate of the prevalence of
lymphedema as sequelae of various other non-cancer-related surgeries and radiotherapy was added
based on hospital discharge statistics.
The basic starting point is the American Cancer Society's "California Cancer Facts & Figures, 2003,
specifically page 3 table entitled "Expected Incidence, Mortality, and Prevalence of Common Cancers in
California, 2003" This reference shows the prevalence of the top 5 cancers for men and women in
California as 698,600, which represents 77% of all cancers. The total of all cases would be 906,300
excluding DCIS cases.
An estimate of the DCIS cases is derived from the ACS “Cancer Facts and Figures 2004”. Carcinoma
in situ of the breast accounts for about 59,390 new cases annually. During this same year the estimated
number of new cases of invasive breast cancer was 217,440. Using the number for invasive breast
cancer to estimate lymphedema would yield an estimate 21.5% low, since the treatment protocols are
the same for DCIS as for early-stage invasive breast carcinoma. The estimate California prevalence was
therefore adjusted by 121.5%, giving a prevalence of all cancers including DCIS of 1,101,155.
A systematic study of the scientific literature on lymphedema resulted in an estimate of the incidence of
lymphedema. Consulting a list of over 2,000 journal references to lymphedema, over 250 contain data
on incidence of lymphedema as sequalae of various surgical and radiative therapies and on the
prevalence of primary lymphedema.
This systematic analysis was presented as a plenary session presentation entitled "Incidence of
Lymphedema –A Literature Review" at the 6th International NLN Conference for Professionals, "New
Frontiers in Lymphedema Research & Therapy" held in Reno in October 2004. A summary of the
findings was published in the NLN quarterly journal LYMPHLink Jan-Mar 2005;17(1):12,27.
The incidence of lymphedema from the various cancer therapies ranges from 10 to 40 percent. A
weighted average for the various cancers of 25% applied to the 1 million+ cancer survivors in California
in 2003 yielding an estimate of the prevalence of lymphedema in California from cancer therapies as
275,289.
To the above cancer-related population is added an estimate of the lymphedema resulting from other
surgical procedures. For example, in Damberg CL, Danielson B et. al.:"The California Report on
Coronary Artery Bypass Graft Surgery 1999 Hospital Data Summary Report" dated August 2003 the
authors state "Each year approximately 26,000 Californians with advanced heart disease undergo
Coronary Artery Bypass Graft." An estimated 25% of these patients, who have a section of their
saphenous vein and associated lymph vessels harvested to perform the CABG, will develop
lymphedema in the lower limb from which the vein was removed, yielding an additional 6,500
lymphedema patients each year.
Other surgical procedures known to be related to lymphedema are hip and knee replacements. There is
no California data on the frequency of these procedures, or the prevalence of the survivors. National
hospital discharge data from 2002 suggest that the number of total hip replacements (165,000) and total
knee replacements (326,000) are on the same order as coronary artery bypass grafts (516,000). One
can guess therefore that another 6,500 lymphedema cases can be added each year from these
procedures.
Another cause of lymphedema is repeated skin infections (cellulitis or lymphangitis). It is not known what
percentage of the 111,438 cases of cellulitis treated in California in 2003 were the result of lymphedema
and what percentage were the primary cause of lymphedema.[Stoberl C & Partsch H: “Erysipel und
Lymphodém: Ei oder henne?” (Erysipelas and lymphedema: egg or hen?) in German, Z Hautkr. 1987;
62:56-62.]
At this point, and until more definitive data mining can be done, it would be prudent to limit the estimate
of lymphedema from all causes to 300,000, with 275,000 from cancer treatment. Dr. Szuba of Stanford
University states "In our (lymphedema) clinic, about 75% of the patients have lymphedema because of
malignancy or its therapy, with about half of these related to breast cancer surgery." [Szuba A, Shin WS,
Strauss HW & Rockson S.: "The third circulation: radionuclide lymphoscintigraphy in the evaluation of
lymphedema", J Nucl Med Jan 1,2003;44 (1):43-57]. Using that ratio would increase the estimate to
367,000 based on the 275,000 cancer-related estimate.
NLN rational for a 2010 bill.doc
The National Lymphedema Network’s rationale for a
Lymphedema Diagnosis & Treatment Cost Saving Bill of 2010
LYMPHEDEMA is a medical condition affecting an estimated 1.5 to 3 million Medicare Beneficiaries
who are not receiving treatment from Medicare according to the current medical standard of care. But
what is worse is that Medicare is spending billions of dollars every year treating a largely preventable
lymphedema-related CELLULITIS.
The NLN hopes that you will consider introducing a lymphedema diagnosis and treatment cost-saving
bill to correct many of the deficiencies in Medicare coverage of lymphedema treatment. We can provide
you with a proposed draft if you are interested in sponsoring this quality of care bill. There is no conflict
with current Congressional efforts to pass a Medicare access bill since this is a quality of care bill. The
bill also does not conflict with any CMS policies, but instead it removes ambiguities and clarifies
coverage issues.
Lymphedema is incurable and progressive, and if left untreated, the swollen area can become fibrous
and prone to serious, debilitating infections. Over time, untreated lymphedema results in disfigurement,
disability and even death. The recognized standard of treatment of lymphedema is Complete
Decongestive Therapy (CDT). CDT comprises four interacting protocols applied in two phases (acute
and ongoing): manual lymph drainage (MLD); compression therapy; lymph drainage exercises; and skin
care. [Refs: ACS 1998, ISL 2003, NLN 2006]. The initial intensive phase is performed by medical
professionals, but ongoing care is patient self-provided using techniques taught the patient by the
healthcare provider.
