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Lymphland International Lymphedema Online
August 8, 2011
Rethinking Breast Cancer Approach - BS42 =
BIRMINGHAM, Ala. (Ivanhoe Newswire) -- A new study shows removing lymph nodes because of the
presence of microscopic cancer cells found in the sentinel node has no impact on survival among women
with early-stage breast cancer.
Researchers studied more than 5,000 women with breast cancer at 126 sites around the country. All the
participants underwent breast-conserving surgery and sentinel lymph node dissection. The sentinel lymph
node is the one that is closest to the tumor.
Results showed survival outcomes were no different between women who underwent total lymph node
removal and those who only had the sentinel lymph node removed.
“This study shows that the presence of tiny sentinel lymph node metastases has no bearing on survival
outcomes,” Armando E. Giuliano, M.D., of Cedars-Sinai Medical Center, was quoted as saying.
Researchers say this finding could spare women the pain and side effects of comprehensive lymph node
removal. Removing lymph nodes can cause complications such as lymphedema, which is a chronic and often
painful swelling in the arm that can be debilitating.
“Treating the patient doesn’t end with stopping the cancer,” Dr. Giuliano said. “We want to make sure we
maximize the patient’s quality of life even after cancer treatment is completed."
SOURCE: Journal of the American Medical Association, August 2011
August 9, 2011
The Benefits of Exercise After Cancer - New York Times – By ANAHAD O'CONNOR -
The report, called Move More, reviewed the findings of 60 studies on the effects of exercise on cancer and
reached some conclusions that may seem contrary to the conventional wisdom that prevailed only a decade
or two ago, when recovering cancer patients were often given mixed advice on physical activity or outright
warned against it. Saying some patients should view light exercise almost as a form of treatment itself, the
report noted that two and a half hours of exercise a week could lower a breast cancer patient’s risk of dying
or cancer recurrence by 40 percent, and could reduce a prostate cancer patient’s risk of dying from the
disease by about 30 percent.
The group that published the report, Macmillan Cancer Support, one of the largest British charities, provides
health care and financial support to cancer survivors and works in partnership with the National Cancer
Research Institute in Britain.
As part of its report, the group questioned more than 400 doctors and nurses in Britain and found that more
than half knew “little or nothing about the benefits of activity in preventing or managing long-term effects” of
cancer, and that one in 10 believed it was important to encourage cancer patients to “rest up” rather than
attempt any physical activity at all. Cancer experts in the United States have also sought in recent years to
spread the word among oncologists that light exercise, in many cases, should be encouraged.
Just last year, the American College of Sports Medicine convened a panel of cancer and exercise
researchers, which developed a set of guidelines on physical activity for people who are undergoing or have
recently completed treatment. The panel recommended adaptations for exercise in people based on their
specific cancers and the side effects of their treatment, like strength-building routines for patients who have
lost muscle mass and shoulder-stabilizing exercises in breast cancer survivors who have had operations that
debilitate the joints in their shoulders.
But the panel also noted that some patients will at times be just too sick to exercise — particularly at the
height of their treatment — and said that in those cases there was nothing wrong with waiting a few days
before attempting activity. The American Cancer Society also promotes moderate exercise but encourages
patients to discuss their exercise plans with their oncologists first, and lists on its Web site a set of
precautions. Among them: avoiding exercise if you have anemia, and steering clear of heavy weights or
strenuous exercise if you have developed osteoporosis, nerve damage or cancer that has spread to the bone.
For those who can handle it, though, a light or moderate exercise regimen could help reduce some side
effects of treatment, the new report stated. Studies have shown, for example, that arm extensions and other
range-of-motion exercises can help relieve lymphedema, a painful swelling of the arm stemming from breast
cancer surgery. It can also help patients who gained weight during treatment slim down and regain some
physical function, and combat some of the exhaustion stemming from chemotherapy.
“The evidence review shows that physical exercise does not increase fatigue during treatment, and can in
fact boost energy after treatment,” the report stated.
For patients looking for help with starting a new regimen, the American College of Sports Medicine and the
American Cancer Society introduced a program that educates and certifies trainers to work specifically with
cancer patients, so they understand their goals and limitations. The college’s Web site explains how patients
can find a certified cancer exercise trainer in their area.
Cancer hotline helps thousands - Toronto Sun – By Sharon Lem -
TORONTO - Kim McColl found two lumps under her arm shortly before she was diagnosed with breast
cancer in 2007.
The retired music teacher from Napanee said she wouldn’t be alive today if it weren’t for the Canadian
Cancer Society’s cancer information service.
“They are one of the reasons I’m still here today,” McColl said, adding she has never hesistated to call with
questions over the last five years. “The service is wonderful, accurate and compassionate. They go out of
their way to send you more information. Nothing is ever too much trouble.”
After undergoing surgery, chemotherapy, radiation and drug therapy, the 65-year-old is now cancer-free.
Unfortunately, still lives with lymphedema, a side effect from breast cancer surgery when her lymph nodes
were removed, that causes swelling in her left arm.
The CCS’s cancer information service — which provides information and connects people to services
available in their communities across the country — recently celebrated its 1 millionth inquiry since the
service began in 1996.
“We know through studies people who are facing cancer, their families or caregivers need cancer
information and this is one of the programs we always support,” said Janet MacVinnie, who manages the
Cancer Information Service in Ontario. “People often feel overwhelmed when dealing with a cancer
diagnosis and treatment. Our Cancer Information Service has been proven to reduce stress and anxiety for
patients.”
There are four centres across Canada, including Hamilton, Montreal, Vancouver and Regina. The CCS
cancer information service answers about 90% of its inquiries by phone and 10% by e-mail.
In addition to answering cancer questions the CCS’s cancer information service made a total of 27,481
referrals to community services in Ontario last year.
The five most common topics include support for patients — either peer support or transportation,
treatment, cancer prevention or risk factors, pathology and staging of the disease, and diagnosis.
The top five site-specific cancer inquiries include breast, colorectal, lung, prostate, and cervical.
Ontario led the number of inquiries across Canada in 2010 with 23,682 inquiries, while Quebec came
second with 16,550 inquiries and British Columbia was third was 7,033 inquiries. Out of the 23,682 Ontario
inquiries, 3,316 inquiries came from Toronto, while 4,114 inquiries came from South Central Ontario
including the GTA.
If you have a question about cancer, call 1-888-939-3333 or e-mail cis@ontario.cancer.ca Monday to
Friday from 9 a.m. to 6 p.m.
The Changing Field of Locoregional Treatment for Breast Cancer - Cancer Network – By Monica Rizzo,
MD -
ABSTRACT: The change to less-morbid local therapy for operable breast cancer continues. Systemic
induction therapy, whether hormonal therapy or chemotherapy, increases the eligibility for breast-conserving
surgery. Sentinel lymph node biopsy (SLNB) has greatly reduced the requirement for axillary dissection, and
recent data show that, in addition, whole-breast irradiation can obviate the need for dissection in most
patients with clinically node-negative, SLN-positive disease. Although resection margins must be negative
for best results, there is no clear evidence that margins exceeding "no ink on tumor" for invasive cancer, or 2
mm for ductal carcinoma in situ, are significantly better. The role of radiation has been clarified, with a clear
survival advantage for patients with node-positive disease; however, hypofractionation, which permits a
briefer period of treatment, and accelerated partial breast irradiation (APBI) show promise of even further
reductions in treatment—although late results for APBI are still needed. Elderly patients (> 70 years) with
node-negative disease and estrogen receptor–positive tumors who have been treated with hormonal therapy
can avoid primary breast irradiation without significant risk of ultimate breast loss or inferior survival.
Since 1990, death rates from breast cancer have decreased, mainly in women younger than 50 years of age
(3.3% per year) vs women aged 50 years or older (2% per year), reflecting the benefit of widespread use of
systemic treatment added to early detection.[1]
Improved local control is also causally associated with improved breast cancer survival. An absolute
reduction in local recurrence at 5 years is associated in a 4:1 ratio with an absolute survival advantage at 15
years in the overviews of clinical trials.[2] Guidelines for locoregional treatment of breast cancer were first
published by the US National Institutes of Health in 1991.[3] Since then, new surgical and radiotherapeutic
techniques have been developed, and revised guidelines for locoregional management were suggested in
2008 by the Biedenkopf Expert Panel Members.[4]
Over the past 50 years there have been major changes in the treatment of patients with breast cancer, with
"less is more" being the theme. Treatment of breast cancer has evolved dramatically from the Halsted radical
mastectomy, and many women now choose breast-conserving surgery and sentinel node biopsy. Breast-
conserving surgery (BCS) is defined as the complete removal of the tumor with a concentric margin of
surrounding healthy tissue and maintenance of acceptable cosmesis. BCS should be followed by radiation
therapy to achieve an acceptably low rate of local recurrence.
Neoadjuvant Chemotherapy
In an effort to increase the number of patients eligible for breast conservation, neoadjuvant chemotherapy
that shrinks the primary tumor before surgery has become an appealing option.[5] In a large randomized
trial, National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol B-18, investigators
randomized 1,523 women with Stage I–IIIa breast cancer to receive doxorubicin(Drug information on
doxorubicin) (Adriamycin, A) and cyclophosphamide(Drug information on cyclophosphamide) (C) either
preoperatively or postoperatively.[6] A reduction in tumor diameter of at least 50% was noted clinically in
80% of the patients, and in 37% no tumor was clinically apparent after chemotherapy. The initial findings of
the study were reported at 5 years[7]; in the 9-year follow-up publication,[6] there continued to be no
difference in overall survival or disease-free survival in patients receiving chemotherapy preoperatively vs
postoperatively. The breast conservation rate was 68% for the neoadjuvant arm and 60% for the adjuvant
arm. The reduction in tumor volume allows an improved cosmetic outcome in the majority of patients.
Induction chemotherapy followed by BCS and radiation therapy is safe and increases the eligibility for breast
preservation in approximately one-fourth of patients with large tumors relative to breast size. From a surgical
standpoint, when the neoadjuvant approach is being considered, it is mandatory to insert a radioopaque
marker into the tumor in order to localize the surgical site after partial or complete tumor regression.
Another important advantage of neoadjuvant chemotherapy is that it probes the chemosensitivity of the
tumor, providing information of great importance in terms of development of systemic treatments for
chemoresistant tumors. Tumors exhibiting the characteristics referred to as luminal A (strongly ER-positive,
PR-positive, HER2-negative) exhibit less-dramatic reductions in volume with neoadjuvant chemotherapy but
will often respond to neoadjuvant therapy with aromatase inhibitors or tamoxifen(Drug information on
tamoxifen). Conversely, for HER2-positive tumors, adding trastuzumab(Drug information on trastuzumab)
(Herceptin) to a standard neoadjuvant regimen achieved a pathologic complete response (pCR) of 65.2%,
compared with a 26% pCR in patients who did not receive trastuzumab.[8]
Margins
The first goal of breast-conservation surgery is to excise all apparent cancer. Adequate margins minimize the
risk of local recurrence. Positive margin status correlates with local failure and is an important predictor of
residual disease after BCS. The definition of what constitutes a clear margin represents one of the ongoing
"great debates" in breast surgical oncology.
The NSABP defines a positive margin as the presence of tumor at the inked margin and a negative margin as
the absence of tumor at the inked margin. Negative margins are associated with lower rates of local failure.
No uniform definition of surgical margin status has been established in the literature among institutions. In
their survey of 702 institutions in North America, Taghian et al[9] found that definitions of negative margins
vary from "no cells on the inked margin" to "no cells at 5 mm from the inked margin." About 50% of
surveyed institutions are using "no cells at the inked margin" as a definition of a negative margin. The same
variation exists for the definition of close margin. Schnitt et al have reported that 31% of institutions surveyed
used a distance of less than 1 mm from the inked margin as a definition of close margin.[10] As reviews of
contemporary series using multimodality therapy for early breast cancer fail to show an advantage for
margins exceeding the "no tumor cells at inked margin" definition, a definition of "close margin" serves no
purpose.[4] In a metaanalysis on 4,660 patients, Dunne et al[11] showed that for patients with ductal
carcinoma in situ (DCIS), a 2-mm margin was superior to a margin of less than 2 mm for avoiding ipsilateral
breast tumor recurrence (OR = 0.53; 95% CI, 0.26–0.96). Since that publication, our institution has
adopted the 2-mm margin criterion in cases of DCIS.
It is still debated whether obtaining a wider margin will decrease the rate of local recurrence after breast-
conserving surgery. What is clear is that it is absolutely unacceptable to have tumor cells at the cut edge of
the excised specimen, regardless of the type of postsurgical adjuvant therapy.[12] For patients with positive
margins who undergo reexcision, residual disease will be found in approximately 50% of the cases, with
rates varying depending on histologic subtype.
Several clinical and morphological factors have been identified to predict a higher rate of positive margins.
[13-15] These include smaller breast size, larger tumor size, previous surgical biopsy for diagnosis, use of
neoadjuvant chemotherapy, lobular histology, mammographic density of the breast tissue, and an extensive
intraductal component.[16]
Use of neoadjuvant chemotherapy can make evaluation of the primary tumor and margin status challenging.
The scattered viable tumor cells are usually situated within the fibrosis and macrophage accumulation at the
site of the tumor mass, so those areas are examined carefully if seen at the margin.
Options for intraoperative evaluation for margin status include gross examination of the specimen, frozen
section, and touch preparation cytology of the margins.[17] Owing to high false-negative rates, technical
complexity, and the duration of such intraoperative procedures, none of these methods has been accepted
as standard for margin assessment.[18,19] In retrospective studies,[20] taking multiple additional margins of
tissue from each aspect of the biopsy cavity during the initial operation reduced the rate of reoperation with
adequate cosmetic results.
Evaluation of the Axilla
Sentinel lymph node biopsy (SNB) has become the standard approach to axillary evaluation in clinically
node-negative patients.
SNB accurately stages the axillary nodes and carries significantly lower rates of complications such as
seroma, infection, arm stiffness, pain, paresthesia, and lymphedema,[21,22] compared with axillary node
dissection. Use of isosulfan blue 1% dye (Lymphazurin), radioisotopes, or both has proved to be less
important than expertise in identifying the sentinel lymph nodes. Obtaining a second node reduces the risk of
false-negative staging. Removing more and more "sentinel lymph nodes" can approach the number of nodes
in an axillary dissection with the attendant risks that the sentinel approach was designed to avoid.[23] SNB
has changed the way breast cancer is treated, and is contraindicated only in cases of inflammatory breast
cancer. In breast oncology it was not clear until very recently whether a positive SNB required a full axillary
dissection. NSABP’s B-04 study failed to show a survival benefit to axillary dissection, but axillary
dissection has remained the standard of care for local control. The greatly improved survival rates associated
with modern systemic therapy have raised the question anew.
The American College of Surgeons Oncology Group Z0011 trial,[24] conducted at 115 sites, tried to
determine the impact of SLB alone vs complete axillary node dissection on survival in clinically node-
negative breast cancer patients undergoing partial mastectomy and whole breast irradiation (WBI). Results
of the Z0011 trial showed no survival advantage for complete axillary node dissection in patients with one or
two positive SLNs. Those patients can be treated safely without axillary node dissection.
Radiation Therapy
BCS followed by radiation therapy has been shown in multiple trials to yield survival and recurrence rates
equivalent to those seen with total mastectomy for patients with early-stage breast cancer.[25] Although the
benefit of whole-breast irradiation (WBI) in terms of reducing local recurrences is well documented, this
technique is associated with many burdens for patients, including daily treatment for 6 weeks and permanent
skin changes. The paradigm "less is more" has certainly applied to the surgical technique used in the breast
and axilla, and the same concept of greater benefit with conservative management may also apply to
radiation therapy. Instead of irradiating the entire breast, a new concept of partial irradiation has emerged.
The rationale of accelerated partial breast irradiation (APBI) is that 90% of breast recurrences occur at or
adjacent to the original tumor bed.[26] This suggests that irradiating the whole breast may be unnecessary.
The first device for breast APBI was approved by the US Food and Drug Administration (FDA) in 2002.
APBI is delivered via insertion of a brachytherapy catheter in the tumor cavity at the time of the original
surgery. The shorter duration of APBI, 5 days (vs 6 weeks with WBI), is very convenient for many patients.
Multiple multicenter randomized clinical trials (including the NSABP B-39/ Radiation Therapy Oncology
Group 0413 phase III trial) have been initiated or completed to compare the effectiveness and safety of
APBI vs WBI.[27]
Shaitelman et al reported on outcomes of APBI in patients treated in the NSABP B-39 trial according to the
American Society for Radiation Oncology (ASTRO) consensus statement on APBI use. Patients were
classified as "suitable," "cautionary," and "unsuitable." At a median follow-up of 53.5 months, the 5-year
actuarial rates of ipsilateral breast tumor recurrence (IBTR) were 2.59%, 5.43%, and 5.28%, respectively,
for the three groups.[28]
Vicini et al[29] recently reported long-term data (median follow-up, 11.1 years) demonstrating equivalent
rates of IBTR among matched pairs of 199 patients who received APBI vs WBI.
The efficacy of APBI has yet to be validated in prospective comparative trials, and limited long-term data
exist for the more than 50,000 women in the US who have been treated with various forms of APBI. At
present, APBI has been associated with better quality of life, patient satisfaction, and body image than WBI.