Medicare does not cover lymphedema treatment materials or treatment by lymphedema- qualified
professionals other than Physical Therapists and Occupational Therapists, nor does Medicare require
that the provider of lymphedema treatment services be qualified in the specialized techniques. While
Medicare does cover and pay for statutorily-limited therapy and sequential compression pumps, many
patients suffer recurrent infections, progressive degradation in their condition and eventual disability
because they cannot afford the compression bandages and garments required for their everyday self-
care.
Denials of coverage for lymphedema compression bandage systems, compression garments and devices
and supplies are based on inconsistent interpretations of Federal statutes and the Medicare publication
system, and CMS has stated repeatedly that a change in the law will be necessary in order for them to
change their policies to cover these medically necessary items. We would like to request that you pursue
such a change.
Please understand that this is NOT a new health mandate. The staff, equipment and facilities are already
in place in most medical providers. Most providers already cover lymphedema treatment, and there are
no exclusions in any medical policies that we are aware of. The Women’s Health and Cancer Rights Act
of 1998 already mandates the treatment of lymphedema resulting from breast cancer treatment.
It can be shown to result in medical savings which exceed ongoing costs by factors of 2-5. A
lymphedema coverage mandate has been in effect in Virginia since 2004, and a similar law was passed
in North Carolina this year, to become effective in 2010. Data from the first five years of operation in
Virginia show claim costs of $1.12-2.82 per year per contract (0.04-0.09% of total claims) not
accounting for the expected savings due to reduced cellulitis rates.
The National Lymphedema Network urges you to consider sponsoring the proposed “Lymphedema
Diagnosis and Treatment Cost Saving Bill of 2010” which has the backing of the National Lymphedema
Network. Please contact us with any questions or with requests for further information, medical
evidence, cost efficacy data or detailed legislative details.
Prepared by Robert Weiss, M.S. with the NLN
Lymphedema Treatment Advocate
LymphActivist@aol.com
National Lymphedema Network
Latham Square, 1611 Telegraph Avenue, Suite 1111
Oakland, CA 94612-2138
Hotline: 1-800-541-3259 or 510-208-3200
Fax: 510-208-3110
www.lymphnet.org
nln@lymphnet.org
This one had pictures that didnt come thru, if you want them tell me how to get them to you and I can
Lymphedema Overview -.doc
Lymphedema Overview
What Is Lymphedema: Lymphedema is a condition caused by injury, trauma or congenital defects
involving the lymph system. When the impairment becomes so great that the lymphatic fluid exceeds the
lymphatic transport capacity, an abnormal amount of protein-rich fluid collects in the tissues of the
affected area. There are two types of lymphedema. Primary lymphedema, which can be present at
birth (congenital), develop at the onset of puberty (praecox) or in adulthood (tarda). Secondary
Lymphedema can be caused by surgeries or radiation treatments and is a common side effect of cancer
treatments that remove or damage lymph nodes resulting in the chronic swelling of a body area or part
nearest the damaged portion of the lymph system.
Stages of Lymphedema:
Stage 1: Tissue is still at the "pitting" stage, which means that when pressed by fingertips, the area
indents and holds the indentation. When lymphedema is diagnosed and treatment is begun in Stage1,
and received consistently, the disease in almost all cases cases will be prevented from progressing, there
will be few complications and the patient will live a long, healthy and virtually normal life.
Stage 2: The tissue now has a spongy consistency and is "non-pitting," meaning that when pressed by
fingertips, the tissue bounces back without any indentation forming. Fibrosis found in Stage 2
lymphedema marks the beginning of the hardening of the limbs and increasing size. When diagnosis and
treatment are received in Stage 2 it is possible that through treatment a patient will return to stage one,
and progression to Stage 3 can be prevented. In Stage 2 the patient will have more frequent
complications, the disease will have effected his/her ability to lead a normal life in some regards and
varying degrees of constant discomfort may be present.
Stage 3: At this stage the swelling is irreversible and usually the limb(s) is/are very large. The tissue is
hard (fibrotic) and unresponsive; at this stage some patients consider undergoing reconstructive surgery
called "debulking". The damage is now irreversible; there is potentially serious chronic pain and the
lymphedema patient faces recurring, difficult and expensive to treat complications. A person with Stage
3 lymphedema is often fully disabled by the disease.
In virtually all cases, lymphedema can be halted from progressing once diagnosis is made and treatment
is begun and continued consistently.
Typical examples of Stage 3 are below – this can be prevented!
PICTURES DELETED
Treatment for Lymphedema: The standard of lymphedema care is a multi-phasic, multi-modal protocol
called "complex decongestive therapy or CDT" consisting of manual lymph drainage, compression
therapy, exercises and skin care. It is administered in two phases; a clinical phase and a home care
phase, elements of which are prescribed by the patient's physician and qualified therapist. Initial
treatment by a qualified lymphedema therapist consists of 2-4 weeks of frequent manual lymph drainage
sessions and compression bandaging, specialized decongestion exercises, and instruction in self-care for
the second phase of treatment. After the initial swelling is reduced to a minimum by the professional
therapist, the patient is measured for a compression garment and continues self-treatment at home with
simplified self-lymph draining, self bandaging, exercises while under compression, wearing of
compression garments and meticulous skin care. The goal is to transfer responsibility for ongoing
treatment to the patient, thereby unburdening the healthcare system. But the provision of the materials
necessary for self-care remains the responsibility of the healthcare system, else the patient cannot be
adherent.
PICTURES DELETED
Complications: When lymphedema remains untreated, protein-rich fluid continues to accumulate, leading
to an increase of swelling and a hardening or fibrosis of the tissue. In this state, the swollen limb(s)
becomes a perfect culture medium for bacteria and subsequent recurrent infections (cellulitis and
lymphangitis). Moreover, untreated lymphedema can lead into a decrease or loss of functioning of the
limb(s), skin breakdown, chronic infections and, sometimes, irreversible complications. In the most
severe cases, untreated lymphedema can develop into a rare form of lymphatic cancer called
Lymphangiosarcoma (most often in secondary lymphedema). Since lymphedema is disfiguring, causes
difficulties in daily living and can lead to lifestyle becoming severely limited, it may also result in
psychological distress.
PICTURES DELETED
Cover Letter to legislatures re an LE mandate.doc
Why Legislation to ensure nation-wide Lymphedema Treatment Coverage is desperately needed
Dear Congressman Kissell,
My young son Dylan (DOB 9/29/06) was born with lymphedema, a life-long disease for which there is
currently no known cure. Lymphedema sufferers face great obstacles due to lack of insurance coverage
for their treatment. Despite the fact that this treatment does not fall under any of the categories for which
insurance companies typically justify denial of coverage, my appeals, and those of so many others, have
fallen on deaf ears.
Lymphedema (known many years ago as elephantiasis) has many causes, but most cases are the result
of treatment for cancer. Only one known course of treatment exists; it is used world-wide by the
medical community, it is not experimental and has decades of proven success. The treatment protocol is
low-tech, uses already available facilities and healthcare staff and requires no new expensive
pharmaceuticals or surgery. Yet lymphedema treatment is currently not covered by Medicare, Medicaid
and some private insurance companies.
Treatment for lymphedema is a medical necessity critical to the health and well-being of those who suffer
from the disease. With treatment, a patient can live a long, healthy and virtually normal life. But without
treatment, the disease grows progressively worse, causing severe deformity, disability and pain, and in
some cases even results in death. It has been proven in studies that the cost of treatment, in the long run,
is equal to or less than the cost of treating the ensuing and inevitable consequences which occur when
lymphedema is not properly managed.
The Federal Government has already mandated coverage for the treatment of lymphedema resulting
from breast cancer. However, the Federal Government cannot require private insurers to adhere to
their mandates as State’s can, which has resulted in only some companies voluntarily complying. Of
those companies which do embrace the Women's Health and Cancer Act, many still will not cover
treatment for lymphedema resulting from other causes, and those cases are often far more extensive and
severe. There is no possible justification for this double standard of covering treatment for some but not
for others. These companies only offer coverage to treat the serious, expensive and often chronic
complications, which are the inevitable result of their failure to cover the proper lymphedema treatment
in the first place.
Lymphedema treatment coverage will not increase costs for Medicare and private insurance company’s
or result in the need for an increase in their premiums; these statements are not speculative, but
documented fact. Mandated coverage for lymphedema has been in effect in Virginia since 2004. A
study conducted by the State of Virginia, which collected data during the first three years of the
mandate, proves that the required coverage is essentially cost neutral. Fiscal impact studies performed
in Massachusetts and California also showed the same results - and none of these studies took in to
account the further savings of reduced complications, reduced absenteeism from work, reduced
disability claims, etc. In short, covering lymphedema treatment is a win-win situation; it is good business
and it will bring to an end the needless human suffering resulting from lack of treatment.
For my insurance company to have denied my child coverage for the only known treatment for his
disease was unconscionable, and I could not sit idly by knowing that Dylan would face this struggle over
and over again for the rest of his life if nothing was done. Appeals to my insurance were futile, as is
consistently the case with lymphedema sufferers around the country, despite the fact that I provided
them the same evidence presented to the North Carolina legislature which resulted in the state mandate
being passed. Therefore, it has been proven that it is not possible for patients to right this wrong by
dealing directly with the insurance companies on an individual basis, and passing mandates state by state
will take decades to achieve lymphedema treatment coverage for all Americans.
This is a nation-wide problem and a nation-wide solution is needed without further delay. Please help
me ensure that no man, woman or child anywhere in the United States is ever denied treatment coverage
for their lymphedema again by sponsoring federal legislation to require nation-wide comprehensive
coverage for this disease.
Thank you for your time and consideration,
Heather Ferguson
------------------------------------------
http://www.timesnews.net/article.php?id=9019468
Fly fishing retreats inspire breast cancer survivors
Leigh Ann Laube
Published January 2nd, 2010
Nancy Puckett didn’t fully understand the connection between fly fishing and battling breast cancer until
she spent a peaceful weekend casting a line in the Great Smoky Mountains as part of the Casting for
Recovery program.
The White Pine, Tenn., resident came away from that weekend a changed woman.
“It’s a blessing to me because there’s nothing like it. It’s the closest thing to paradise I can describe on
Earth. It absolutely changed my desire to help others, to tell others about the ladies I met, how many
years some had been in remission, about the courage to get out there in the water and to use my arm,”
Puckett said.
Casting for Recovery (CFR), founded in 1996, is a national non-profit support and educational program
for breast cancer survivors. CFR offers free retreats tailored to promote and support mental and
physical healing through shared experiences and the learning of new skills. At the end of 2008, CFR had
had served 3,500 women in 269 retreats across the country.
During the two and a half day retreats, the sport of fly fishing is used to promote physical, emotional and
spiritual healing. The program allows women to get away from their cancer, but provides gentle exercise
through fly fishing as well as support from medical and psychosocial professionals.
Puckett was diagnosed with breast cancer in April 2005. She was later diagnosed with lung cancer. She
applied for Casting for Recovery, but wasn’t selected to participate that first year.