[30,31] Some concerns remain, however, that longer follow-up may reveal complications of the less
fractionated delivery of irradiation to the surrounding normal tissue. Only the late results of randomized trials
will address this issue.
Selection of patients able to avoid breast irradiation was addressed in a National Cancer Institute Breast
Intergroup study led by Dr. Kevin Hughes. Patients in the study were women over 70 years of age with
estrogen receptor–positive breast cancers that had been completely excised. They were free of axillary
nodal metastases based on either clinical or pathological criteria and were receiving 5 years of tamoxifen
therapy. The investigators previously reported 5-year data from the trial,[32] and an updated report with a
median follow-up exceeding 10 years was presented at the 2010 meeting of the American Society of
Clinical Oncology.[33] The 5-year and 10-year trial results showed that women randomized to lumpectomy
plus WBI vs lumpectomy alone had no advantage in either survival or breast preservation rates compared
with those receiving lumpectomy without irradiation. Although local recurrence rates were higher in the
group treated with lumpectomy alone, they remained acceptably low and there was no difference in risk of
distant metastasis or death from any cause.
Sophisticated techniques of breast irradiation can now avoid "hot spots" and consequently allow
hypofractionation compared with the number of fractions previously used. The work of Whelan and
colleagues has shortened the duration of whole-breast treatment from 6 weeks to 3 weeks. This was initially
demonstrated in older women but is now being evaluated in younger women as well, and would appear to
provide some of the benefit of APBI with whole breast treatment.[34]
Financial Disclosure: The authors have no significant financial interest or other relationship with the
manufacturers of any products or providers of any service mentioned in this article
August 10, 2011
Local Woman Pushes For Improved Street, Sidewalk Conditions For Residents with Disabilities -
Patch.com –
Barbara Lebow says she was stopped by police for riding her mobility scooter in the road against traffic;
now she’s pointing out “trouble spots” and advocating for ADA compliance
A Fort Lee woman living with limited mobility is intensifying her efforts to bring about changes she hopes will
enable her and others to get around town safer and a little more conveniently after a run in with police last
month.
Barbara Lebow, who suffers from a combination of lymphedema and arthritis, conditions that make walking
and standing extremely painful, relies on a mobility scooter to travel from point A to point B in Fort Lee. She
said her main goal in advocating for better accessibility and full ADA compliance in her hometown isn’t just
for people with mobility scooters, but also for those who use wheelchairs or walkers to get around or even
people who push baby strollers.
“My goal is to make it easier for everybody,” Lebow said. “That’s my agenda. I would like to see corner-
appropriate corner cutouts that aren’t going to put anyone in danger and get them off the sidewalk. My next
goal would then be to get people into stores. There a number of stores you can’t get into. [The scooter]
doesn’t jump. It won’t go up a flight of steps.”
The issue of ADA compliance recently came to a head for Lebow when she had what she called an
“unfortunate encounter” with an “unprofessional” policeman while trying to get home—she lives on Bridge
Plaza North—from “the non-accessible Fort Lee Post Office” on Main Street, taking what she thought was
“the safest route.”
“I was on the road in the wrong direction; I was going towards traffic, not along with traffic,” Lebow
admitted, adding that the incident occurred on Lemoine Ave. about halfway to Bridge Plaza North from
Citibank. “I was driving towards traffic so they could see me. I didn’t know that I had to follow the bicycle
rules.”
She said she was riding her scooter in the street, which is legal if you travel in the direction of traffic like
bicyclists, because there’s no ramp to get off the sidewalk on the southwest corner of the intersection of
Lemoine and Bridge Plaza North, and the southeast corner, which does have a ramp, isn’t much better. That
ramp is cut at roughly a 45-degree angle, forcing the scooter to move faster, Lebow said, and she’s
“petrified” to go down it with a constant stream of cars making right turns on red lights.
“That’s why I was riding in the street,” she said. “That’s why the police officer stopped me. The one corner,
I couldn’t get off once I got on, and the other one … I’m scared to death of it.”
Lebow told Patch she was not ticketed for the violation, but rather let off with a warning. She also said that
as a result of the incident she is now better informed of the rules of the road regarding scooters and has “met
several Fort Lee policemen who have been wonderful.”
“[The police] spent a tremendous amount of time researching the laws,” Lebow said. “As a result, I now
wear a helmet. This is not a fashion statement. … It was a misunderstanding; I’ll accept that. But as far as I’
m concerned, it was a bad situation.”
At the July 21 regular meeting of the Fort Lee Mayor and Council, Lebow expressed her concerns and
related the incident to the borough’s governing body.
“In New Jersey, by law, handicapped people are allowed to use mobility scooters,” she told Fort Lee
Mayor Mark Sokolich and members of the Council. “Why anyone would want to use one is beyond me. …
Their access is cut off to most stores, many buildings and other destinations.”
She added that her knees and legs absorb the shock of every bump in the road, and that potholes pose
another serious risk.
“I have been approaching [Sokolich] for four years,” Lebow later told Patch. “For four years he has been
committing to me that he would take a ride with me because I wanted him to walk in my moccasins. When
you’re using a mobility scooter, the world is a whole different place.”
But while Sokolich didn’t take a ride with Lebow personally, he did assign Michael Maresca of the Fort Lee
Department of Public Works to the task, he said, “to identify what the problem areas are.”
Lebow said she was appreciative of the opportunity to point out some of those problem areas, and added
that Fort Lee has “for the most part” done a good job with recent work on Anderson and Center Avenues
when it comes to ADA compliance. But she also said there are still plenty of “trouble spots” in town.
“Mike was terrific,” Lebow said of the roughly 90-minute, ride-along survey. “It was probably far better
than anything I could have had because he knows the streets, and now it was just tweaking his look.”
Among those “trouble spots” in Fort Lee Lebow identified for Patch—she’s been known to ride around
town with a tape measure at the ready—are the following:
· Linwood Ave. and Bridge Plaza South – “NE and NW corners have traffic light bases in corner cut-
outs—impassable.”
· Center Ave. and Bridge Plaza South – “NW and SW corners in bad condition with potholes. Divider
[is in] very bad condition. NW corner [has] very steep ramp up.”
· Center Ave. and Whitman St. – “No corner cut into circular driveway”
· Sidewalk on Lemoine Ave. - “In front of mall where Starbucks/Boston Chicken are is only 22 inches
wide with bush overgrowth and fire hydrant placement.”
· Staples on West St. – “There is a cutout onto the sidewalk, which is blocked by a fire hydrant. Once
you get past the fire hydrant, you realize there is no curb cutout to get off sidewalk.”
· Bridge Plaza North, west of Linwood Ave. – “Cutout is not in crosswalk and is way too deep,
catching the back wheels of the scooter going down and is too steep going up. It sits about 2 inches above
the roadway.”
· Main St. – “Almost all driveways and ramps are 2 inches above asphalt because of decorative brick.”
· Bridge Plaza South and Martha Washington Way – “No corner cutouts; just broken curb and bad
potholes.”
Complicating the matter is the fact that the worst of the “trouble spots” are right where Lebow lives, and the
very stretch of Lemoine Ave. she has to traverse to get from her home to Main St. is Port Authority
jurisdiction.
“I’d say that some of [the problems areas] have been identified,” Sokolich said. “The major bone of her
contention is that some of the curbs don’t have an appropriate ramp to allow her to get onto that sidewalk.
Unfortunately, some of those sidewalks are far from being in our control.”
But the mayor said jurisdiction “generally hasn’t stopped me in the past.”
“I never use it as an excuse,” Sokolich said. “If a road needs to be paved, and it’s a state road, and it’s in
abominable condition, I do it and deal with the consequences later. But on this, it’s going to be very, very
difficult to do it because it’s a very, very high curb. I’m not saying no. We’ve written letters to the Port
Authority, and we’re waiting to hear from them on what their position is. But those curbs are all metal-
structured, reinforced. You’re talking tens of thousands of dollars to do what it is that they want
accomplished, and those are funds that are not available to us at the moment.”
Lebow said she’s personally tried to get someone from the Port Authority to listen.
“But I’m just one squeaky wheel,” she said.
She also said she’s been working with the Bergen County chapter of Heightened Independence and
Progress (HIP CIL), an advocacy group for people with disabilities and independent living.
Nancy Hodgins of HIP CIL said she has also contacted the Port Authority on Lebow’s behalf, but that she
hasn’t had much more luck getting a response. She did say however that she’s hopeful she’ll get some
answers when the person she’s waiting to hear back from returns from vacation.
But Hodgins also said ADA compliance problems in general are not unique to Fort Lee.
“The law is very clear,” Hodgins said, adding that there are “varying levels of compliance” among
municipalities.
“Some towns are very good at [being in compliance], and others are not,” she said.
Hodgins called Lebow a “strong advocate,” who is doing the right thing by speaking out, and said people
like Lebow have as much of a right to get around safely as pedestrians.
Lebow, who works full-time from home as the director of sales and marketing for a firm that sells restaurant
equipment and supplies and also volunteers in community—she’s a member of the local R.A.C.E.S. team,
for example—doesn’t want people to feel sorry for her. She just wants to call attention to an issue that a lot
of people may not think much about.
“I do have a life,” Lebow said. “Most often people see me, and they make a really bad assumption that I’m
sitting home eating bon bons all day. I work from home, but that’s a whole other issue. Even though I may
have mobility issues I do whatever I can to give back to Fort Lee”
Sokolich says that in addition to writing letters to the Port Authority to deal with what Lebow refers to as
“the offending corner” at Lemoine Ave. and Bridge Plaza North, the borough is doing what it can to help.
“Those roads that are in our control, as soon as I have the special projects team concluding a couple other
things, I do plan on getting them out there to take care of a couple of those problem areas in the hopes that
we can accommodate her,” Sokolich said.
Lebow, who has been using a mobility scooter for about 10 years, said she’s going to work with HIP CIL
on a survey project in Hackensack she hopes to be able to bring to Fort Lee.
“This is not where I plan on stopping this quest,” she said. “Until the Port Authority of New York and New
Jersey becomes ADA-compliant, I will continue to advocate.”
August 11, 2011
Ryan joins Aloha Home Care – TCPalm –
Elizabeth Ryan has accepted a position with Aloha Home Care, 548 N.W. University Ave., Port St. Lucie,
as lead therapist for lymphedema treatments.
Ryan has extensive experience working with lymphedema and wound patients in their homes, the company
said in a news release. She provides education, sizing for custom garments, and demonstrates wrapping and
self management skills.
Linda Hanisak, director of professional services at Aloha, said in a news release, "I have worked with
Elizabeth and have watched her patients receive excellent results as well as return to more active lifestyle.
Elizabeth makes a difference in the quality of life for her patients."
To contact Ryan, or for information on lymphedema treatment, call 772-562-1559
August 13, 2011
Reveal release regain - Trinidad Guardian – by Michelle Loubon -
Suspended on wings, archangel Gabriel bursts through the clouds with sword in hand. Hindu deity Lord
Ganesh, the son of Shiva and Parvati, is easily recognisable by an elephantine countenance with a curved
trunk and big ears. These portraits are not hanging in a religious sanctuary. Instead, they add a pious touch
to the lab-clean Glencoe office of bio energy therapist Meera Jadoo. At a time when nerves are frayed due
to stressful daily activities, Jadoo is putting her faith in Scenar therapy and “crystal light balancing” to ease
the tension. Scenar is an acronym for Self Controlled Energo Neuro Adaptive Regulation. Although they are
not etched on the walls, Jadoo’s watchwords are “Reveal, Release, Regain.” It’s visible on her azure-
coloured buttons-up.
Against the backdrop of a pantheon of gods, Jadoo explained Scenar therapy hinges on the theory of
Chinese acupuncture. Acupuncture is defined as an alternative medicine that treats patients by insertion and
manipulation of needles in the body. Its proponents variously claim it relieves pain, treats infertility, disease,
prevents disease, or promotes general health. She depends upon healing hands—not needles. Jadoo said:
“Scenar therapy incorporates the technique of Chinese acupuncture to eliminate mental blockages. It’s done
using a small machine that energises the blocked pathways along the body. It would ensure the life-force
energy flows more efficiently. She added: “When we have blocked pathways, it creates illnesses and
diseases in the body. So Scenar therapy works on the theory of traditional Chinese medicine. We work on
the acupressure points, reflex zones, and meridians (the energy pathway itself). We have 14 different
meridians—mental, physical and emotional—in the body.”
In a nutshell, Scenar therapy is a non-invasive pain-free biofeedback therapy that fortifies and invigorates the
body’s natural healing ability which promotes health and vitality and re-establishes balance in the body.
Affirming the benefits to be derived from Scenar therapy, Jadoo said: “All diseases tell us what is going on in
the emotional and mental body. It’s good. It’s a step forward. It takes you forward.”
Crystal light balancing
Coupled with Scenar therapy, Jadoo engages in “crystal light balancing”. It employs chromotherapy
technique which utilises colour and light to bring about healing and balance to a person’s mental, emotional,
physical and spiritual body. Jadoo added: “It works on the emotional body by using light to clear the
meridians of emotional blockages. We are using different coloured lights according to the meridian and
dealing with the emotion that needs to be addressed and clearing it. We are working to calm the whole body
mentally and emotionally.” She added: “At the end of the therapy, we are trying to get the person whole in
terms of balancing, energising and harmonising. We are working on pain relief therapy for all kinds of
injuries; even those derived from sporting activities.”
Targets women, children
While Scenar therapy, which was developed by the Russian space programme in the ’60s, is intended to
empower people to take charge of their lives and get rid of their depression, Jadoo noted it was specially
targeted toward women and children. It was even more timely for victims of abuse. Jadoo added: “These
therapies are especially directed at women and children who experience abuse. They won’t feel life is
against them. It brings out the painful emotions and helps you deal with it. Once you understand what is
happening then you can go deeper and deeper into the depression and find ways to manage it and deal with
it.” Jadoo felt women and children should be well treated to create a more just and equitable society.
Carrying a burden for the children, Jadoo added: “Children are the future of the nation. We need to take
extra care of the young ones. We need to build positive people to lead our nation.”
Willing to help Nelson
Recently, Jadoo said she was moved by a Sunday Guardian report which highlighted lymphedema (massive
growths) affecting Valencia resident Marissa Nelson. She said: “To think she is only 28. She needs help. I
am willing to help her with Scenar therapy; Anything that would give her confidence and a reason to live.
People in such cases can be suicidal and suffer from low self-esteem.”
Back pains led to Scenar therapy
Jadoo had tested her techniques with positive results. Having graduated from City University, London,
Jadoo worked as an optometrist—specialising in eye examinations. She immersed herself in her work until
she began experiencing excruciating back pains in 2001. They increased in intensity and sleepless nights
dogged her footsteps. Reflecting on that period of misery, Jadoo said: “I suffered from back pain for many
years. I went to many specialists and I did MRI and nobody could figure out what was causing the pain. I
did physiotherapy.” The pain did not go away. Cringing, Jadoo added: “At times, I couldn’t get off the bed.
I tried anything people suggested. But still the pain was debilitating to the point where I couldn’t walk, eat or
sleep.”
Tries Scenar therapy
Frustrated and fed up, Jadoo sought the help of a homeopathic doctor in Canada in 2009. She employed
Scenar therapy which delivered her from the pains. Jadoo realised she was drawn to the therapy. She
attended homeopathic bio energy workshops hosted by Dr Sushilla Lalsingh in Canada. Jadoo said: “After
three weeks, the pain was almost gone. So now, that’s how I got into it; I ended up doing the courses with
it. I recognised how calming and how much it relieved the different pains.” Gushing over the discovery,
Jadoo said: “When you complete the therapy it tends to have a healing effect. It tends to allow the brain take
over the healing process within the body. It can also be used for people with mental disorders. It tends to
produce the good feelings hormones to calm them down. “It works with the mental, emotional and physical.”
Now that she has mastered Scenar therapy, she’s comfortable and optimistic about practising on other
people. Charity begins at home. Even her nephew Ardan, five, has been subject to Scenar therapy. “I try it
on Ardan when he had bumps and bruises. It is effective and pain-free. It is very comfortable for people.”
About Meera Jadoo
Jadoo lives at Tunapuna. She attended St Joseph’s Convent, St Joseph. She has a brother Rajiv and sister
Tara. Jadoo practised with Ferreira Optical until August 2010. For two years, she was a member of the
T&T Optometrist Association. Her work took her to Tobago where she spent a long time. Among her
hobbies are reading, solving crosswords, other puzzles and outdoor activities like walking, exercising and
going to the seaside—especially Maracas for bake and shark. Her parents are Raj and Sati Jadoo. She
admires their humanitarianism. Working alongside Rotary, Jadoo said her father had assisted in the
distribution of wheelchairs, hampers and helped people raise funds for heart surgery. He has even worked
on a campaign to eradicate polio. Jadoo said: “There is a strain that has come back.” She’s adamant about
carving her own niche. “My father is established. I left a steady job to do therapy. I am into this on my own.
I put my savings into this project. I heeded my inner calling.” But, like her parents, she’s not hesitant about
lending a helping hand to those less fortunate. “When I did optometry, I did charity and lectures on diabetes.
I helped with eye tests in remote places like Toco and Poole Village. I believe in helping where I can.”
August 15, 2011
Swollen arms and legs are a large - and treatable - part of a post-cancer treatment patient's world - London
Free Press - by By Marilyn Linton, QMI Agency –
Several years after her cancer treatment, Dr. Dianne Kipnes noticed serious and persistent swelling in her
lower limbs. "My legs and feet were swollen to the point where you could hardly see my knees," she says.
When it didn't go away and was finally diagnosed as lymphedema, Kipnes, a clinical psychologist and
president of the Dianne and Irving Kipnes Foundation in Edmonton, became increasingly frustrated: She
discovered there was no cure and very little available treatment to keep her condition under control.
She's not alone in that frustration. A 2009 study by the Canadian Lymphedema Framework found a lack of
standardized care for patients in Canada, no provincial health coverage, a lack of resources for assessment
and treatment and a real need to teach lymphedema prevention and self-management.
According to Dr. Anna Towers, who runs a lymphedema clinic at Montreal's McGill University Health
Centre, lymphedema is an accumulation of lymphatic fluids that occurs when there is removal of, disruption
or damage to lymph nodes or vessels, usually following surgery or radiation treatment for cancer.
"Wherever there are blood vessels, you have lymphatic vessels. They are everywhere," Dr. Towers explains.
The lymphatic system is made up of lymph fluid whose white blood cells help to fight infection; lymph nodes
to filter out toxins and germs; and lymph vessels which transport the lymph fluid.
"Myths about lymphedema include the impression that nothing can be done about it, that lymph treatments
don't work, and that lymphedema is benign and doesn't lead to serious health consequences," Dr. Towers
says. Some doctors dismiss it, and others don't realize that it can show up years after cancer treatment.
Dianne Kipnes' cancer was treated seven years ago, but her lymphedema began only two years ago.
At Dr. Towers' clinic, the first weeks include getting the swollen limb down to a normal size. This entails
teaching patients how to layer bandages which need refitting every other day. Patients have massage
treatments designed to help lymphatic circulation. Exercise and diet advice is given, as are compression
garments that are individually fitted and not just bought off a drugstore shelf.
"The most important thing people at risk need to understand is that early intervention and early detection is
critical to limiting the extent to which they will suffer," says Ian Soles, president of Edmonton's Salutaris
Centre for Lymphatic and Massage Therapy, a private clinic offering much-needed therapeutic services. Left
untreated, the condition can lead to cellulitis and other skin infections, some of them life-threatening.
Soles is a Vodder-certified registered massage therapist and that particular treatment, which he describes as
a technique which stretches the skin to stimulate lymph flow, is what helps Dianne Kipnes cope with her
lymphedema. "Sixty per cent of the lymph vessels are in the top two layers of the skin," explains Soles: The
gentle rhythmic massage used in the technique developed by a German doctor in the 1930s moves the fluid
and proteins out of the lymphatic system to properly drain.
Soles described the lymph system as "the sewer system of the body" in that it's the transportation component
of the immune system and gets rid of toxins, fat particles, viruses and large proteins. "Typically, the lymph
system dumps one to two litres of lymph fluid into the subclavian vein every 24 hours. Then the fluid runs
through the kidney, the waste goes to the bladder and is urinated out."
When this system is damaged, massage shifts the fluid to the body's healthier lymphatic system. His clinic
also tackles getting the swelling under control before advising patients to get compression garments, giving
them exercises and teaching them self-management.
"I can tell you I never had leg envy the way I have with lymphedema," says Dianne Kipnes. "It can be ugly.
But it's more than a vanity issue. If you don't get treatment, you get complications." Adds Dr. Towers: "Up
to 25% of cancer patients get lymphedema. By catching it early, we could reduce it to 10 or 5%."
Body politics
"After cancer surgery, people should be monitored for the earliest sign of swelling," says Dr. Anna Towers.
"They should also become active as soon as it is safe as that helps drainage. But Canada needs programs to
prevent, diagnose and treat patients. People are diagnosed with cancer and the health system responds
immediately. Then they develop lymphedema and they find themselves abandoned."
What causes it?
Half of all lymphedema cases occur because of radiation treatment to cancers of the prostate, breast, colon,
cervix or uterus. The rest of lymphedema cases are related to heredity, hip surgery, obesity or varicose
veins. An increase in the number of cancer survivors coupled with obesity and an aging society means
lymphedema can't be ignored.
Symptoms
According to the Lymphedema Institute in Houston, TX, common symptoms include:
A chronic, heavy swollen limb
Localized fluid accumulation in other body areas
Discoloration of skin overlying the lymphedema
Deformity
Severe fatigue
Weighty limbs – CANOE –by: Marilyn Linton, QMI Agency
Several years after her cancer treatment, Dr. Dianne Kipnes noticed serious and persistent swelling in her
lower limbs. "My legs and feet were swollen to the point where you could hardly see my knees," she says.
When it didn't go away and was finally diagnosed as lymphedema, Kipnes, a clinical psychologist and
president of the Dianne and Irving Kipnes Foundation in Edmonton, became increasingly frustrated: She
discovered there was no cure and very little available treatment to keep her condition under control.
She's not alone in that frustration. A 2009 study by the Canadian Lymphedema Framework found a lack of
standardized care for patients in Canada, no provincial health coverage, a lack of resources for assessment
and treatment and a real need to teach lymphedema prevention and self-management
According to Dr. Anna Towers, who runs a lymphedema clinic at Montreal's McGill University Health
Centre, lymphedema is an accumulation of lymphatic fluids that occurs when there is removal of, disruption
or damage to lymph nodes or vessels, usually following surgery or radiation treatment for cancer.
"Wherever there are blood vessels, you have lymphatic vessels. They are everywhere," Dr. Towers explains.
The lymphatic system is made up of lymph fluid whose white blood cells help to fight infection; lymph nodes
to filter out toxins and germs; and lymph vessels which transport the lymph fluid.
"Myths about lymphedema include the impression that nothing can be done about it, that lymph treatments
don't work, and that lymphedema is benign and doesn't lead to serious health consequences," Dr. Towers
says. Some doctors dismiss it, and others don't realize that it can show up years after cancer treatment.
Dianne Kipnes' cancer was treated seven years ago, but her lymphedema began only two years ago.
At Dr. Towers' clinic, the first weeks include getting the swollen limb down to a normal size. This entails
teaching patients how to layer bandages which need refitting every other day. Patients have massage
treatments designed to help lymphatic circulation. Exercise and diet advice is given, as are compression
garments that are individually fitted and not just bought off a drugstore shelf.
"The most important thing people at risk need to understand is that early intervention and early detection is
critical to limiting the extent to which they will suffer," says Ian Soles, president of Edmonton's Salutaris
Centre for Lymphatic and Massage Therapy, a private clinic offering much-needed therapeutic services. Left
untreated, the condition can lead to cellulitis and other skin infections, some of them life-threatening.
Soles is a Vodder-certified registered massage therapist and that particular treatment, which he describes as
a technique which stretches the skin to stimulate lymph flow, is what helps Dianne Kipnes cope with her
lymphedema. "Sixty per cent of the lymph vessels are in the top two layers of the skin," explains Soles: The
gentle rhythmic massage used in the technique developed by a German doctor in the 1930s moves the fluid
and proteins out of the lymphatic system to properly drain.
Soles described the lymph system as "the sewer system of the body" in that it's the transportation component
of the immune system and gets rid of toxins, fat particles, viruses and large proteins. "Typically, the lymph
system dumps one to two litres of lymph fluid into the subclavian vein every 24 hours. Then the fluid runs
through the kidney, the waste goes to the bladder and is urinated out."
When this system is damaged, massage shifts the fluid to the body's healthier lymphatic system. His clinic
also tackles getting the swelling under control before advising patients to get compression garments, giving
them exercises and teaching them self-management.
"I can tell you I never had leg envy the way I have with lymphedema," says Dianne Kipnes. "It can be ugly.
But it's more than a vanity issue. If you don't get treatment, you get complications." Adds Dr. Towers: "Up
to 25% of cancer patients get lymphedema. By catching it early, we could reduce it to 10 or 5%."
Body politics
"After cancer surgery, people should be monitored for the earliest sign of swelling," says Dr. Anna Towers.
"They should also become active as soon as it is safe as that helps drainage. But Canada needs programs to
prevent, diagnose and treat patients. People are diagnosed with cancer and the health system responds
immediately. Then they develop lymphedema and they find themselves abandoned."
What causes it?
Half of all lymphedema cases occur because of radiation treatment to cancers of the prostate, breast, colon,
cervix or uterus. The rest of lymphedema cases are related to heredity, hip surgery, obesity or varicose
veins. An increase in the number of cancer survivors coupled with obesity and an aging society means
lymphedema can't be ignored.
Symptoms
According to the Lymphedema Institute in Houston, TX, common symptoms include:
A chronic, heavy swollen limb
Localized fluid accumulation in other body areas
Discoloration of skin overlying the lymphedema
Deformity
Severe fatigue
Learn more!
www.salutariscentre.com
www.lymphnet.org
www.lymphedemainstitute.org
www.vodderschool.com
www.lymphontario.ca
Learn How to Prevent Lymphedema - KEPR 19 –
A free Lymphedema prevention, education, and training class is being offered Tuesday, August 16th, from
1pm to 2pm at the Tri-Cities Cancer Center in the Resource Center. Sara Nelson, DPT, will teach this class.
Lymphedema affects both men and women and refers to the swelling that occurs most often in the arms or
legs due to a blockage in the lymph system, which prevents the proper drainage of lymph fluid. Following
certain types of surgeries, as many as 49% of people may develop secondary lymphedema. Understanding
early symptoms can help prevent severe discomfort and permanent damage.
Anyone who has had lymph nodes removed will benefit from the material presented in this class. Learn more
about the lymphatic system, lymphedema prevention, early symptom detection, use of compression, basic
self-massage, and when to seek professional treatment related to lymphedema. Dr. Nelson is an expert in
the field of lymphedema therapy.
To reserve a seat at the next class or for more information please call (509) 737-3427. The Tri-Cities
Cancer Center is located at 7350 W. Deschutes Ave., Kennewick.
The Tri-Cities Cancer Center is able to offer programs like this at no cost, thanks to generous contributions
from organizations like Therapy Solutions and others. Donations to the Tri-Cities Cancer Center Foundation
stay local and are used to provide valuable non-reimbursed cancer programs and services for patients, their
families and the community.
Senior community works to meet their residents “where they are now” - AnnArbor.com –
Tanum Ollila from Brookdale Place in Ann Arbor joined us on the show this past weekend. She has been
busy with many new residents moving to their senior community, located on Ann Arbor-Saline Road.
Brookdale Place has two “neighborhoods,” one for assisted living, and one for those receiving memory care.
Tanum talked about Clare Bridge, their memory care community, and how the staff work hard at “meeting
someone in their journey, where they are now.” If their resident believes it’s 1941, and they are taking the
train here from Kentucky, then that’s where their staff needs to be with them.
Brookdale Place completes a life history form for each of their new residents, to get to know and appreciate
the details of his or her background. Knowing residents' interests and what their lives have been like better
ensures the residenst receive the appropriate care and attention to optimize their quality of life.
When looking for a facility for your mom or dad, Tanum believes it is super important to visit the community.
How do you feel when you walk in the door? Look at the residents, and how they are being treated. Do you
see interaction with the staff? Do you see residents engaged?
Tanum’s biggest hurdle is getting families to come see the facility. So many people believe senior facilities are
still old-style nursing homes, dreary and depressing. Families are frequently shocked when they see how nice
a senior community can be.
Bill's Roundup: Grants, Drugs & College - Prescott eNews –
Dr. Penny Wills talks about the community and Yavapai College; and several grants have been received to
provide support services to local residents.
The Susan G Komen Phoenix affiliate has awarded a grant to Yavapai Regional Medical Center. YRMC
officials note the nearly $19,000 grant will help treat low and middle income women suffering from
lympedema, a painful condition that can occur as a result of cancer or cancer treatment, such as
mastectomy, radiation therapy or chemotherapy. Donna Hannah is the only lymphedema therapist serving
Yavapai County and accomplished Oncology Nurse Nancy Ledoyen will serve in that role at the new
Breast Care Center at YRMC’s East Campus in Prescott Valley. New Chief Nursing Officer Diane Drexler
will also help with the opening of the Center. During a recent tour of that facility, Komen Phoenix leaders
learned about key medical services the center will provide, including digital mammography, breast ultrasound
and stereotactic biopsy. The Center is scheduled to open this October.
Yavapai County Sheriff’s Office K-9 teams have received a $9000 grant award. This award comes from
the Yavapai County Community Foundation to help offset expenses involving the Sheriff’s Office K-9 Units.
Four Patrol K-9 Units are specifically assigned to drug interdiction on major interstates and County
highways. According to Sergeant Jeff Jaeger, a portion of the money will be used for training and equipment
including portable kennels, training toys and leashes. Search dog team handlers will use their portion of the
monies for training, K-9 first aid supplies and rattlesnake vaccinations, along with radio and GPS equipment.
Last Wednesday, a K-9 deputy working drug interdiction confiscated more than 3 and a half pounds of
marijuana following a traffic stop on Interstate 40 at Crookton Road in Seligman. Sixty-three year old
Oklahoma resident Tomie Adams was arrested for transportation of marijuana for sales.
The Dewey-Humboldt Board of Adjustment meets at 10 tomorrow morning. Newly appointed Board
members Judy and Frank Davidson will be sworn in to start the meeting and there will be an election of a
new Vice Chair. Bob Bowman currently serves in that position. The work study session will include a
presentation and discussion by former Mayor Len Marinaccio on recurring Open Meeting Law issues, with
an overview of the Law itself. There will also be a presentation on Robert’s Rules of Order and a review of
Riggin’s Rules.
Following a lunch break at 12:15, there will be consideration of Board of Adjustment procedures and a
review of Board zoning regulations. A training date for new members on powers and limitations of the Board
is expected to be established and the date and time for holding meetings will be discussed. The work study
session will be held in Town Council chambers on south Highway 69.
A Cottonwood woman has been arrested after allegedly forging a prescription. The Pharmacy Manager at
the Walgreen’s Store on Main Street met with Police and told them a female subject presented a forged
prescription. He pointed out the quantity was changed from 30 to 80 pills of hydrocoden. The doctor who
wrote the prescription was contacted and she confirmed the quantity was 30 pills. Thirty-three year old
Therese Brady was not home when an officer went to her residence, but she was contacted by cell phone
and agreed to meet the officer at the Police Department. Brady was shown a copy of the forged prescription
and she was arrested for presenting a forged instrument that contains false information and for attempting to
obtain or procure the administration of a narcotic drug by fraud, deceit or misrepresentation.
Chino Valley residents need to be aware of increased traffic due to school being back in session. During a
recent live appearance on Talk of the Town on KQNA, Police Commander Mark Garcia explained both
Territorial and Del Rio Elementary Schools are located on side streets and in addition to increased traffic,
there are kids walking to and from school. Garcia says officers will also be checking to make sure motorists
are stopping for school buses. Since the first day was held last Wednesday, this week marks the first full
week of school in the District.
The Prescott Fire Department is hosting a Regional Mass Casualty Incident Exercise tomorrow morning.
The Interagency Exercise will consist of a simulated emergency involving 2 aircraft at the Airport with live
fire and up to 25 patients who will need to be treated by responding agencies. This simulated incident is
designed to assist regional providers in the use of multi-agency partnerships, response of area responses and
to provide strategies in resource management, fire suppression techniques, emergency transportation, airport
emergency operation techniques, hospital mass casualty capabilities and participating agency safety
practices. Some of the 25 regional agencies scheduled to participate include the Prescott Airport
Department, Prescott Police, the Regional Communication Center, the Central Yavapai, Chino Valley,
Mayer and Groom Creek Fire Districts; the Department of Public Safety, Yavapai College, the Trauma
Intervention Program and the Prescott Unified School District.
New Yavapai College President Penny Wills is looking forward to the start of the Fall Semester. Wills, the
former Northeast Iowa Community College President was named Yavapai College President last May and
she officially started on August 1st. Last Monday, the Governing Board held a transitional workshop with
the new President on the Policy Governance Model. Wills explains that meeting was proposed by former
College President Jim Horton and added that she appreciates the community support for the school.
Those who wish to meet Wills can do so at a Yavapai College Foundation reception at 5 this Wednesday
night at the College’s Sculpture Garden on East Sheldon Street. She was introduced during the Board’s
voting session on Tuesday and during the Prescott Valley Town Council’s voting session on Thursday night.
Tailored Strategies for DCIS Management - Cancer Network – By Sara H. Javid,-
Few areas in breast disease elicit as much controversy as the management of DCIS. The review by Sanders
and Simpson, “Can We Know What to Do When DCIS Is Diagnosed?” nicely highlights those
controversies. While the answers to this question may not be cut-and-dried (no surgical pun intended), we
endorse the authors' conclusion that there never will be a “one-size-fits-all” algorithm for DCIS treatment,
and that treatment should instead be carefully tailored to the individual patient.