“So I just asked God to bless the person who was [selected] and that it would benefit them. The next
year [in 2008], I put my name in again, and I was selected to go. I had an opportunity with Casting for
Recovery to be with women who truly understood and continue to understand the battle that I’m
fighting. The concept of the fly fishing entails many things. It builds your self-esteem, makes you active
and use muscles and strength that I had forgotten I had,” she said.
“I had the privilege of having my own fly fisherman guide who was so kind and helpful. He never
became upset because he had helped with Casting for Recovery many times. His name was Charlie.
Casting for Recovery just changed my life. I love to fly fish. I do it in the winter. In November, I was
out. I had myself geared up, layered up and was tossing that rod. I do it just for the peace and the
therapy. To me, it’s an individual thing and it’s a talent or a gift or skill that can never be totally
mastered. The more you do it, the better you get at it.”
Puckett said fly fishing serves as a weekly date that she can do with her husband.
Puckett suffers from lymphedema — a swelling caused by a blockage in the lymphatic system — in her
left arm. Fly fishing taught her to use that arm again.
“It’s probably the most therapeutic activity that I have been able to do since I’ve been able to use my
arm. The fly fishing helps me relax and not think about the fact that I had cancer,” she said.
Mary Johnson, from Shady Valley, Tenn., has been a fly fishing instructor in the Tri-Cities area for more
than a decade, and she belongs to an all-women fly fishing chapter in the Smokies. She’ll serve as a
leader for the Casting for Recovery retreat scheduled for April 2010 in Gatlinburg.
“It’s just such an incredible thing, and I have seen women who have just blossomed. The rest of their life
has just spun out of control, and this one weekend they can be with other people who understand where
they are in their life. They’re outside. They learn to tie flies. They’re on a fabulous private trout stream
stocked with fish,” Johnson said.
Casting for Recovery relies on local volunteers and organizations to support its community-based
retreats.
“The retreat leaders and staff raise all the money. All these women get to come on full scholarship,”
Johnson said. “They get free lodging, meals and instruction. We get lots of donations, cash and door
prizes. The community supports this program, and it’s absolutely heartwarming.”
It might seem an odd combination — teaching breast cancer survivors to fly fish — but to Johnson, it’s
not only about providing a healing connection the natural world and relieving everyday stressors, but fly
fishing techniques provide gentle exercise for joint and soft tissue mobility.
“The actual surgery that these women have had to go through, the motion of casting helps them stretch
out those muscles,” Johnson said. “Because it’s an above-your-shoulder thing, your hand is up in the air.
It doesn’t compromise the lymphedema aspect. So there are physical reasons, but there are also women
instructors, so it makes the women more open to talk about what they’re going through. ... It gives them
such hope. It’s a beautiful thing to watch.”
Though the focus of the weekend is on fly fishing, Casting for Recovery does make available to the
women a psychotherapist, and a health-care professional, such as a physical therapist or nurse.
“It is all about fly fishing, but if someone wants to avail themselves of someone in those fields, they’re
available for free,” Johnson said.
Participants learn the fundamentals of fly casting, entomology, knot-tying and equipment basics, but most
importantly, they spend time on the water practicing catch-and-release fishing.
The Gatlinburg retreat is the closest retreat for women in the Tri-Cities. It will take place April 9-11 at
the Lodge at Buckberry Creek. A second retreat will be held March 19-21 at Tumbling Creek Lodge in
McEwen, Tenn. McEwen is located in Humphreys County, west of Nashville.
Tennessee retreats are for Tennessee residents, Johnson said, and the Gatlinburg retreat can
accommodate 15 women. To be eligible to attend a retreat, you must be a breast cancer survivor at any
stage. Participants for each of the scheduled 2010 retreats will be selected at random from all eligible
applications received by Casting for Recovery by the retreat deadline. There is no cost to participants to
attend, other than the expenses involved in traveling to and from the retreat location.
Although women can participate in a retreat only once, there are some reunion weekends being planned
for past participants, Johnson said.
The Gatlinburg retreat will go on regardless of the weather, she said. “We’ve done this in the snow, and
everybody loved it. Last year, we had a bear on the porches of the lodge. The year before it snowed.
Nothing stops this,” she said.
During their special weekend, participants are treated like queens, Puckett said. “When you go in, you’ll
find roses on your bed with mints, or someone knocks on your door with chocolate chip cookies. Prizes
are given each day that are donated just for these women for that weekend. It’s like you are a
celebrity,” she said.
Puckett caught a small native trout during her fishing adventure, and shared the joy with the others.
“Regardless of who caught what size, it was like someone won a million dollars,” she recalled. “The
unity among these ladies was just grand. Of course everybody wanted to catch the big one, but we were
so excited with whoever caught whatever.”
The deadline to apply for the Gatlinburg retreat is Jan. 20, 2010. The deadline to apply for the McEwen
retreat is Jan. 8, 2010. The only Virginia retreat will be May 19-21 in Orkney Springs. Application
deadline is March 12, 2010.
For more information about the Vermont-based Casting for Recovery, or for an application, call (802)
362-9181 or visit www.castingforrecovery.org.
http://www.news-press.com/article/20100105/COLUMNISTS40/100104060/1013
Melanie Payne
January 5, 2010
Melanie Payne: Another complication I certainly did not need
One reason I wanted to avoid the lymph node surgery was because of a possible complication called
lymphedema.
Before I had the surgery, I went to see a specialist, Ellen Poage, a certified lymphedema therapist.
Lymph nodes work as filters and help the body fight infection. They drain away proteins, salt, water and
white blood cells.
If the lymphatic system isn’t draining correctly, lymph fluid builds and causes swelling, or lymphedema.
Lymphedema is not uncommon in women who have had lymph nodes removed because of breast
cancer. But it’s much more common in women who have all or most of the lymph nodes removed than
those who have only one or a few removed in the sentinel node procedure.
Poage, who is also a registered nurse, took pre-operative measurements of my arms and gave me
exercises to do that would lessen the chances of me getting lymphedema.
Poage also told me what types of lifestyle changes I should expect, such as not lifting extremely heavy
objects and not get my blood pressure checked or injections in my right arm.
Because my type of breast cancer, Ductal carcinoma in situ, or DCIS, was slightly more aggressive and
had begun to break out of the milk duct, I had a sentinel lymph node biopsy in the very unlikely event the
cancer had spread.
The biopsy involves injecting a radioactive dye in the breast and then removing the primary lymph node
or nodes that drain fluid from the breast. The thought is these are the most likely to contain cancer cells if
the disease has spread.
Poage said women often believe that because they only had one or two lymph nodes removed in this
procedure — I had four — that they are not at risk for lymphedema.
This is not true, she said.
“By taking out a lymph node, the capacity (of the system) has been reduced,” Poage said when I
interviewed her recently. “That puts the person at risk. Everyone who has had a lymph node removed is
at risk for lymphedema.”
Also increasing the risk for lymphedema is the radiation treatments, Poage said.
Radiation causes inflammation and that can lead to lymphedema.
Lymphedema can develop years after the surgery, Poage said. So often physicians won’t recognize that
a woman has lymphedema when she comes into the office with swelling in her arm or hand.
Worse, some doctors tell women they simply need to “live with it,” Poage said. The swelling isn’t usually
painful, but it can cause numbness, an achy feeling from the tight stretched skin, and it is uncomfortable
and unsightly.
If lymphedema does develop, Poage said, see a certified lymphedema therapist right away.
A therapist can use massage to help drain the fluid, provide skin care, fit you with a compression sleeve
and help you develop exercises that will alleviate the swelling.
----------------------------------------
http://www.curetoday.com/index.cfm/fuseaction/article.show/id/2/article_id/1312
Pumping Iron
BY LACEY MEYER
In the past, doctors advised breast cancer survivors with lymphedema to avoid heavy lifting because of
the possibility of infection and symptom flare-ups. But a study, published in August 2009 in The New
England Journal of Medicine, shows that weight-lifting may actually be beneficial and help reduce
lymphedema symptoms, not exacerbate them.
According to lead author Kathryn Schmitz, PhD, of the University of Pennsylvania Abramson Cancer
Center, the study shows that participating in a safe, structured weight-lifting routine can help women with
lymphedema take control of their symptoms and reap the many rewards of weight-lifting on their overall
health as they begin life as a cancer survivor.
Removing lymph nodes alters the body’s ability to respond to inflammation, infection, trauma, and injury,
Schmitz says, and “exercise, apart from this study, has been known for a long time to improve the body’
s response to injury, infection, inflammation, and trauma.”
The year-long study involved 141 breast cancer survivors with lymphedema; half took part in a twice-a-
week, slowly progressive weight-lifting program and the other half did not. The weight-lifting program
included stretching, cardiovascular warm-up, abdominal and back exercises, and weight-lifting
exercises. Women in the weight-lifting program began with very light weights and gradually increased by
the smallest possible increments. During weight-lifting, participants wore a custom-fitted compression
garment on the affected arm and were monitored by a lymphedema specialist throughout the study.
Strength training (weight-lifting) exercises—specifically training the affected limb—reduced the risk of
aggravating the condition because these women had trained their arms in a way that they would be less
likely to hurt themselves during daily activities, such as carrying heavy groceries or lifting a child. Women
in the weight-lifting group also had greater improvements in self-reported severity of lymphedema
symptoms and upper- and lower-body strength. They also had a lower incidence of lymphedema
exacerbations as assessed by a certified lymphedema specialist (14 percent in the weight-lifting group
had flare-ups versus 29 percent in the control group). In each arm of the study, however, the proportion
of women who had an increase of 5 percent or more in limb swelling was similar: 11 percent in the
weight-lifting group, and 12 percent in the control group.
But these results don’t mean it’s OK to throw all lymphedema precautions and activity restrictions out
the window. Women with lymphedema should always be extra cautious when doing any strenuous
activity or heavy lifting with the affected arm because of the increased risk of injury and added stress.
When doing work where there may be injury to the skin, such as gardening, it is best to wear protective
gloves. Women with lymphedema should also avoid getting I.V. lines, shots, or blood drawn in the
affected arm and always be aware of any changes, such as heaviness, puffiness, fullness, achiness, or
redness in a certain area, and see a doctor immediately if any of these occur.
“Those [traditional] guidelines are real and should always be used,” Schmitz says, “but the likelihood that
[women with lymphedema] are going to hurt themselves with the occasional activities of life that require
a lot of the upper body will be reduced if they will engage in upper body strength training.”
Breast cancer survivor Sharon Cowden, MD, helped create an exercise DVD, Strength & Courage:
Exercises for Breast Cancer Survivors, for survivors with lymphedema to use at home. Cowden
underwent an axillary node dissection seven years ago, which put her at increased risk for lymphedema.
She credits exercise and weight-lifting with helping her regain upper body strength and flexibility.
“I’m a pediatrician, so I lift kids all day—a lot of kids,” Cowden says. “Also, I’m a golfer, and upper
strength and flexibility are necessary for a good game. My game has never been better. My handicap
has dropped 10 points since my surgery in large part because of these exercises.”