The pathologic evaluation of DCIS within a surgical specimen is challenging and is a critical juncture that
impacts all subsequent treatment recommendations. Two key factors for determining breast conservation
candidacy are extent of disease (“size”) and surgical margin width, which along with tumor grade and
presence of necrosis are paramount to making decisions regarding whether re-excision, mastectomy, and/or
radiation is necessary. The authors suggest that to assess disease extent, all surgical specimens containing
DCIS should be processed with serial sectioning and sequential submission of the entire specimen (so-called
“serial sequential sampling”) so that the extent of DCIS can be measured in three dimensions. As surgeons,
we strongly endorse this concept, although in practice such extensive processing is labor-intensive and can
become impractical for pathologists to perform routinely. Acknowledging these limitations, the College of
American Pathologists (CAP) stipulates that any of four different methods for measuring the extent of DCIS
may be used: serial sequential sampling, nonsequential sampling, span measurement of DCIS on one slide,
and/or measured distance between two affected margins.[1] In practice, the measurement of DCIS extent
varies across institutions and is at best an estimate of disease burden.
The definition of a surgically “clear” margin is a hotly debated issue in DCIS management due to its
implications for whether radiation therapy is required. The National Surgical Adjuvant Breast and Bowel
Project (NSABP) B-17 randomized trial that led to the broad-scale adoption of radiation following breast
conservation for DCIS demonstrated that radiation reduced the local recurrence rate from 27% to 12%.[2]
Similarly, the randomized European Organisation for Research and Treatment of Cancer (EORTC) 10853
trial also demonstrated the efficacy of radiation in reducing risk of local recurrence; in this trial it was
reduced from 14% to 7% at 10-year follow-up.[3] However, both trials were limited in that 40% or more
of tumors were not measured pathologically for extent of disease. Furthermore, the surgical margins were
often unoriented and unmeasured in these early studies, making comparative assessment of surgical margin
width impossible to perform. In these trials, surgical margins were considered to be negative as long as
cancer was not present at the resection line (NSABP), or was at least 1 mm from that margin (EORTC)—
definitions that would generally be considered inadequate by modern standards. Given this variability, subset
analyses could not be conducted to identify select groups of patients for whom radiation therapy might not
be necessary.
We tend to disagree with the authors' suggestion that architectural pattern alone (ie, micropapillary DCIS)
should steer surgical recommendations away from an attempt at breast conservation. While micropapillary
DCIS tends to have a multifocal distribution within the breast (not unlike lobular carcinoma in situ), this is not
invariably true. Before recommending mastectomy, we verify with percutaneous sampling that the extent of
disease is truly widespread, rather than assuming this to be the case on the basis of histological subtyping. As
long as the patient is counseled appropriately about the risk of needing re-excision or possibly mastectomy
to attain clear margins (as all breast conservation patients should be), breast conservation should still be
offered regardless of the DCIS pathologic subtype.
Silverstein and Lagios have been the most outspoken in advocating against the universal need for post-
lumpectomy radiation for DCIS. Their Van Nuys Prognostic Index (which utilizes tumor size, margin width,
grade, presence or absence of necrosis, and patient age) purports to predict risk of local failure with
excision alone in order to elucidate who may avoid or benefit from radiation therapy.[4,5] Unfortunately, the
Van Nuys scale has not been consistently validated by independent groups. In contrast to Sanders and
Simpson's suggestion, we generally do not apply the Van Nuys algorithm to predict who may forgo radiation
therapy.[6,7] Instead, we take an individualized approach in which we perform the rigorous pathologic
(serial sequential sectioning of entire specimen) and radiographic examinations (specimen radiographs and,
when needed, post-lumpectomy mammogram to confirm absence of residual calcifications) and then make
individualized decisions based on the extent of disease and margin width, as well as consideration of the
patient's stated preferences and goals.
Since DCIS does not have significant metastatic potential, we believe there is more room for individualized
approaches to care than one might identify for invasive disease, for which mortality risk is a factor.
Silverstein's retrospective series demonstrated that when 10-mm margins were attained, radiation had no
benefit in reducing an already low 8-year local failure rate of 4%. If margin width was between 1 mm and <
10 mm, the addition of radiation therapy led to a nonsignificant reduction, and only when margins were < 1
mm did it yield a significant benefit.[8] However, 10-mm margins are viewed by most as excessive, if not
unattainable, and can often lead to marked cosmetic deformity, particularly in a modest-sized breast. It is
generally accepted that 1 mm is insufficient unless it is present at an anatomic breast boundary (eg, pectoralis
fascia) and that local recurrence risk decreases as margin width progressively increases from 1 mm to 10
mm. Having said that, we generally consider ≥ 2- to 3-mm margins to be negative. We do not require wider
(5-mm) margins for higher grade DCIS as Sanders and Simpson suggest, because this could lead to an
excessive number of re-excision surgeries. In our multidisciplinary approach, our pathologists carefully
sample and examine surgical margins, and when we see a narrow margin that is only focally present, our
radiation oncologists consider increasing the boost dose to this site.
Prospective trials have been conducted to analyze whether wider margins can replace the need for radiation
therapy for DCIS. One prospective trial of 158 patients by Wong et al failed to show that excision to ≥ 1-
cm margins alone was adequate for treatment of small (≤ 2.5 cm) low- or intermediate-grade DCIS.[9] The
study was closed prematurely because of a high local failure rate of 2.4% per year, or a 5-year projected
rate of 12%. The multi-institutional ECOG 5194 trial also prospectively evaluated whether excision alone
served as adequate treatment of DCIS, and this study did demonstrate a satisfactorily low 5-year local
recurrence rate of only 6.1% among patients with low/intermediate-grade DCIS.[10] Although all cases of
low/intermediate-grade DCIS ≤ 2.5 cm were eligible for the study, the median tumor size in this group of
565 patients was only 6 mm, with 76.5% of the tumors less than 10 mm. In addition, although margin width
of ≥ 3 mm was accepted as negative, nearly 50% of patients in this group had margins ≥ 1 cm and only
28% had margins < 5 mm. In light of these findings, we generally advise our patients that excision alone is
adequate for treatment of low/intermediate-grade DCIS with more minimal disease than the criteria
suggested by the ECOG study would accept—those patients with < 1 cm extent of low/intermediate-grade
DCIS with at least 5- to 10-mm margins. We do not recommend surgical excision alone for high-grade
DCIS, even when it is small (< 1 cm), given the high 5-year recurrence rate of 15% in this subgroup.
Regarding the role of sentinel lymph node biopsy (SLNB) for DCIS, we echo the authors' recommendation
that SLNB should be performed when there is pathologic suspicion of invasion (either parenchymal or
angiolymphatic) on core biopsy due to the high risk of upstaging to invasive carcinoma in this setting. We
also advocate for the use of SLNB in mastectomy for DCIS. However, the role of SLNB in “identifying
occult invasion in patients with pure DCIS on lumpectomy” is dubious and yields little useful prognostic
information at the cost of a 3% to 7% risk of chronic arm lymphedema. In addition, SLNB can be readily
performed subsequent to the initial lumpectomy if upstaging to invasive disease occurs, since high success
rates for SLNB have been demonstrated by several groups in this setting.[11,12] In fact, the National
Comprehensive Cancer Network 2010 clinical practice guidelines do not recommend SLNB in the setting
of lumpectomy for DCIS (regardless of grade); a joint committee of the American College of Surgeons, the
American College of Radiology, and the College of American Pathologists reached a similar conclusion.[13]
In summary, we support Sanders and Simpson's conclusion that the management of DCIS needs to be
individualized, depending on such factors as histologic grade, the extent of disease, and margin status.
However, we would argue that the subset of patients who can be successfully and confidently treated by
lumpectomy alone (DCIS < 1 cm, margins > 5 mm, low or intermediate grade) is far smaller than the
majority who still benefit from the addition of radiation therapy.
Financial Disclosure: The authors have no significant financial interest or other relationship with the
manufacturers of any products or providers of any service mentioned in this article.
Management of DCIS—A Work in Progress - Cancer Network – By Swati Kulkarni –
Improved screening practices have lead to a dramatic increase in the diagnosis of ductal carcinoma in situ
(DCIS) over the past 40 years. At present, it accounts for about 30% of newly diagnosed breast cancers.
[1] Our current understanding of the natural history of DCIS indicates that it is an immediate, nonobligate
precursor of invasive cancer. DCIS is confined to the breast parenchyma, but if it progresses to invasive
breast cancer, the potential exists for the development of distant metastasis and subsequent death. The
primary goal of treating DCIS is thus to prevent the development of invasive cancer. Treatment of DCIS is
successful for most women; however, the disease can recur, and half of all local recurrences present as
invasive breast cancer. At present, we still have a limited understanding of which cases of DCIS will
ultimately progress to invasion and which cases will be resistant to therapy. Therefore, tailored management
of DCIS is still a work in progress.
Key Studies of DCIS Treatment
The current treatment recommendations for DCIS are based on the findings from four prospective
randomized studies conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP B17
and NSABP B24), the European Organisation for Research and Treatment of Cancer (EORTC), and
DCIS trialists in the United Kingdom, Australia, and New Zealand (UK/ANZ).[2-5] NSABP B17
compared lumpectomy alone to lumpectomy and whole-breast radiation in women diagnosed with DCIS
who had negative surgical margins. The addition of radiation reduced the risk of both noninvasive and
invasive recurrence by 50%. NSABP B24 compared lumpectomy and whole-breast radiation to
lumpectomy, whole-breast radiation, and tamoxifen(Drug information on tamoxifen); it found that the
addition of tamoxifen further reduced the incidence of invasive in-breast recurrence by 44%. The incidence
of contralateral invasive breast cancer was also reduced by 52%.[6] In the two NSABP studies, negative
surgical margins were not required and some women received a radiation boost to the lumpectomy cavity in
addition to the whole-breast radiation. The two other studies found that radiation reduced recurrence by an
amount similar to that seen in the NSABP studies; however, no benefit was seen with the addition of
tamoxifen, and none of the studies demonstrated a survival benefit from the addition of radiation.[7] In these
original studies, the effects of histologic grade, margin width, and hormone receptor status on risk of
recurrence were not evaluated.
An update of the two NSABP studies was recently published by Wapnir et al. The goal of the update was
to evaluate long-term invasive ipsilateral in-breast recurrence outcomes in the two studies. The update
confirmed previous findings: mortality from DCIS is low regardless of treatment, and recurrence risk is
highest in patients who do not receive radiation therapy or tamoxifen.[6]
Prognostic Factors and Treatment Decisions
Since these studies were first published, a number of investigators have attempted to identify prognostic and
predictive factors that would enable clinicians to provide a more tailored approach to therapy for DCIS, to
insure that women are neither overtreated nor undertreated. The authors highlight appropriate specimen
processing and specimen imaging techniques for ensuring an adequate resection, and they note the
importance of margin status as a strong prognostic factor. In addition to obtaining specimen radiographs,
imaging of the breast after surgical resection but prior to radiotherapy should be done to ensure that no
residual calcifications remain. The effect of margin status on the risk of recurrence in DCIS has been
assessed in a number of retrospective studies.[8] There is a consensus that negative surgical margins (no
tumor at the ink) are associated with a reduced incidence of recurrence, but beyond that, there is little
agreement on what constitutes a negative margin for DCIS and how this information can be used to make
clinical decisions about adjuvant therapy. Among the reasons for this lack of consensus about margin status
in DCIS are the following:
• Margin widths in the operating room can differ significantly from margin widths found in pathology because
of the specimen compression that can occur as a result of specimen mammography after needle localization.
• Specimen processing can vary from institution to institution.
• It is difficult to study margin status prospectively.
The authors also include histologic grade and morphology as important factors that may impact the choice of
surgical therapy and adjuvant therapy. Caution should be exercised in interpreting studies because of the
different DCIS scoring criteria and the morphologic heterogeneity of DCIS lesions, which may not be
apparent on the core biopsy.[9] Particular attention has been focused on identifying clinicopathologic
variables that identify women who may forgo radiation therapy. Having margin widths greater than 1 cm has
been suggested as a potential criterion for omitting radiation.[10,11] Based on the findings from ECOG
5194, women with low-grade DCIS appear to have a lower incidence of recurrence when radiation is
omitted, but long-term follow-up data have not been reported.
Younger women are at increased risk of recurrence; at present, however, age alone should not sway the
choice of surgical therapy towards mastectomy in women motivated to undergo breast conservation.[12] In
addition, a number of tools that incorporate a range of pathologic and clinical factors—such as the Van
Nuys Prognostic Index[10] and the Memorial Sloan-Kettering Cancer Center nomogram[13]—have been
developed, although to date neither of these two tools has been validated in a prospective fashion.
Surgical Management of DCIS
Once the diagnosis of DCIS has been confirmed on core biopsy, the recommendation for surgical
management should be based on the extent of microcalcifications identified on diagnostic mammography.
MRI has been widely used at many centers in recent years to determine extent of disease. At present,
however, its role in management is controversial, and MRI may in fact be detrimental, since it increases the
number of women who undergo mastectomy.[14] Standard treatment for DCIS includes breast-conserving
surgery, often involving wire or radioactive seed localization; whole-breast radiation therapy; and tamoxifen
for localized DCIS. Simple mastectomy and sentinel node biopsy are recommended for extensive or
multicentric DCIS and for women in whom adequate cosmesis cannot be achieved because of breast size.
Women who undergo lumpectomy for pure DCIS do not require sentinel lymph node biopsy (SLNB) as
part of their procedure. If there is a question of microinvasion on core biopsy, an associated mass, or
extensive DCIS requiring mastectomy, then SLNB should be added. Some experts include the presence of
high-grade DCIS as a criterion warranting SLNB, since this is yet another characteristic associated with an
increased likelihood of finding invasive cancer. It should be remembered, however, that SLNB is an
additional surgical procedure with associated risks and morbidity, including seroma, infection, temporary
paresthesias, and lymphedema; thus, it should not be used as a tool for identifying the presence of occult
invasion in women with pure DCIS on core biopsy. SLNB cannot be reliably performed in the absence of
breast parenchyma; therefore, the rationale for performing SLNB in women undergoing mastectomy is to
avoid having to do an axillary dissection, with all of its associated morbidities, in the event that invasive
cancer is identified in the mastectomy specimen.
Current Status of Molecular Markers
Lari et al recently completed an extensive review of molecular markers in DCIS, and they concluded that for
the most part, the data on the prognostic and predictive value of these markers are contradictory.[15] A
greater understanding of the utility of estrogen receptor (ER) and HER2/neu status in DCIS will likely
emerge with the upcoming publication of multicenter randomized trials—NSABP-B35, which randomly
assigned women with DCIS to treatment with either tamoxifen or aromatase inhibitors, and B-43, which is
examining the effect on HER2-positive DCIS of adding trastuzumab(Drug information on trastuzumab)
(Herceptin) to the treatment regimen. Going foreward, more research clearly needs to be focused on
furthering our understanding of the biology of DCIS before we can comfortably stratify DCIS and offer
patients a more individualized approach.
Financial Disclosure: The author has no significant financial interest or other relationship with the
manufacturers of any products or providers of any service mentioned in this article.
August 16, 2011
"Integrative medicine" further evolves into "evidence-based complementary medicine. Nothing changes -
ScienceBlogs (blog) – by Orac -
One of these days I'm going to end up getting myself in trouble.
The reason, as I've only half-joked before, is that, even though I'm not even 50 yet, I'm already feeling like a
dinosaur when it comes to "complementary and alternative medicine" (CAM) or, as it's called more
frequently now, "integrative medicine" (IM). These days, we now have the National Center for
Complementary and Alternative Medicine (NCCAM), the Bravewell Collaborative, and a number of other
forces are conspiring to "integrate" quackery with real medicine. As part of that task, it's been necessary to
rebrand quackery, a process that's been going on for at least 20 years now. I described this evolution of
quackery in what was a bit of a facetious post that strikes me in retrospect as being a bit pretentious when I
reread it. Not that I'm incapable of pretentiousness; it's in my blood, and at times it has to come out.
In any case, near the end of that post, I pointed out that CAM was rebranded because the very name
contained the words "complementary" and "alternative," both of which imply (correctly, as it turns out) that
the quackery falling under the CAM rubric is inferior to science-based medicine, mere icing on the cake.
Where real medicine does the real work of curing the patient, CAM is merely "complementary"; i.e.,
unnecessary but helpful. Of course, CAM is not only unnecessary but most of it is not particularly helpful
(some of it can even be harmful). Calling it "integrative medicine" is a subtle change, but, I think, intentional.
If you "integrate" something, it implies more equality. Indeed, practitioners of IM even come out and say that
they're "integrating" the "best of both worlds." In reality, as I like to emphasize agains and again as something
that can't be repeated too often, IM is "integrating" quackery with medicine. I'll also repeat what I said a
couple of weeks ago after reading the words of a CAMster: CAM is indeed dead, but it is the CAMsters
themselves who killed it. The killing of CAM was deliberate and calculated, with CAM replaced by IM. I
speculated that it wouldn't be long before even the term "integrative medicine" wouldn't be enough.
I was more right than I realized.
So sayeth Barrie Cassileth, PhD, Chief of the Integrative Medicine Service at--depressingly--one of our
greatest cancer centers, Memorial Sloan-Kettering:
During the 1960s and 1970s, the concept of a holistic approach to treating disease that took into account
the body, mind, and spirit grew in patient popularity and morphed into two basic categories: alternative and
complementary, which later became known by its acronym CAM (complementary and alternative
medicine). However, because alternative therapy refers to unproven or disproven treatments that have no
place in legitimate cancer care, integrative medicine experts, including Barrie R. Cassileth, PhD, Chief,
Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center in New York, say the terminology
is misleading and confusing and needs to be abandoned. Even the term "integrative medicine" can be
misleading, said Dr. Cassileth, who instead uses a more accurate term to describe the practice of integrative
oncology: evidence-based complementary medicine.