Because up to 62 percent of all breast cancer survivors have some kind of arm or shoulder problem
resulting from curative surgery, reconstructive surgery, or radiation therapy, Schmitz recommends
survivors have a physical therapist evaluate their shoulder and arm for general weakness or changes in
range of motion that may require treatment prior to starting an exercise program with the upper body.
“It would be a terrific safeguard to go see a physical therapist,” Schmitz says, “even if you don’t have
lymphedema, even if you had few lymph nodes removed, or no lymph nodes removed.”
For some women with lymphedema, however, weight-lifting and strength training may cause more harm
than benefit, Schmitz says. This includes women with a lot of symptoms and whose lymphedema is
“really reactive. She has a lot of flare-ups and fluctuations, her limbs get bigger and smaller over the
course of weeks, or she finds herself at the physical therapist often. She’s likely not going to do well with
strength training.”
Although several previous studies have suggested weight-lifting is safe for breast cancer survivors, the
recent NEJM study is the longest and largest to date.
Another strength of the study is its delivery in community fitness centers—primarily YMCAs that offer
the LIVESTRONG program, a collaboration between the Lance Armstrong Foundation and the
YMCA to develop programs specifically for cancer survivors—which will facilitate future dissemination
of the weight-lifting program. However, this study had only one year of follow-up and lymphedema can
sometimes develop 5 to 10 years after surgery.In addition to consulting a doctor and physical therapist,
Schmitz offers a few tips for women interested in embarking on a new weight-lifting routine:
1. Start low, and progress slowly. Start with the lowest possible resistance with the weight. If you are
using a dumbbell, it should be a 2-pound dumbbell or something very light. If using a machine, it should
be set on the top plate. Progressing slowly means that you should do a couple of sessions for each
upper body exercise before you increase the resistance. When you do increase the resistance, do so by
a small amount. Increases in weight should be made gradually, and only after a week or two of doing the
exercise at least twice a week to ensure you aren’t having any worsening of symptoms.
2. Listen to your body and respond to your symptoms. If you have a change in upper body symptoms
that would be consistent with the symptoms of lymphedema—a sense of heaviness, fullness, puffiness,
achiness, and/or redness in a particular area, that would be associated with a cellulitic infection, which
means you should stop immediately and see a physical therapist.
3. Learn and use perfect form. Find a trainer who can teach you how to do the exercises properly. For
example, back muscles are really big and wrist muscles are not, so if you try to finish a back exercise
with your wrist, you will create inflammation in your wrist from doing too much with the tiny wrist
muscles.
4. Ease back into it. If you take a break from exercise, either because you have a cold or are on
vacation for a week, you need to back off on the resistance and rebuild again.
5. Get the goods. Always wear a well-fitting compression garment during weight training. Consult with a
physical therapist or lymphedema specialist on how the compression band should fit and where to get
one.
6. Find help. Find a lymphedema therapist through the National Lymphedema Network or a specialized
trainer with the YMCA program to instruct you a few times before exercising on your own. If you can’t
find a trainer in your area, check out Cowden’s Strength & Courage DVD, available online at http:
//www.strengthandcourage.net/dvd/research.aspx
-------
http://www.herald-mail.com/?cmd=displaystory&story_id=238886&format=html
Robinwood series addresses women's health
By CRYSTAL SCHELLE
February 1, 2010
For years, it's been the embarrassing secret women didn't even want to talk about to other women.
A study by Kaiser Permanente in 2008 found that one-third of women suffered from urinary
incontinence, which is the accidental, unintentional release of urine.
Urinary incontinence can happen anytime and anywhere, making daily activities often difficult. That's why
physical therapists Andrea Rankin and Karla Trotta, with Total Rehab Care at Robinwood Medical
Center, want women to know that there is help.
Rankin and Trotta are leading the first in a weekly series of presentations during February on problems
that affect women. The series is called "Let's Talk, Ladies." Hosted by Total Rehab Care, the first one is
Friday, Feb. 5, and addresses urinary incontinence. Other topics will be pelvic pain, Lymphedema and
osteoporosis.
Although incontinence has often be thought of as an older woman's problem, Rankin said women of all
ages - including those in child-bearing years and even as young as 12 - could learn something from the
workshop.
"Urinary incontinence is not a disease," Trotta said, "it's really a symptom."
Urinary incontinence happens when the muscles that support the bladder become weak. Because it is
muscle-related, Trotta said, physical therapy helps.
Many things can cause a woman to develop urinary incontinence, she said. These include the stress of
childbirth, urinary tract infections or diet - such as drinking too much fluid, drinking too little fluid, or
consuming beverages that are too acidic.
Rankin said there are three main types of urinary incontinence:
• Stress - When muscles around the urethra are weak, sneezing, coughing or laughing increases pressure
on the muscles and causes leakage.
• Urge incontinence -This is the sudden feeling a woman has that she must go to the bathroom.
• Mixed incontinence - This includes symptoms of both stress and urge.
Rankin said physical therapists can help a woman strengthen her pelvic-floor muscles. One way is
through teaching women the proper way to do Kegel exercises. Trotta said the key is doing the simple
exercises properly.
"A lot of women bulge the pelvic floor, instead of lifting it," she said.
She said physical therapists can use a biofeedback unit to see if a patient contracts her muscles properly.
Rankin said therapy for urinary incontinence can include other exercises and sometimes surgery.
Both Rankin and Trotta said it's hard to predict how long a woman must participate in therapy. Rankin
said it's dependent, oftentimes, on the patient herself to make sure she is following through outside the
therapy room.
"We always say the ball's in their court," she said.
On average, Rankin said it will take about three months before a woman feels she can safely do her
regular activities without an extra maxi pad or Depends stuffed in her purse for emergencies.
"Gradually she'll gain the confidence when she can go out in public," she said.