One wonders, one does, why Dr. Cassileth doesn't eliminate the name "integrative medicine" from her own
service at MSKCC, given that she's the chief of the service, if she really thinks that the term is now
outmoded. Of course, "Evidence-Based Complementary Medicine" Service would be kind of a clunky
name, but I suppose it could be shortened to EBCM, which reminds me of ICBM, which reminds me of
nuclear explosions. Sorry, I just can't help it. I was, after all, raised during the Cold War and still remember
the fallout shelter and air raid drills we had in grade school. Younger farts than this old fart probably won't
make such associations.
It is, of course, also interesting that Dr. Cassileth doesn't choose to use the term "science-based
complementary medicine." I've discussed the difference between science-based medicine and evidence-
based medicine before, and Dr. Cassileth seems to be perpetuating the difference. Remember, evidence-
based medicine downplays prior plausibility based on basic science, relegating basic science considerations
to the lowest rung on the evidence hierarchy, whereas science-based medicine does consider prior
plausibility. I know I use the example of homeopathy often in trying to illustrate this, but it's just so perfect an
example. Homeopathy, as you recall, posits that (1) like cures like (i.e., you use a substance that causes a
symptom in order to eliminate that symptoms) and (2) diluting such a remedy to the point of nonexistence (as
in many orders of magnitude more than Avagadro's number) makes it stronger. It's pure magical thinking,
invoking the ancient principles of sympathetic magic. Even so, because of the limitations in randomized
clinical trials and the fact that, by design, at the very minimum 5% of such trials will be false positives
because of where scientists choose by convention to set their measure of statistical significance, there are a
number of false positive trials of homeopathy. Also, as John Ioannidis has shown us, in actuality it's more
than 5% of clinical trials that produce false positive results. Because evidence-based medicine fetishizes
randomized clinical trials above all else, it just won't allow scientists to reject homeopathy, because there are
always equivocal trials to which woo-meisters can point as "evidence" that there might just be something to
homeopathy. Contrast this to science-based medicine, where, because the principles of homeopathy violate
well-established laws of physics, homeopathy can be relegated to being impossible; that is, until homeopaths
produce evidence for it at least as compelling as all the evidence from physics, chemistry, and biochemistry
that say homeopathy can't work.
Here's a hint: Equivocally "positive" clinical trials are not enough.
I realize that I just digressed into fairly well-trodden territory, but I felt I had to do it, because Dr. Cassileth
said something in this interview that actually partially made sense:
By making the term evidence-based complementary medicine more commonplace, Dr. Cassileth is hoping
to educate both medical professionals and patients about the helpful, appropriate complementary therapies
that are available, and distinguish them from the all-too-available questionable approaches.
"If promoted techniques are found to be worthless or if they are patently absurd, such as homeopathy, they
should be avoided. The medical world is in turmoil around these issues, and the public typically cannot tell
the difference between viable interventions and quackery. I spend half my time studying whether
complementary approaches relieve patients' specific physical and emotional symptoms and the other half
trying to get rid of quackery. It's not an easy task," said Dr. Cassileth.
Did Dr. Cassileth just characterize homeopathy as "patently absurd" and "useless"? Shockingly, she did! It's
rare indeed for an advocate of CAM/IM to characterize any alternative medical system as absurd. True, it's
completely appropriate to characterize homeopathy as absurd. It's even refreshing to hear. There's just one
problem. As you might recall, Dr. Cassileth herself supports alternative medicine modalities every bit as
ridiculous as homeopathy, having done a number of studies of acupuncture, including for hot flashes. When
the study was negative, she tried to spin it as being due to acupuncture that was "not optimal." She's also
proud of a study she's doing on acupuncture right now:
We are also enthusiastic about our acupuncture research program, and we're about to complete a study of
acupuncture treatment for lymphedema. We first conducted a small pilot to make sure that acupuncture was
safe. It was. The study had a stopping rule: achieving at least a 30% reduction in lymphedema in a minimum
of 40% of patients. The study stopped very quickly. Now we are embarked on a larger pilot with a
mechanism component.1 The regimen is two acupuncture treatments a week for 4 weeks and then monthly
follow-up phone calls to make sure that no adverse late events occur. These are important areas of research
for us.
I would argue that Dr. Cassileth is rather selective in what she considers to be "patently absurd" and that the
principles of acupuncture are pretty darned absurd, arguably as absurd as those of homeopathy. Think
about it. What's the idea behind acupuncture? Basically, it's vitalism, in which it is believed that sticking
needles into certain parts of the body somehow "unblocks qi," which is basically "life energy" or "vital force."
This qi flows through pathways known as meridians, which (of course) do not correspond to any known
anatomic structures, no matter how much acupuncturists try to convince us that they do. What is less
"patently absurd" about acupuncture than homeopathy? I'm having a hard time thinking of anything, other
than the fact that acupuncture involves the insertion of actual needles into the skin and can therefore cause
actual complications.
In any case, I went and looked up Dr. Cassileth's study, A safety and efficacy pilot study of acupuncture for
the treatment of chronic lymphoedema. First off, it didn't help that the study was published in Acupuncture in
Medicine. CAM journals tend to be--shall we say?--not particularly rigorous. Dr. Cassileth's paper fits right
in. Basically, it's an uncontrolled study of acupuncture in women with lymphedema due to breast cancer
surgery. Practitioners of traditional Chinese medicine on staff at MSKCC treated nine women with
lymphedema, and these were the results:
Study goals were met after nine subjects were treated: four women showed at least a 30% reduction in the
extent of lymphoedema at 4 weeks when compared with their respective baseline values. No serious
adverse events occurred during or after 73 treatment sessions.
Now hold on there, pardner.
I realize that this study was designed only to assess safety, but without a control group the 40% of women
showing at least 30% decrease in lymphedema is a meaningless number. For one thing, four weeks is far too
short a time period. Lymphedema can wax and wane over time; that several women at four weeks doesn't
mean much at all; doing nothing could well have yielded a similar result. There's no way to know. Similarly,
because lymphedema can wax and wane, single measurements are not particularly informative. Repeated
measurements over time are needed. Finally, the most accurate way to measure lymphedema is not arm
circumference, but rather water displacement. (The patient sticks her arm in a long bucket of water, and the
amount of water displaced is measured.)
More importantly, when I looked at Table 2, which showed the characteristics of the women who had a
"response" to acupuncture, I noticed something right away. The baseline difference in centimeters between
the unaffected arm and the lymphedematous arm was much smaller in the responders (2.2 cm) than in the
non-responders (6.4 cm). In other words, the women who "responded" to acupuncture had mild
lymphedema, which is the sort of lymphedema that's more likely to wax and wane. Basically, as far as telling
us anything other than that they didn't have any complications in nine patients; the study tells us little or
nothing about acupuncture for lymphedema. Based on physiology and science alone, however, it's incredibly
implausible that acupuncture would do anything for lymphedema anyway.
Basically, Dr. Cassileth is trying to have it both ways. First, she's trying to paint herself as a proponent of
science, an enemy of quackery, even, describing a recent IM conference:
At the other end of the spectrum, in Europe and in other parts of the world, purveyors of bogus "treatments"
have taken over the term "integrative medicine." In Europe especially, integrative medicine and integrative
oncology have become synonymous with quackery.
An important issue that emerged at this conference was the extent to which quackery is a huge problem
throughout Europe and in other parts of the world. In the United States, where quackery has been
prominent for many decades, it is a $40 billion-a-year business.
All of which makes me wonder how Dr. Cassileth defines "quackery," when she believes that acupuncture
works. She does realize, however, the power of language, as she laments the association of "integrative
medicine" with quackery:
It also makes it very difficult for health-care professionals because they're not always sure what the terms
integrative medicine and integrative oncology imply. Words have meaning, and they can have a detrimental
as well as clarifying impact. We fought very hard to get away from the term "alternative therapy" because
there are no viable alternatives to mainstream cancer care. We have to clarify the terminology, and I am now
referring to complementary therapies as "evidence-based complementary medicine."
Dr. Cassileth's right. Words have meaning, and language has power. That's the very reason that "quackery"
morphed into "alternative medicine," "alternative medicine" morphed into "complementary and alternative
medicine," and "complementary and alternative medicine" morphed into "integrative medicine." It's the same
reason that "integrative medicine" is now morphing into the clunkier, less sexy, "evidence-based
complementary medicine." The problem is that evidence is as evidence does, and the evidence being used to
support quackery like acupuncture is no better than the evidence homeopaths use to try to support their
woo. I'm glad to hear that Dr. Cassileth is worried about quackery; I'm not so glad to see that the main
reason she's worried about it is because she wants to protect the quackery she believes in from being tainted
with all the other quackery. I would suggest that Dr. Cassileth needs to reassess exactly what it is that she
means by "evidence-based complementary medicine" and consider adding some actual basic science
considerations to the mix. I realize that she's trying to be one of the good guys, but she's become part of the
problem.
se Training & Consulting to Provide Breast Cancer Rehabilitation Training September 10 – 11 in Pittsburgh,
Pennsylvania - SBWire (press release) –
Lafayette, CO -- (SBWIRE) -- 08/16/2011 -- Klose Training & Consulting, a lymphedema certification
and education company, will provide professional training for Breast Cancer Rehabilitation at LifeCare
Hospital (formerly HealthSouth) in Monroeville, Pennsylvania, September 10-11, 2011. The educational
program is designed to provide essential knowledge of outpatient therapeutic approaches in breast cancer
care.
Klose Training’s breast cancer rehabilitation course totals 16 hours of instruction. Course curriculum
includes a comprehensive review of current diagnostic, surgical, radiation, reconstructive and medical
oncologic management for breast cancer.
The course instructor is Jodi Winicour, PT, CMT, CLT-LANA, MLD/CDT Instructor. Jodi is a 1993
graduate from Indiana University’s Physical Therapy program and obtained her massage therapy
certification in 1997 from Michigan’s Health Enrichment Center. Since 2000, Jodi has served as a class
instructor for Klose Training & Consulting’s Lymphedema Therapy Certification course. She is the author
and instructor for one of Klose Training’s most successful continuing education courses, “Breast Cancer
Rehabilitation.”
About Klose Training
Klose Training & Consulting provides Lymphedema Therapy Certification Courses internationally and
throughout the U.S. They are dedicated to providing individual attention to each participant during the initial
training, and offer ongoing support and education throughout the careers of their graduates. For more
information about Lymphedema Certification Courses, please visit http://www.klosetraining.com
New business aids in fight against breast cancer - Berkshire Eagle – New business aids in fight against
breast cancer
Berkshire Eagle - By Amanda Korman –
PITTSFIELD -- After several years in Philadelphia, a family-owned business selling fashionable medical
devices for breast cancer survivors is moving to the downtown Pittsfield space previously occupied by the
now-defunct Berkshire Living magazine.
Planning to open at 7 North St. on Sept. 6, LympheDIVAs sells lightweight, stylish compression sleeves and
gloves that address lymphedema, an arm-swelling condition associated with breast cancer treatment.
The company, founded by Rachel Levin Troxell in 2006, continued on under the leadership of her parents,
Dr. Howard and Judy Levin, after Troxell died from breast cancer in 2008 at age 37. Troxell's brother, 35-
year-old Josh Levin, is now president and precipitated the company's move to Pittsfield to make good on a
long-held desire to live in the Berkshires.
"I thought it would be a great place to live and to work," said Levin, who is bringing two employees from
Philadelphia and hiring two more in the Berkshires.
Manufactured in North Carolina, the compression sleeves and gloves will be dyed and packaged at the
Pittsfield location. The company sells online and to distributors.
Troxell began LympheDIVAs with two business partners after she had a number of lymph nodes removed
during breast cancer treatment and contracted lymphedema. The only option on the market at the time was a
thick, hot, ACE-bandage-like sleeve, but Troxell wanted something more comfortable and fashionable.
Five years later, the company sells about 18,000 thin, sweat-resistant, colorful pieces annually. Pairs of
sleeves and fingerless gloves sell for between $100 and $145. LympheDIVAs operates with a budget
between $500,000 and $1 million each year, Howard Levin said, and began turning a profit last year. Levin
estimated that LympheDIVAs makes up about 0.1 percent of the compression sleeve market, but he and his
family hope to see that amount increase to about 10 percent in the future.
At bottom, the family says their business is about giving breast cancer survivors options.
"At its core this is a mission-driven business," said Howard Levin.
For women who want to minimize the sleeve's visibility, there are 30 different skin tones. For those who'd
prefer to show off a style item, there are patterns from leopard skin to paisley to tattoo.
As in any fashion business, the company's seven employees confer twice a year about their spring/summer,
fall/winter and sports lines.
"[Rachel] wanted them to have something that was fun -- it's not lemonade out of lemons, but it's sort of like
that," said Judy Levin. "It just makes them feel good, and that was very important to Rachel."
In black and hot pink, the packaging, too, says "boutique" rather than "drug store," another element that
Levin said was significant to her late daughter.
"This is Rachel's legacy, and we made a promise that we would try to make it a success," Judy Levin said.
"Basically, this is what she wanted, and we feel she is living on in this."
For more information on LympheDIVAs: www.lymphedivas.com, 1-866-411-3482.
August 18, 2011
Health dept to check filaria cases - Times of India –
ALLAHABAD: Besides creating awareness on malaria, the health department has deputed teams to
prepare the blood slides of patients having symptoms of filarial. The teams, equipped with filarial detecting
kits, will meet the people between 10pm and 12 midnight. They will be led by the district malaria officer
(DMO). This would be done because many patients have complained that they have fever only during night.
The teams would comprise doctors and basic health workers including ASHAs and ANMS.
Filaria or filariasis is an infectious disease caused by threadlike worms called roundworms. Swelling of arms,
breasts and legs are its major symptoms. This swelling is called lymphedema because of the name lymphatic
filariasis. Filaria also causes damage to the lymph system which leads to fluid collection. The swelling also
increases the risk of bacterial infection.
Deputy chief medical officer Dr Kalim Akmal told TOI: "As the threat filarial infection also looms large,
health department has instructed the medical officers and para-medical staff to take care of patients having
symptoms of filarial." He added: "We have advised medical teams to make blood slides of patients suffering
from fever to ascertain whether they are filaria positive or not."
Free cancer information service helpful to 830 in Ontario Northeast region - Sault This Week – By Ontario
Press Service press release –
Fear, anxiety, helplessness, anger – these are some of the often overwhelming feelings that people can
encounter when dealing with cancer. When faced with a cancer diagnosis, knowledge is power. In early
August, the Canadian Cancer Society celebrated helping one million Canadians answer their cancer-related
questions. Since 1996, this free service has provided information on all types of cancer, diagnostic tests,
treatments, side effects, and clinical trials. In 2010, the service responded to more than 23,000 inquiries in
Ontario and of this number 831 inquiries were from Ontario Northeast region, which includes Sault Ste.
Marie, Sudbury, North Bay and Timmins.
Kim McColl of Napanee, Ont. contacted the service numerous times since receiving a breast cancer
diagnosis back in 2007. "The Cancer Information Service is one of the many reasons I think I'm still here,"
said McColl. "Their information is accurate and compassionate. They go out of their way to send you more
information. Nothing is ever too much trouble."
Now four years later, the retired music teacher is living cancer-free but side effects of the breast cancer
surgery she endured remain. Even now, McColl doesn't hesitate to call the Cancer Information Service
when she has any questions. In June of this year, she contacted the service about lymphedema, a common
condition that affects many breast cancer patients and survivors.
"People often feel overwhelmed when dealing with a cancer diagnosis and treatment," says Janet MacVinnie
who manages the Cancer Information Service in Ontario. "Our Cancer Information Service has been proven
to reduce stress and anxiety for patients because the service helps them get a better understanding of their
type of cancer, treatment options and find services in their community."
If you know someone who is facing cancer, either as a patient or caregiver, the Cancer Information Service
can be reached at 1 888 939-3333 (TTY 1 866 786-3934) or cis@ontario.cancer.ca. Assistance is
available in more than 100 languages through a professional interpreter service
August 16, 2011
Lymphedema Depot Presents Re-Designed Solaris ReadyWrap - Wire Service Canada (press release) –
Solaris Inc has redesigned the ReadyWrap line of compression binders to create a versatile full-leg, low
profile, low stretch compression garment. ReadyWrap medical binders are the perfect alternative to elastic
compression hosiery. With standard-sized foot, calf, knee, and thigh units, you can get an off-the-shelf full-
leg solution that offers a custom fit.
The low-stretch materials ReadyWrap is made from work with the venous and lymphatic systems to
naturally improve fluid movement, enhancing the calf's natural muscle pump and producing low resting and
high working pressures. ReadyWrap's easy Velcro™ closure system also allows for easy donning and
removing. This is especially helpful for individuals who have difficulty putting on elastic compression
garments.
Where previously only the foot and calf pieces were available in standard sizes, the knee and thigh pieces
have now been added to the standard-sized line.
Design improvements have been made in each of the separate ReadyWrap units. The foot piece is now left-
right specific and offers increased compression around the ankle. This is a simple, easy to don foot
compression device that does not involve any wrapping or troublesome extra pieces to manage. It is thin
enough to often be worn inside regular street shoes.
The straps on the calf and thigh units have been re-designed to offer smooth gradation of pressure and an
ability to accommodate irregularly shaped limbs, all without gapping of the individual straps.
The knee piece goes on last for easy adjustment as needed. The whole leg system can be used in cases of
primary or secondary lymphedema, chronic venous insufficiency, lipedema and related disorders. The full leg
system is optional; if the patient only needs compression in the lower leg then individual pieces can be utilized
to create the compression device that is needed.
Lymphedema Depot distributes ReadyWrap in Canada, in addition to the Solaris Tribute, Caresia and Swell
Spots. Learn more about ReadyWrap and all the Solaris products at http://LymphedemaDepot.com.
Lymphedema Depot can be reached at info@lymphedemaDepot.com.
August 18, 2011
Industry Leaders Hinson and Friel Join Wright Therapy Products - PR Newswire (press release) –
PITTSBURGH, Aug. 18, 2011 /PRNewswire/ -- Wright Therapy Products, Inc. announced today that
Michael Hinson has been appointed President and Chief Executive Officer of the company. The company,
based in Oakdale, PA, manufactures and sells pneumatic compression devices targeted for the treatment of
lymphedema, venous insufficiency and the sports medicine markets. Hinson joins Wright Therapy after
holding senior financial and sales leadership positions at MEDRAD, Inc, a global leader of diagnostic and
therapeutic devices.
"I'm very excited to join a company like Wright Therapy," said Hinson. "The company is well-positioned to
serve our growing senior population, the group primarily afflicted with these terrible diseases. I know I
speak for everyone at Wright when I say we're proud to provide solutions that help these patients live
normal lives." Hinson will also serve on the company's Board of Directors.
Wright Therapy additionally announced that John Friel, former President & CEO of MEDRAD, Inc. has
joined the company's Board of Directors. Friel orchestrated MEDRAD's global strategies for two decades.
During his tenure, Friel sparked the innovation and commitment to excellence that drove significant growth at
MEDRAD and solidified the company as a global leader. "I am very honored to join Wright Therapy's
Board of Directors and am excited about the potential manufacturing job growth the company brings to the
Western PA region," he said. "Given that I have lymphedema myself, I value the positive impact Wright's
innovative technology and products have on patients like me."
Jim Liken, chairman of Wright's Board of Directors commented, "We're extremely pleased to add Mike and
John to our leadership team. Their backgrounds working with a high-growth medical device company will
be very useful as we complete our current investor funding activities and look to fuel our growth in the U.S.
market."
About Wright Therapy Products
Wright Therapy Products is a leading provider of Compression Therapy Systems. In 2011, we will
celebrate 28 years of excellence, innovation, and quality. Our expertise in compression technologies is
helping medical professionals provide solutions so their patients can live life to the fullest. Improving quality
of life for patients is the core of our commitment. Our vision of the future commits resources and expertise to
the development of new cost effective treatments that provide solutions to real pressing healthcare needs.
www.wrighttherapy.com
SOURCE Wright Therapy Products, Inc.
August 23, 2011
King City district sued over discrimination - Monterey County Herald – By CLAUDIA MELÉNDEZ
SALINAS
Former teacher says disability was ignored
Former King City photography teacher Kathryn Beilby was diagnosed with chronic lymphedema and
osteoarthritis in 2002, which made her limbs swell up and walking painful.
Nonetheless, she continued working until 2006, when she asked the King City Union School District to give
her accommodations under the American with Disabilities Act: Namely, she wanted to park closer to her
classroom and she wanted the classroom to be closer to an accessible restroom.
Instead the district gave her a golf cart, which allowed her to move about, even ride to the restroom.
A year after State Administrator John Bernard took over the district, the golf cart was gone.
"The first day he saw me going toward the bathroom in it, I saw that look on his face that said 'This isn't
gonna be going on,'" Beilby said. "It went downhill from there. He decided last August when I came back to
school he did not think I was disabled at all."
Beilby is now suing Bernard and the district for employment discrimination, failure to prevent discrimination
and harassment, failure to accommodate her disability, retaliation and infliction of emotional distress. Beilby
is seeking damages, restoration of all her employment benefits, loss of future earnings and other unspecified
damages.
Beilby declined to say how much she's seeking. A call to her attorney was not returned.
It is the second lawsuit that has been filed against Bernard in recent weeks. Last month, the King City
Teachers Association sued Bernard for eliminating the district's long-held practice of allowing teachers to
give a better grade to those students who did well on state standardized tests.
Bernard is under fire for several practices he's implemented since taking over the district in 2009, when the
district was bankrupt and received an emergency loan from the state. In previous interviews and at an
Assembly hearing on school takeovers last week, Bernard said that change brings discomfort, and that the
district was in need of many changes.
On Monday, Bernard declined to comment for this story.
"I'm not able to respond to the lawsuit since it's a personnel matter," he said. "We'll resolve this using the
legal process."
A photography teacher since 1982, Beilby was reassigned to teach art for the 2010-11 school year as part
of Bernard's district re-organization. She was given a bigger classroom — which meant more walking. By
October, she had to take a week off due to increased pain in her knees, she said.
"I was supposed to have knee surgery in December, it got postponed to March, so I had one knee done in
March and one in May," Beilby said. "I missed going to family functions, birthdays, just because (Bernard)
decided I didn't need a golf cart."
Beilby also asked for an accessible bathroom, so a "Port-O-Potty" was parked outside her classroom — a
humiliating experience, Beilby said.
"Defendant's installing of the 'Port-O-Potty' was demeaning to plaintiff, unsafe and inappropriate for
plaintiff's use, and unacceptable in the presence of high school-aged students and others on campus," the
lawsuit reads.
Attorneys for Bernard and the district have filed an answer to Beilby's complaint denying all the charges, and
indicating they intend to mount an affirmative defense, which means they'll argue the district was excused or
justified in its behavior.
For instance, the answer alleges Beilby was careless and negligent, that she has not exhausted all
appropriate administrative remedies, and that, if there was any injury or damage, they were caused by third
unknown parties.
Claudia Meléndez Salinas can be reached at 753-6755 or cmelendez@montereyherald.com.
August 24, 2011
Seven years of swollen limbs – Trentonian - By Emily Mountney
John Glover really misses square dancing.
He also misses driving, among other things.
The 55-year-old Trenton resident has suffered with a disease called bilateral lymphedema for seven years.
"It all started with a fall down some concrete stairs," said Glover.
In June of 2004, while carrying the lumber needed to build shelves into a friend's apartment, he slipped on
some concrete steps and fell. Within 45 minutes, his feet, ankles and legs had swollen.
The swelling has never gone away — in fact, the circumference of his feet at one point reached 37 inches.
Jogging pants and pyjama pants are his only pant choices — nothing else can fit around his legs. The only
shoes he can wear are a pair of knitted slippers, made by his cousin. His friend, Donna Pearce, took the
slippers to a shoe repair business and got them to attach a rubber sole onto the shoe. She then crafted an
insole for the slipper, to make it more like a shoe.
Pearce is a retired multi-skilled hospital worker.
She helps Glover on a daily basis, preparing food, his pills, washing the dishes, doing the cleaning, shopping
for him and even helping him in the bathroom.
"I'm like his Jack of all trades," she said.
Glover also suffers from arthritis in his knees, which often "give out" due to the arthritis combined with the
weight of his legs.
He also suffers from epilepsy and Dupuytren's contracture. He said he has seen more doctors in the past
seven years than in his entire life.
Currently there is no known cure for bilateral lymphedema.
Glover has been told by specialists his swelling is caused by the albumin in his blood.
Everyone has albumin in their blood, but his is at a low level.
"It is a protein used to pull fluids from the body for discharge at a later time. My albumin seeps through the
vein walls and into the flesh," he said.
There could be a solution to his plight, Glover said, but he has been unable to access it.
Glover said that a machine called a Lympha Press is often used to help lymphedema sufferers control the
swelling in their limbs.
Through a series of pneumatic sleeves, it pushes the albumin back into the veins so it can be discharged from
the body.
The machine costs upward of $8,000 and can only be purchased by a doctor from stores in Oshawa or
Kingston.
"The one thing I really need, I can't get it," said Glover. "I'm willing to use it every day."
"My understanding is that there is also a man in the surrounding area that has a need for the use of this same
machine," Glover said. "He may be able to use it after I have no need for it."
Glover said the machine is used daily and could take up to two years for full results.
"At least my legs would go back to their normal size," he said.
Glover hopes to acquire the machine, although he said he doesn't know how to go about it.
He has tried contacting local agencies for help, but said he has been unsuccessful so far.
He said he has had no response from MP Rick Norlock's office. The office of MPP Lou Rinaldi told him
they had forwarded Glover's information to the Minister of Health.
While there are other alternatives for treatment, finances and transportation keep Glover from accessing
them.
A Kingston clinic offers therapy for lymphedema, but transportation is $70 per day — $1,400 per month —
which Glover can't afford.
Recently, Glover and Pearce took a trip to the YMCA for him to try out the treadmills.
After walking just a few minutes, Pearce said she noticed a slight decrease in the size of his legs.
"I would pay for the membership, but I have no way to get there," said Glover, adding he can't drive himself,
and cabs would become too costly.
"He can't stand outside and wait for the bus by himself," said Pearce. "His knees could give out and he could
fall and there would be no one there to help him."
Physiotherapy Associates Opens New Physical Therapy Clinic in Golden, CO - PR Newswire (press
release) –
Clinic offers a comprehensive range of physical therapy services
RED ROCKS, Colo., Aug. 24, 2011 /PRNewswire/ -- Physiotherapy Associates, the nation's foremost
provider of outpatient rehabilitation services, recently opened a new physical therapy clinic in Golden, CO.
The clinic offers a comprehensive range of services, including: orthopedic physical therapy, sports
medicine/injury rehabilitation, vestibular rehabilitation, oncology rehabilitation, lymphedema management,
Healthy Partner Programs, geriatric programs, injury prevention and women's health.
Clinic director Marcey Gibson, MPT, CLT, is a graduate of the University of Colorado. She has been
practicing for over seven years in Evergreen and along the Front Range. She is an oncology specialist
certified in the Vodder technique for lymphedema management. Ms. Gibson has extensive experience
managing balance and gait impairments, as well as neurological impairments.
Ms. Gibson stated, "I look forward to providing the highest level of clinical expertise and personalized care
in the Red Rocks area. The ultimate goal for all my patients is to achieve the highest level of functional
independence with their daily and recreational activities using an evidence-based approach."
Steve DiPaola, PT, OCS, Area Vice President, stated, "We are thrilled to open this new physical therapy
clinic in the Golden community inside the Red Rocks Medical Center. The state-of-the-art cancer care
center offers medical oncology, radiation oncology, a breast care clinic of excellence and a cancer care
advisory facility. We are proud to be a part of this premier health center that offers a holistic and
individualized approach to patient care."
Pete Grabaskas, PT, COO of Physiotherapy Associates, stated, "We continue to open clinics like this Red
Rocks facility to reach patients that want to lead healthy lives. This clinic will offer the residents of Golden a
broad range of outstanding physical therapy services."
The clinic offers three compelling reasons to visit: one-on-one care; treatment programs that are overseen by
licensed physical therapists; and successful patient outcomes.
The new clinic is located at 400 Indiana Street, Suite 280 in Golden, CO. There is ample parking with easy
access to the therapy center.
For more information or to schedule a consultation at the clinic, call 720.398.0999 for appointments. The
clinic can be found online at: www.physiocorp.com/facility/60633.
About Physiotherapy Associates
Physiotherapy Associates is the nation's foremost provider of outpatient rehabilitation services.
Physiotherapy Associates employs an industry-leading team of physical therapists and healthcare
practitioners who are dedicated to high-quality patient care. The company provides physical therapy,
industrial rehabilitation and orthotics and prosthetics services to thousands of patients across the United
States. With more than 650 clinics, Physiotherapy Associates is national in scope, local in care. For more
information, visit www.physiocorp.com, follow us on Twitter (@physiocorp) or become a Physio fan on
Facebook.
SOURCE Physiotherapy Associates
August 26, 2011
September events at Gilda's Club Delaware Valley - phillyBurbs.com -
Gilda's Club Delaware Valley is a warm and welcoming place dedicated to building social and emotional
support for men, women and children living with cancer or who have a loved one with cancer. The club also
offers bereavement counseling after the loss of a loved one to cancer. All workshops, sessions and services
are free.
Gilda's Club Delaware Valley is located in Warminster at 200 Kirk Road. Please call 215-441-3290 (www.
gildasclubdelval.org) to become a member or to register for a program or activity.
Here's a list of events happening at the club in September:
"Dinner and Lecture: Talking about Lymphedema with Gina," Sept. 28, 6:30-8 p.m. -- Lymphedema is a
very real concern for many people and in many ways it can be prevented! Gina Smith is a Physical Therapist
for Cancer Treatment Centers of America and is certified as a Lymphedema Therapist.
August 28, 2011
Boat race on lake benefits paddlers, 2 charities - BlueRidgeNow.com - By Jessica Goodman
LAKE LURE
There was the steady pounding of the drum on Lake Lure as 10 paddlers, with direction from a steersman
and a drummer, paddled their way to victory Saturday during the Lure of the Dragons boat race.
“This venue is growing,” said organizer Tom McKay with Pinnacle Sotheby's International Realty. Ten
teams from across the state, from Raleigh to Charlotte, competed in the games.
The boat race supported two charities, according to Carole McKay, including Camp Lure Crest for
Christian youth and the Hickory Nut Gorge Outreach, which provides food and money in Rutherford
County.
“We started this (boat race) four years ago,” Tom McKay said.
A few of the teams featured cancer survivors, including the Healing Dragons of Charlotte. The team was
started in 2009 and has traveled from Washington, D.C., to Florida to compete in dragon boat races.
Jan Kuhn, a member of the team and breast cancer survivor, said the exercise she gets paddling helps her
condition. She has lymphedema in her arm after having cancer and losing her lymph nodes. The exercise
with the dragon boats forces the fluid out of her arm and reduces the swelling associated with lymphedema,
she said.
“It's better than it ever was,” Kuhn said.
“It's really cool to be part of a team at this part of my life,” fellow member Sherry Latten said.
“It's so much fun. It's a great challenge. It's a full-body exercise,” Kuhn added.
The race was part of the seventh annual Hickory Nut Gorge Olympiad, a three-day, family sports festival.
The festival will conclude today with the Race to the Rock starting at 7 a.m. with a 25-mile bike race and
5K, and a medal ceremony for all events at 10 a.m. at Chimney Rock Park.
For more information about the Olympiad, visit www.hickorynutolympiad.com or call 828-429-9011.
August 29, 2011
Tina, needed to join something to read this and I don’t want to join things now, sorry:
Lymph Drainage Massage May Help Edema in Systemic Sclerosis – Medscape –
This is the first study to assess manual lymph drainage in patients with SSc, although the technique has been
used to relieve lymphedema in women who had ...
Lymphedema Support Group Meeting - Ventura County Star –
Your lymphatic system is crucial to keeping your body healthy. But when lymph vessels are unable to
adequately drain lymph fluid, usually from an arm or leg, Lymphedema, a swelling, occurs.
Lymphedema is caused by a blockage in your lymphatic system, an important part of your immune and
circulatory systems. The blockage prevents lymph fluid from draining well, and as the fluid builds up, the
swelling continues.
While there's no cure for Lymphedema, it can be controlled through diligent care of your affected limb. And
having a support system comprised of healthcare professionals and others with Lymphedema has proven to
be an excellent way to share information on its challenges and to receive information on the latest ways to
live a quality life with Lymphedema.
A Lymphedema Support Group, facilitated by Catherine Hines, P.T., C.L.T., a certified Lymphedema
therapist and physical therapist on staff at Los Robles Hospital, meets the last Wednesday of every month
from 7:00 p.m. to 8:30 p.m. at The Lymphedema Treatment Center at the East Campus of Los Robles
Hospital. in the small conference room near the cafeteria, 150 Via Merida, Westlake Village, CA 91362.
Lymphedema patients, their loved ones and caretakers are invited to attend. To make a reservation or for
further information, please call 805-370-4001
August 31, 2011
Berks business log - PennLive.com –
Reading Eagle
St. Joseph Medical Center's Wound Care program added a second outpatient location with a new facility at
Keiser and Broadcasting roads in Spring Township.
It is in the building owned by Berks Family Practice, which relocated there after its building in Kenhorst was
destroyed by a fire in 2010.
Other services at the Spring Township facility include laboratory, physical therapy and lymphedema
management.
The hospital will continue to operate the wound care and hyperbaric medicine program at Sixth and Walnut
streets.
The new location will provide care to patients with hard-to-heal and chronic wounds, including venous
ulcers, diabetic ulcers and pressure sores.
???
Peter Olfs, former head of corporate communications at International Siemens AG, Munich, Germany, will
present "Is There a Way Out for Old Industrialized Nations? Chances To Catch up with Global Realities"
Sept. 9 from 1 to 2:15 p.m. in Luerssen Building 5 at Penn State Berks.
The lecture is part of the fall engineering, business and computing division research interest group series and
is free and open to the public.