Both therapists said they are excited about offering the Let's Talk Ladies presentation. They want to get
the word out about what can be done to help women with urinary incontinence.
Some men also have urinary incontinence issues, Trotta said, and they are welcome to attend the talks.
"We want to educate them and let them know that this isn't something normal that they have to tolerate,"
Trotta said. "And this is information that can take back to their sisters, mothers, aunts or adult children.
That's why it's called Let's Talk Ladies."
--------------------------------------------------------------------------------
If you go ...
What: Let's Talk Ladies
When: 8 to 9 a.m. Fridays, Feb. 5 through 26
Where: Robinwood Medical Center, room 122 (yellow entrance by the waterfall), east of Hagerstown
Cost: Free
Contact: Contact Mendy Bishop at 301-790-8649 or mendy.bishop@wchsys.org
Topics:
Feb. 5 - Incontinence
Feb. 12 - Pelvic pain
Feb. 19 - Lymphedema
Feb. 26 - Osteoporosis
------
Medical Center opens in Scottsdale
Staff Report ~ 2/3/2010
Desert Springs Cancer Care Center, the first medical oncology practice located north of Loop 101 in
Scottsdale and first green-built facility in Arizona, is now open. The 5,000 square-foot outpatient clinic’s
traditional patient services include: medical oncology and hematology consultations; chemotherapy and
all therapeutic infusions; and on-site pharmacy and laboratory. The practice will also offer lymphedema
therapy, organic manicures and pedicures, classes on patient nutrition and skin care, yoga, on-site wig
and prosthetic services and a boutique with vitamins, jewelry, fashion, make-up and more.
Some of the sustainable properties include: automatic lighting and CFLs; tinted and shaded windows;
low water usage plumbing and 100 percent copper piping; low odor/zero VOC paint and more.
Desert Springs Cancer Care Center is located on the northeast corner of Scottsdale and Deer Valley
Roads. The address is 21803 N. Scottsdale Road in Scottsdale, and the clinic is open from 7 a.m. to 7
p.m. seven days a week. Desert Springs Cancer Care Center accepts most forms of insurance. For
information, visit www.desertspringscc.com.
http://www.thefoothillsfocus.com/020310-medical.asp
-----
Tummy Solutions - Lypossage
February 3, 2010
Comments (0) Recommend Print this page E-mail this article Share
Del.icio.us Facebook Digg Reddit Newsvine
Buzz up!Twitter FarkIt Type Size A A A Q. Why Do I Have Cellulite, Lumps, and Bulges?
A. The fatty tissue of your body acts as its "toxic waste disposal site," where substances that it cannot
metabolize are dumped. This congested tissue has poor blood circulation (you'll notice that cellulite-
prone areas are cool to the touch.) Lymphatic flow may also be restricted by tight undergarments and
pantyhose. Lypossage cleanses the body of stagnant, stalled lymphatic fluid (lymphedema) that can
create the lumps and bulges we know as figure imbalance. The deeper Lypossage strokes break up
adhesions under the skin that can contribute to the dimpled, uneven appearance of cellulite. Lypossage
also tones the muscles, lifting and firming sagging tissue.
http://www.theleafchronicle.com/article/20100203/ASKEXPERT/100202006
----------------
http://savannahnow.com/sports/2010-02-05/grandmother-walk-tybee-half-marathon
Grandmother to walk Tybee half-marathon
68-year-old raising money for lymphatic research
Posted: February 5, 2010 - 12:16am
Advertisement
By Noell Barnidge
The idea came to Wanda Glass in the middle of the night.
The 68-year-old resident of Sun City Hilton Head, a retirement community in Bluffton, S.C., had been
searching for a way to raise money for lymphatic research. Her grandson, 12-year-old Will Miles, was
born with primary lymphedema, a disease in which excess lymphatic fluid collects in tissues and causes
them to swell.
Glass flirted with the idea of securing sponsors and walking from her home to Miles' home on Hilton
Head Island.
"But that wasn't a practical situation because it's dangerous," she said Thursday night. "Then (the Critz
Tybee Run Half-Marathon and 5K on Tybee Island) came up and I thought, 'This is what I'm going to
do.' "
Glass is registered to walk 13.1 miles in Saturday's half-marathon. She is accepting sponsors for her
walk via a per-mile basis or flat donation to the Community Foundation of the Lowcountry to benefit the
Will Miles Lymphatic Research Foundation.
"I'm praying that there will be lots of interest," Glass said. "All this money will go to research. Every
penny."
To sponsor Glass or to make a donation, visit www.cf-lowcountry.org. Scroll over the "give" banner,
click on "Donate Online," click "Field of Interest Funds" and select the Will Miles Lymphatic Research
Fund.
"It's been my passion to make people aware of this disease so that money can be raised for research,"
Glass said. "I want to see him cured. A lot of cancer patients have this, too, as adults; especially breast
cancer patients.
"The lymphatic system is probably one of the most important systems in your body because it transports
the toxins out of your body. When that doesn't work, then you've got issues."
Glass has been training for the Tybee Run at her Sun City home.
"Last Friday, I tried to do the 13-mile," she said. "I walked for three hours and did 12.7 miles, so I
shouldn't have any trouble. They give you 3? hours Saturday to accomplish it. I should be able to do it.
I'll pick up the pace a little bit."
Today is the deadline to register for the Critz Tybee Run Half-Marathon and 5K on Tybee Island. The
event will be capped at 3,000 participants: 1,500 runners in the half-marathon, 1,500 runners in the 5K.
The cost is $45 for the half-marathon and $35 for the 5K. Participants cannot register the day of the
race. To register, visit www.active.com. For more information, and to download a registration form and
route maps, visit www.critztybeerun.com.