Olfs theorizes that as a society, we live above our means, the poor keep getting poorer, our values are
vanishing and as the blood toll rises, our species is dying out.
His presentation focuses on tasks for developed and developing nations, the future role of universities and
practical solutions to combat the issues facing our world.
For more information, contact Dr. Jui-Chi Huang, chairman of the EBC-RIG and assistant professor of
economics, at JXH74@psu.edu.
???
Women2Women and Count Me In will hold its first pitch party Sept. 7 from 6 to 8 p.m. at the Greater
Reading Chamber of Commerce & Industry's Center for Business Excellence, 49 Commerce Drive,
Spring Township.
The purpose is to help women business owners and entrepreneurs practice their business pitches and
receive professional feedback.
Those interested also can use the party to prepare for M3 1000, the Make Mine a Million $ Business
contest, on Sept. 25 and 26 in Philadelphia.
???
The TriCounty Area Chamber of Commerce has Chamber member job openings listed on its website.
Job seekers can visit www.tricountyareachamber.com and find job openings from Chamber member
businesses and organizations.
The new feature is the result of a survey to the membership which indicated a need for the service. Chamber
members can email their job opening information to jeff@tricountyareachamber.com.
Job seekers are welcome to drop resumes off at the Chamber office or send them via email.
For more information, visit www.tricountyareachamber.com or call 610-326-2900.
???
Lehigh Valley Restaurant Group Inc., a franchisee of Red Robin Gourmet Burgers, Inc., is looking for more
than 150 workers to fill slots at the new Red Robin in Tilden Ridge, 125 Wilderness Trail, Tilden Township.
The restaurant is opening in early October. Michael Coleman is the general manager.
For more information, visit the hiring trailer on site to apply in person at 125 Wilderness Trail, off Cabela
Drive.
August 24, 2011
Physiotherapy Associates Opens New Physical Therapy Clinic in Golden, CO - PR Newswire via Yahoo!
Finance
Clinic offers a comprehensive range of physical therapy services
RED ROCKS, Colo., Aug. 24, 2011 /PRNewswire/ -- Physiotherapy Associates, the nation's foremost
provider of outpatient rehabilitation services, recently opened a new physical therapy clinic in Golden, CO.
The clinic offers a comprehensive range of services, including: orthopedic physical therapy, sports
medicine/injury rehabilitation, vestibular rehabilitation, oncology rehabilitation, lymphedema management,
Healthy Partner Programs, geriatric programs, injury prevention and women's health.
Clinic director Marcey Gibson, MPT, CLT, is a graduate of the University of Colorado. She has been
practicing for over seven years in Evergreen and along the Front Range. She is an oncology specialist
certified in the Vodder technique for lymphedema management. Ms. Gibson has extensive experience
managing balance and gait impairments, as well as neurological impairments.
Ms. Gibson stated, "I look forward to providing the highest level of clinical expertise and personalized care
in the Red Rocks area. The ultimate goal for all my patients is to achieve the highest level of functional
independence with their daily and recreational activities using an evidence-based approach."
Steve DiPaola, PT, OCS, Area Vice President, stated, "We are thrilled to open this new physical therapy
clinic in the Golden community inside the Red Rocks Medical Center. The state-of-the-art cancer care
center offers medical oncology, radiation oncology, a breast care clinic of excellence and a cancer care
advisory facility. We are proud to be a part of this premier health center that offers a holistic and
individualized approach to patient care."
Pete Grabaskas, PT, COO of Physiotherapy Associates, stated, "We continue to open clinics like this Red
Rocks facility to reach patients that want to lead healthy lives. This clinic will offer the residents of Golden a
broad range of outstanding physical therapy services."
The clinic offers three compelling reasons to visit: one-on-one care; treatment programs that are overseen by
licensed physical therapists; and successful patient outcomes.
The new clinic is located at 400 Indiana Street, Suite 280 in Golden, CO. There is ample parking with easy
access to the therapy center.
For more information or to schedule a consultation at the clinic, call 720.398.0999 for appointments. The
clinic can be found online at: www.physiocorp.com/facility/60633.
About Physiotherapy Associates
Physiotherapy Associates is the nation's foremost provider of outpatient rehabilitation services.
Physiotherapy Associates employs an industry-leading team of physical therapists and healthcare
practitioners who are dedicated to high-quality patient care. The company provides physical therapy,
industrial rehabilitation and orthotics and prosthetics services to thousands of patients across the United
States. With more than 650 clinics, Physiotherapy Associates is national in scope, local in care. For more
information, visit www.physiocorp.com, follow us on Twitter (@physiocorp) or become a Physio fan on
Facebook.
September 5, 2011
Gene mutation shown to cause leukemia and lymphedema - Science Daily –
Researchers have discovered a gene that when mutated can cause lymphedema (swollen limbs due to a
failure of the lymph system), immune abnormalities, deafness and leukemia. The identification of the gene
responsible for causing this rare combination of medical conditions, known as Emberger syndrome, could
allow earlier identification and treatment of those at risk.
This study, which is published online in the journal Nature Genetics on Sept. 4, showed that it is caused by a
mutation in the GATA2 gene.
Mutations in this gene have very recently been associated with the development of leukemia and
immunodeficiency but had not previously been linked to lymphedema.
The study was led by a team at St George's, University of London and St George's Hospital. The
researchers recruited eight patients with Emberger syndrome, two of whom had a family history of the
condition. In collaboration with colleagues at Kings College London, they carried out Next Generation
Sequencing (a new technique which can rapidly sequence all the genes in the human genome) on these
patients to identify any genetic patterns that could provide clues about the disease. All eight patients had a
mutation in the GATA2 gene.
Consultant geneticist, Dr Sahar Mansour, who led the study with Professors Steve Jeffery and Peter
Mortimer, said: "Emberger syndrome affects only a handful of people in the UK. However, little is known
about the development of both the lymphatic system or leukemia This gene obviously has a crucial role in
both and is an important piece of the jigsaw puzzle. It may lead to a better understanding of why these
problems develop and eventually target treatment for both."
The identification of a mutation in GATA2 adds to the increasing number of genes responsible for causing
Primary Lymphedema. It is the fourth gene to be associated with the condition to be identified at St
George's, which runs the UK's only specialist clinic for primary lymphedema.
Professor Mortimer who runs this specialist clinic said: "The genetic causes of lymphedema are important
developments in the understanding of both cause and mechanism for lymphatic disorders which are a
neglected area of clinical practice. Gene testing is already changing the means by which lymphedema is
categorised and diagnosed. In the future it will lead to treatment through drugs acting on molecular targets."
Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by
University of St George's London.
Journal Reference:
1. Pia Ostergaard, Michael A Simpson, Fiona C Connell, Colin G Steward, Glen Brice, Wesley J
Woollard, Dimitra Dafou, Tatjana Kilo, Sarah Smithson, Peter Lunt, Victoria A Murday, Shirley Hodgson,
Russell Keenan, Daniela T Pilz, Ines Martinez-Corral, Taija Makinen, Peter S Mortimer, Steve Jeffery,
Richard C Trembath, Sahar Mansour. Mutations in GATA2 cause primary lymphedema associated with a
predisposition to acute myeloid leukemia (Emberger syndrome). Nature Genetics, 2011; DOI: 10.1038/ng.
923
Rethinking Breast Cancer Approach - BS42 =
BIRMINGHAM, Ala. (Ivanhoe Newswire) -- A new study shows removing lymph nodes because of the
presence of microscopic cancer cells found in the sentinel node has no impact on survival among women
with early-stage breast cancer.
Researchers studied more than 5,000 women with breast cancer at 126 sites around the country. All the
participants underwent breast-conserving surgery and sentinel lymph node dissection. The sentinel lymph
node is the one that is closest to the tumor.
Results showed survival outcomes were no different between women who underwent total lymph node
removal and those who only had the sentinel lymph node removed.
“This study shows that the presence of tiny sentinel lymph node metastases has no bearing on survival
outcomes,” Armando E. Giuliano, M.D., of Cedars-Sinai Medical Center, was quoted as saying.
Researchers say this finding could spare women the pain and side effects of comprehensive lymph node
removal. Removing lymph nodes can cause complications such as lymphedema, which is a chronic and often
painful swelling in the arm that can be debilitating.
“Treating the patient doesn’t end with stopping the cancer,” Dr. Giuliano said. “We want to make sure we
maximize the patient’s quality of life even after cancer treatment is completed."
SOURCE: Journal of the American Medical Association, August 2011
August 9, 2011
The Benefits of Exercise After Cancer - New York Times – By ANAHAD O'CONNOR -
The report, called Move More, reviewed the findings of 60 studies on the effects of exercise on cancer and
reached some conclusions that may seem contrary to the conventional wisdom that prevailed only a decade
or two ago, when recovering cancer patients were often given mixed advice on physical activity or outright
warned against it. Saying some patients should view light exercise almost as a form of treatment itself, the
report noted that two and a half hours of exercise a week could lower a breast cancer patient’s risk of dying
or cancer recurrence by 40 percent, and could reduce a prostate cancer patient’s risk of dying from the
disease by about 30 percent.
The group that published the report, Macmillan Cancer Support, one of the largest British charities, provides
health care and financial support to cancer survivors and works in partnership with the National Cancer
Research Institute in Britain.
As part of its report, the group questioned more than 400 doctors and nurses in Britain and found that more
than half knew “little or nothing about the benefits of activity in preventing or managing long-term effects” of
cancer, and that one in 10 believed it was important to encourage cancer patients to “rest up” rather than
attempt any physical activity at all. Cancer experts in the United States have also sought in recent years to
spread the word among oncologists that light exercise, in many cases, should be encouraged.
Just last year, the American College of Sports Medicine convened a panel of cancer and exercise
researchers, which developed a set of guidelines on physical activity for people who are undergoing or have
recently completed treatment. The panel recommended adaptations for exercise in people based on their
specific cancers and the side effects of their treatment, like strength-building routines for patients who have
lost muscle mass and shoulder-stabilizing exercises in breast cancer survivors who have had operations that
debilitate the joints in their shoulders.
But the panel also noted that some patients will at times be just too sick to exercise — particularly at the
height of their treatment — and said that in those cases there was nothing wrong with waiting a few days
before attempting activity. The American Cancer Society also promotes moderate exercise but encourages
patients to discuss their exercise plans with their oncologists first, and lists on its Web site a set of
precautions. Among them: avoiding exercise if you have anemia, and steering clear of heavy weights or
strenuous exercise if you have developed osteoporosis, nerve damage or cancer that has spread to the bone.
For those who can handle it, though, a light or moderate exercise regimen could help reduce some side
effects of treatment, the new report stated. Studies have shown, for example, that arm extensions and other
range-of-motion exercises can help relieve lymphedema, a painful swelling of the arm stemming from breast
cancer surgery. It can also help patients who gained weight during treatment slim down and regain some
physical function, and combat some of the exhaustion stemming from chemotherapy.
“The evidence review shows that physical exercise does not increase fatigue during treatment, and can in
fact boost energy after treatment,” the report stated.
For patients looking for help with starting a new regimen, the American College of Sports Medicine and the
American Cancer Society introduced a program that educates and certifies trainers to work specifically with
cancer patients, so they understand their goals and limitations. The college’s Web site explains how patients
can find a certified cancer exercise trainer in their area.
Cancer hotline helps thousands - Toronto Sun – By Sharon Lem -
TORONTO - Kim McColl found two lumps under her arm shortly before she was diagnosed with breast
cancer in 2007.
The retired music teacher from Napanee said she wouldn’t be alive today if it weren’t for the Canadian
Cancer Society’s cancer information service.
“They are one of the reasons I’m still here today,” McColl said, adding she has never hesistated to call with
questions over the last five years. “The service is wonderful, accurate and compassionate. They go out of
their way to send you more information. Nothing is ever too much trouble.”
After undergoing surgery, chemotherapy, radiation and drug therapy, the 65-year-old is now cancer-free.
Unfortunately, still lives with lymphedema, a side effect from breast cancer surgery when her lymph nodes
were removed, that causes swelling in her left arm.
The CCS’s cancer information service — which provides information and connects people to services
available in their communities across the country — recently celebrated its 1 millionth inquiry since the
service began in 1996.
“We know through studies people who are facing cancer, their families or caregivers need cancer
information and this is one of the programs we always support,” said Janet MacVinnie, who manages the
Cancer Information Service in Ontario. “People often feel overwhelmed when dealing with a cancer
diagnosis and treatment. Our Cancer Information Service has been proven to reduce stress and anxiety for
patients.”
There are four centres across Canada, including Hamilton, Montreal, Vancouver and Regina. The CCS
cancer information service answers about 90% of its inquiries by phone and 10% by e-mail.
In addition to answering cancer questions the CCS’s cancer information service made a total of 27,481
referrals to community services in Ontario last year.
The five most common topics include support for patients — either peer support or transportation,
treatment, cancer prevention or risk factors, pathology and staging of the disease, and diagnosis.
The top five site-specific cancer inquiries include breast, colorectal, lung, prostate, and cervical.
Ontario led the number of inquiries across Canada in 2010 with 23,682 inquiries, while Quebec came
second with 16,550 inquiries and British Columbia was third was 7,033 inquiries. Out of the 23,682 Ontario
inquiries, 3,316 inquiries came from Toronto, while 4,114 inquiries came from South Central Ontario
including the GTA.
If you have a question about cancer, call 1-888-939-3333 or e-mail cis@ontario.cancer.ca Monday to
Friday from 9 a.m. to 6 p.m.
The Changing Field of Locoregional Treatment for Breast Cancer - Cancer Network – By Monica Rizzo,
MD -
ABSTRACT: The change to less-morbid local therapy for operable breast cancer continues. Systemic
induction therapy, whether hormonal therapy or chemotherapy, increases the eligibility for breast-conserving
surgery. Sentinel lymph node biopsy (SLNB) has greatly reduced the requirement for axillary dissection, and
recent data show that, in addition, whole-breast irradiation can obviate the need for dissection in most
patients with clinically node-negative, SLN-positive disease. Although resection margins must be negative
for best results, there is no clear evidence that margins exceeding "no ink on tumor" for invasive cancer, or 2
mm for ductal carcinoma in situ, are significantly better. The role of radiation has been clarified, with a clear
survival advantage for patients with node-positive disease; however, hypofractionation, which permits a
briefer period of treatment, and accelerated partial breast irradiation (APBI) show promise of even further
reductions in treatment—although late results for APBI are still needed. Elderly patients (> 70 years) with
node-negative disease and estrogen receptor–positive tumors who have been treated with hormonal therapy
can avoid primary breast irradiation without significant risk of ultimate breast loss or inferior survival.
Since 1990, death rates from breast cancer have decreased, mainly in women younger than 50 years of age
(3.3% per year) vs women aged 50 years or older (2% per year), reflecting the benefit of widespread use of
systemic treatment added to early detection.[1]
Improved local control is also causally associated with improved breast cancer survival. An absolute
reduction in local recurrence at 5 years is associated in a 4:1 ratio with an absolute survival advantage at 15
years in the overviews of clinical trials.[2] Guidelines for locoregional treatment of breast cancer were first
published by the US National Institutes of Health in 1991.[3] Since then, new surgical and radiotherapeutic
techniques have been developed, and revised guidelines for locoregional management were suggested in
2008 by the Biedenkopf Expert Panel Members.[4]
Over the past 50 years there have been major changes in the treatment of patients with breast cancer, with
"less is more" being the theme. Treatment of breast cancer has evolved dramatically from the Halsted radical
mastectomy, and many women now choose breast-conserving surgery and sentinel node biopsy. Breast-
conserving surgery (BCS) is defined as the complete removal of the tumor with a concentric margin of
surrounding healthy tissue and maintenance of acceptable cosmesis. BCS should be followed by radiation
therapy to achieve an acceptably low rate of local recurrence.
Neoadjuvant Chemotherapy
In an effort to increase the number of patients eligible for breast conservation, neoadjuvant chemotherapy
that shrinks the primary tumor before surgery has become an appealing option.[5] In a large randomized
trial, National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol B-18, investigators
randomized 1,523 women with Stage I–IIIa breast cancer to receive doxorubicin(Drug information on
doxorubicin) (Adriamycin, A) and cyclophosphamide(Drug information on cyclophosphamide) (C) either
preoperatively or postoperatively.[6] A reduction in tumor diameter of at least 50% was noted clinically in
80% of the patients, and in 37% no tumor was clinically apparent after chemotherapy. The initial findings of
the study were reported at 5 years[7]; in the 9-year follow-up publication,[6] there continued to be no
difference in overall survival or disease-free survival in patients receiving chemotherapy preoperatively vs
postoperatively. The breast conservation rate was 68% for the neoadjuvant arm and 60% for the adjuvant
arm. The reduction in tumor volume allows an improved cosmetic outcome in the majority of patients.
Induction chemotherapy followed by BCS and radiation therapy is safe and increases the eligibility for breast
preservation in approximately one-fourth of patients with large tumors relative to breast size. From a surgical
standpoint, when the neoadjuvant approach is being considered, it is mandatory to insert a radioopaque
marker into the tumor in order to localize the surgical site after partial or complete tumor regression.