The 5K will start at 8 a.m. at the north end of the island, near the lighthouse. The half-marathon will
begin at 8:30 a.m. at Butler Avenue and 15th Street. Both races will end on Tybrisa Street near the pier.
CRITZ TYBEE RUN
What: Half-marathon and 5K
When: Saturday, 5K at 8 a.m.; half-marathon at 8:30 a.m.
Where: Tybee Island
Registration: www.active.com
Info: call 912-355-3527.
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http://professional.cancerconsultants.com/oncology_main_news.aspx?id=44589
Early Physiotherapy May Prevent Lymphedema After Axillary Lymph Node Dissection
Researchers from Spain have reported that women who undergo axillary lymph node dissection for
early-stage breast cancer and receive physiotherapy for one year after surgery have less lymphedema
than women not receiving such therapy. The details of this study appeared in the January 16, 2010 issue
of the British Medical Journal.[1]
Lymphedema refers to swelling of the arm due to an accumulation of lymph fluid. It commonly affects
women who have had axillary lymph nodes removed for the staging of early breast cancer. The most
common chronic side effect of axillary lymph node dissection is lymphedema. Early postsurgical
rehabilitation improves mobility and shoulder function but has no effect on lymphedema. Researchers
from the University of Pennsylvania have recently reported that a program of twice weekly, slowly
progressive weight lifting increased strength and reduced lymphedema symptoms without affecting arm
and hand swelling in breast cancer survivors with stable lymphedema.
The current study involved 116 women who had lymph node dissection for early-stage breast cancer
between 2005 and 2006. All women in the study received an educational status, and half were randomly
allocated to receive early physiotherapy by a physiotherapist. The physiotherapy program included
“manual lymph drainage, massage of scar tissue, and progressive active and action assisted shoulder
exercises.” The study period was one year.
Lymphedema developed in 14 women (25%) in the control group and four (7%) in the physiotherapy
group.
Lymphedema developed four times earlier in the control group compared with the treated group.
Comments: These authors concluded: “Early physiotherapy could be an effective intervention in the
prevention of secondary lymphedema in women for at least one year after surgery for breast cancer
involving dissection of axillary lymph nodes.”
Reference:
[1] Lacomba MT, Sanchez MJY, Goni AZ, et al. Effectiveness of early physiotherapy to prevent
lymphoedema after surgery for breast cancer : randomised, single blinded, clinical trial. British Medical
Journal. 2010;340:
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http://www.wireservice.ca/index.php?name=News&file=article&sid=2152
News by LymphedemaDepot
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Most-read story in Health:
100% CERTIFIED ORGANIC POMEGRANATE FACIAL OIL
Lymphedema Depot brings Solaris Products to British Columbia
Published on Monday, February 08, 2010
Lymphedema Depot is bringing Solaris compression products for lymphedema and other chronic
swelling conditions to presentations in Burnaby and Victoria, BC.
Lymphedema Depot, the exclusive Canadian distributor of Solaris compression products for the
treatment of lymphedema and other chronic edemas will be appearing at a conference in Burnnaby, BC,
near Vancouver, and will also be hosting an open house and product demonstration in Victoria, BC for
all interested parties.
The Victoria event will take place on Friday, March 5, from 12:30 in the afternoon to 5:30 pm. It will be
held at The Emily Carr Branch of the Greater Victoria Library, 3500 Blanshard Street, Victoria. John
Mulligan will present the Solaris compression products including the Solaris Tribute, Caresia bandage
liners, Swell Spots edema and fibrosis pads and ReadyWrap inelastic medical binders for chronic
venous insufficiency and other conditions.
"This will be our first opportunity to present the Solaris products to the Vancouver Island health care
community and patient population," says Mulligan. "We are looking forward to meeting the fitters,
therapists and medical garment retailers on the Island, as well as interested patients who want the best in
medical compression devices." There is no charge for this event. For more information, contact
Lymphedema Depot at 905-687-8500.
On Saturday, March 6, 2010, Lymphedema Depot will be presenting and talking about Solaris
compression products at the British Columbia Lymphedema Association's first Lymphedema Awareness
Day in Burnaby, BC. The event will be held at Bonsor Recreation Complex, 6550 Bonsor Ave,
Burnaby, BC, from 8:30 am to noon. The event is free but registration is required. For more information
please contact the BCLA at 866-991-2252 or visit their website at www.bclymph.org.
"We are very excited to partner with the BCLA on this first Lymphedema Awareness Day event. They
have lined up an excellent program of speakers and product vendors. This will be a wonderful
opportunity for the lymphedema care community and patient population to come out and find out more
about lymphedema and the care of this condition," states Mulligan. "They will also get a rare opportunity
to see the finest in lymphedema care products first hand and get to ask questions and obtain valuable
information from the vendors. I will be there to showcase the Solaris compression products which I
believe are the finest compression products on the market and make living with lymphedema and other
chronic swelling conditions easier, bringing simplicity, elegance and effectiveness to a self-care regimen
that formerly was frustrating, difficult and time-consuming."
"Breast cancer survivors and survivors of other cancers, often experience chronic swelling as a result of
damage to the lymphatic system," according to Mulligan. "Solaris compression products are designed to
address swelling resulting from lymph node removal, cancer treatments, mastectomy and lumpectomy.
The same products can also be used to address swelling from chronic venous insufficiency, lipedema,
dependent swelling, post-surgical swelling, primary lymphedema and other disorders of the lymph
system."
For more information about these events or about Solaris compression garments in Canada, visit www.
LymphedemaDepot.com, or call us at 905-687-8500.
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