Another important advantage of neoadjuvant chemotherapy is that it probes the chemosensitivity of the
tumor, providing information of great importance in terms of development of systemic treatments for
chemoresistant tumors. Tumors exhibiting the characteristics referred to as luminal A (strongly ER-positive,
PR-positive, HER2-negative) exhibit less-dramatic reductions in volume with neoadjuvant chemotherapy but
will often respond to neoadjuvant therapy with aromatase inhibitors or tamoxifen(Drug information on
tamoxifen). Conversely, for HER2-positive tumors, adding trastuzumab(Drug information on trastuzumab)
(Herceptin) to a standard neoadjuvant regimen achieved a pathologic complete response (pCR) of 65.2%,
compared with a 26% pCR in patients who did not receive trastuzumab.[8]
Margins
The first goal of breast-conservation surgery is to excise all apparent cancer. Adequate margins minimize the
risk of local recurrence. Positive margin status correlates with local failure and is an important predictor of
residual disease after BCS. The definition of what constitutes a clear margin represents one of the ongoing
"great debates" in breast surgical oncology.
The NSABP defines a positive margin as the presence of tumor at the inked margin and a negative margin as
the absence of tumor at the inked margin. Negative margins are associated with lower rates of local failure.
No uniform definition of surgical margin status has been established in the literature among institutions. In
their survey of 702 institutions in North America, Taghian et al[9] found that definitions of negative margins
vary from "no cells on the inked margin" to "no cells at 5 mm from the inked margin." About 50% of
surveyed institutions are using "no cells at the inked margin" as a definition of a negative margin. The same
variation exists for the definition of close margin. Schnitt et al have reported that 31% of institutions surveyed
used a distance of less than 1 mm from the inked margin as a definition of close margin.[10] As reviews of
contemporary series using multimodality therapy for early breast cancer fail to show an advantage for
margins exceeding the "no tumor cells at inked margin" definition, a definition of "close margin" serves no
purpose.[4] In a metaanalysis on 4,660 patients, Dunne et al[11] showed that for patients with ductal
carcinoma in situ (DCIS), a 2-mm margin was superior to a margin of less than 2 mm for avoiding ipsilateral
breast tumor recurrence (OR = 0.53; 95% CI, 0.26–0.96). Since that publication, our institution has
adopted the 2-mm margin criterion in cases of DCIS.
It is still debated whether obtaining a wider margin will decrease the rate of local recurrence after breast-
conserving surgery. What is clear is that it is absolutely unacceptable to have tumor cells at the cut edge of
the excised specimen, regardless of the type of postsurgical adjuvant therapy.[12] For patients with positive
margins who undergo reexcision, residual disease will be found in approximately 50% of the cases, with
rates varying depending on histologic subtype.
Several clinical and morphological factors have been identified to predict a higher rate of positive margins.
[13-15] These include smaller breast size, larger tumor size, previous surgical biopsy for diagnosis, use of
neoadjuvant chemotherapy, lobular histology, mammographic density of the breast tissue, and an extensive
intraductal component.[16]
Use of neoadjuvant chemotherapy can make evaluation of the primary tumor and margin status challenging.
The scattered viable tumor cells are usually situated within the fibrosis and macrophage accumulation at the
site of the tumor mass, so those areas are examined carefully if seen at the margin.
Options for intraoperative evaluation for margin status include gross examination of the specimen, frozen
section, and touch preparation cytology of the margins.[17] Owing to high false-negative rates, technical
complexity, and the duration of such intraoperative procedures, none of these methods has been accepted
as standard for margin assessment.[18,19] In retrospective studies,[20] taking multiple additional margins of
tissue from each aspect of the biopsy cavity during the initial operation reduced the rate of reoperation with
adequate cosmetic results.
Evaluation of the Axilla
Sentinel lymph node biopsy (SNB) has become the standard approach to axillary evaluation in clinically
node-negative patients.
SNB accurately stages the axillary nodes and carries significantly lower rates of complications such as
seroma, infection, arm stiffness, pain, paresthesia, and lymphedema,[21,22] compared with axillary node
dissection. Use of isosulfan blue 1% dye (Lymphazurin), radioisotopes, or both has proved to be less
important than expertise in identifying the sentinel lymph nodes. Obtaining a second node reduces the risk of
false-negative staging. Removing more and more "sentinel lymph nodes" can approach the number of nodes
in an axillary dissection with the attendant risks that the sentinel approach was designed to avoid.[23] SNB
has changed the way breast cancer is treated, and is contraindicated only in cases of inflammatory breast
cancer. In breast oncology it was not clear until very recently whether a positive SNB required a full axillary
dissection. NSABP’s B-04 study failed to show a survival benefit to axillary dissection, but axillary
dissection has remained the standard of care for local control. The greatly improved survival rates associated
with modern systemic therapy have raised the question anew.
The American College of Surgeons Oncology Group Z0011 trial,[24] conducted at 115 sites, tried to
determine the impact of SLB alone vs complete axillary node dissection on survival in clinically node-
negative breast cancer patients undergoing partial mastectomy and whole breast irradiation (WBI). Results
of the Z0011 trial showed no survival advantage for complete axillary node dissection in patients with one or
two positive SLNs. Those patients can be treated safely without axillary node dissection.
Radiation Therapy
BCS followed by radiation therapy has been shown in multiple trials to yield survival and recurrence rates
equivalent to those seen with total mastectomy for patients with early-stage breast cancer.[25] Although the
benefit of whole-breast irradiation (WBI) in terms of reducing local recurrences is well documented, this
technique is associated with many burdens for patients, including daily treatment for 6 weeks and permanent
skin changes. The paradigm "less is more" has certainly applied to the surgical technique used in the breast
and axilla, and the same concept of greater benefit with conservative management may also apply to
radiation therapy. Instead of irradiating the entire breast, a new concept of partial irradiation has emerged.
The rationale of accelerated partial breast irradiation (APBI) is that 90% of breast recurrences occur at or
adjacent to the original tumor bed.[26] This suggests that irradiating the whole breast may be unnecessary.
The first device for breast APBI was approved by the US Food and Drug Administration (FDA) in 2002.
APBI is delivered via insertion of a brachytherapy catheter in the tumor cavity at the time of the original
surgery. The shorter duration of APBI, 5 days (vs 6 weeks with WBI), is very convenient for many patients.
Multiple multicenter randomized clinical trials (including the NSABP B-39/ Radiation Therapy Oncology
Group 0413 phase III trial) have been initiated or completed to compare the effectiveness and safety of
APBI vs WBI.[27]
Shaitelman et al reported on outcomes of APBI in patients treated in the NSABP B-39 trial according to the
American Society for Radiation Oncology (ASTRO) consensus statement on APBI use. Patients were
classified as "suitable," "cautionary," and "unsuitable." At a median follow-up of 53.5 months, the 5-year
actuarial rates of ipsilateral breast tumor recurrence (IBTR) were 2.59%, 5.43%, and 5.28%, respectively,
for the three groups.[28]
Vicini et al[29] recently reported long-term data (median follow-up, 11.1 years) demonstrating equivalent
rates of IBTR among matched pairs of 199 patients who received APBI vs WBI.
The efficacy of APBI has yet to be validated in prospective comparative trials, and limited long-term data
exist for the more than 50,000 women in the US who have been treated with various forms of APBI. At
present, APBI has been associated with better quality of life, patient satisfaction, and body image than WBI.
[30,31] Some concerns remain, however, that longer follow-up may reveal complications of the less
fractionated delivery of irradiation to the surrounding normal tissue. Only the late results of randomized trials
will address this issue.
Selection of patients able to avoid breast irradiation was addressed in a National Cancer Institute Breast
Intergroup study led by Dr. Kevin Hughes. Patients in the study were women over 70 years of age with
estrogen receptor–positive breast cancers that had been completely excised. They were free of axillary
nodal metastases based on either clinical or pathological criteria and were receiving 5 years of tamoxifen
therapy. The investigators previously reported 5-year data from the trial,[32] and an updated report with a
median follow-up exceeding 10 years was presented at the 2010 meeting of the American Society of
Clinical Oncology.[33] The 5-year and 10-year trial results showed that women randomized to lumpectomy
plus WBI vs lumpectomy alone had no advantage in either survival or breast preservation rates compared
with those receiving lumpectomy without irradiation. Although local recurrence rates were higher in the
group treated with lumpectomy alone, they remained acceptably low and there was no difference in risk of
distant metastasis or death from any cause.
Sophisticated techniques of breast irradiation can now avoid "hot spots" and consequently allow
hypofractionation compared with the number of fractions previously used. The work of Whelan and
colleagues has shortened the duration of whole-breast treatment from 6 weeks to 3 weeks. This was initially
demonstrated in older women but is now being evaluated in younger women as well, and would appear to
provide some of the benefit of APBI with whole breast treatment.[34]
Financial Disclosure: The authors have no significant financial interest or other relationship with the
manufacturers of any products or providers of any service mentioned in this article
August 10, 2011
Local Woman Pushes For Improved Street, Sidewalk Conditions For Residents with Disabilities -
Patch.com –
Barbara Lebow says she was stopped by police for riding her mobility scooter in the road against traffic;
now she’s pointing out “trouble spots” and advocating for ADA compliance
A Fort Lee woman living with limited mobility is intensifying her efforts to bring about changes she hopes will
enable her and others to get around town safer and a little more conveniently after a run in with police last
month.
Barbara Lebow, who suffers from a combination of lymphedema and arthritis, conditions that make walking
and standing extremely painful, relies on a mobility scooter to travel from point A to point B in Fort Lee. She
said her main goal in advocating for better accessibility and full ADA compliance in her hometown isn’t just
for people with mobility scooters, but also for those who use wheelchairs or walkers to get around or even
people who push baby strollers.
“My goal is to make it easier for everybody,” Lebow said. “That’s my agenda. I would like to see corner-
appropriate corner cutouts that aren’t going to put anyone in danger and get them off the sidewalk. My next
goal would then be to get people into stores. There a number of stores you can’t get into. [The scooter]
doesn’t jump. It won’t go up a flight of steps.”
The issue of ADA compliance recently came to a head for Lebow when she had what she called an
“unfortunate encounter” with an “unprofessional” policeman while trying to get home—she lives on Bridge
Plaza North—from “the non-accessible Fort Lee Post Office” on Main Street, taking what she thought was
“the safest route.”
“I was on the road in the wrong direction; I was going towards traffic, not along with traffic,” Lebow
admitted, adding that the incident occurred on Lemoine Ave. about halfway to Bridge Plaza North from
Citibank. “I was driving towards traffic so they could see me. I didn’t know that I had to follow the bicycle
rules.”
She said she was riding her scooter in the street, which is legal if you travel in the direction of traffic like
bicyclists, because there’s no ramp to get off the sidewalk on the southwest corner of the intersection of
Lemoine and Bridge Plaza North, and the southeast corner, which does have a ramp, isn’t much better. That
ramp is cut at roughly a 45-degree angle, forcing the scooter to move faster, Lebow said, and she’s
“petrified” to go down it with a constant stream of cars making right turns on red lights.
“That’s why I was riding in the street,” she said. “That’s why the police officer stopped me. The one corner,
I couldn’t get off once I got on, and the other one … I’m scared to death of it.”
Lebow told Patch she was not ticketed for the violation, but rather let off with a warning. She also said that
as a result of the incident she is now better informed of the rules of the road regarding scooters and has “met
several Fort Lee policemen who have been wonderful.”
“[The police] spent a tremendous amount of time researching the laws,” Lebow said. “As a result, I now
wear a helmet. This is not a fashion statement. … It was a misunderstanding; I’ll accept that. But as far as I’
m concerned, it was a bad situation.”
At the July 21 regular meeting of the Fort Lee Mayor and Council, Lebow expressed her concerns and
related the incident to the borough’s governing body.
“In New Jersey, by law, handicapped people are allowed to use mobility scooters,” she told Fort Lee
Mayor Mark Sokolich and members of the Council. “Why anyone would want to use one is beyond me. …
Their access is cut off to most stores, many buildings and other destinations.”
She added that her knees and legs absorb the shock of every bump in the road, and that potholes pose
another serious risk.
“I have been approaching [Sokolich] for four years,” Lebow later told Patch. “For four years he has been
committing to me that he would take a ride with me because I wanted him to walk in my moccasins. When
you’re using a mobility scooter, the world is a whole different place.”
But while Sokolich didn’t take a ride with Lebow personally, he did assign Michael Maresca of the Fort Lee
Department of Public Works to the task, he said, “to identify what the problem areas are.”
Lebow said she was appreciative of the opportunity to point out some of those problem areas, and added
that Fort Lee has “for the most part” done a good job with recent work on Anderson and Center Avenues
when it comes to ADA compliance. But she also said there are still plenty of “trouble spots” in town.
“Mike was terrific,” Lebow said of the roughly 90-minute, ride-along survey. “It was probably far better
than anything I could have had because he knows the streets, and now it was just tweaking his look.”
Among those “trouble spots” in Fort Lee Lebow identified for Patch—she’s been known to ride around
town with a tape measure at the ready—are the following:
· Linwood Ave. and Bridge Plaza South – “NE and NW corners have traffic light bases in corner cut-
outs—impassable.”
· Center Ave. and Bridge Plaza South – “NW and SW corners in bad condition with potholes. Divider
[is in] very bad condition. NW corner [has] very steep ramp up.”
· Center Ave. and Whitman St. – “No corner cut into circular driveway”
· Sidewalk on Lemoine Ave. - “In front of mall where Starbucks/Boston Chicken are is only 22 inches
wide with bush overgrowth and fire hydrant placement.”
· Staples on West St. – “There is a cutout onto the sidewalk, which is blocked by a fire hydrant. Once
you get past the fire hydrant, you realize there is no curb cutout to get off sidewalk.”
· Bridge Plaza North, west of Linwood Ave. – “Cutout is not in crosswalk and is way too deep,
catching the back wheels of the scooter going down and is too steep going up. It sits about 2 inches above
the roadway.”
· Main St. – “Almost all driveways and ramps are 2 inches above asphalt because of decorative brick.”
· Bridge Plaza South and Martha Washington Way – “No corner cutouts; just broken curb and bad
potholes.”
Complicating the matter is the fact that the worst of the “trouble spots” are right where Lebow lives, and the
very stretch of Lemoine Ave. she has to traverse to get from her home to Main St. is Port Authority
jurisdiction.
“I’d say that some of [the problems areas] have been identified,” Sokolich said. “The major bone of her
contention is that some of the curbs don’t have an appropriate ramp to allow her to get onto that sidewalk.
Unfortunately, some of those sidewalks are far from being in our control.”
But the mayor said jurisdiction “generally hasn’t stopped me in the past.”
“I never use it as an excuse,” Sokolich said. “If a road needs to be paved, and it’s a state road, and it’s in
abominable condition, I do it and deal with the consequences later. But on this, it’s going to be very, very
difficult to do it because it’s a very, very high curb. I’m not saying no. We’ve written letters to the Port
Authority, and we’re waiting to hear from them on what their position is. But those curbs are all metal-
structured, reinforced. You’re talking tens of thousands of dollars to do what it is that they want
accomplished, and those are funds that are not available to us at the moment.”
Lebow said she’s personally tried to get someone from the Port Authority to listen.
“But I’m just one squeaky wheel,” she said.
She also said she’s been working with the Bergen County chapter of Heightened Independence and
Progress (HIP CIL), an advocacy group for people with disabilities and independent living.
Nancy Hodgins of HIP CIL said she has also contacted the Port Authority on Lebow’s behalf, but that she
hasn’t had much more luck getting a response. She did say however that she’s hopeful she’ll get some
answers when the person she’s waiting to hear back from returns from vacation.
But Hodgins also said ADA compliance problems in general are not unique to Fort Lee.
“The law is very clear,” Hodgins said, adding that there are “varying levels of compliance” among
municipalities.
“Some towns are very good at [being in compliance], and others are not,” she said.
Hodgins called Lebow a “strong advocate,” who is doing the right thing by speaking out, and said people
like Lebow have as much of a right to get around safely as pedestrians.
Lebow, who works full-time from home as the director of sales and marketing for a firm that sells restaurant
equipment and supplies and also volunteers in community—she’s a member of the local R.A.C.E.S. team,
for example—doesn’t want people to feel sorry for her. She just wants to call attention to an issue that a lot
of people may not think much about.
“I do have a life,” Lebow said. “Most often people see me, and they make a really bad assumption that I’m
sitting home eating bon bons all day. I work from home, but that’s a whole other issue. Even though I may
have mobility issues I do whatever I can to give back to Fort Lee”
Sokolich says that in addition to writing letters to the Port Authority to deal with what Lebow refers to as
“the offending corner” at Lemoine Ave. and Bridge Plaza North, the borough is doing what it can to help.
“Those roads that are in our control, as soon as I have the special projects team concluding a couple other
things, I do plan on getting them out there to take care of a couple of those problem areas in the hopes that
we can accommodate her,” Sokolich said.
Lebow, who has been using a mobility scooter for about 10 years, said she’s going to work with HIP CIL
on a survey project in Hackensack she hopes to be able to bring to Fort Lee.
“This is not where I plan on stopping this quest,” she said. “Until the Port Authority of New York and New
Jersey becomes ADA-compliant, I will continue to advocate.”
August 11, 2011
Ryan joins Aloha Home Care – TCPalm –
Elizabeth Ryan has accepted a position with Aloha Home Care, 548 N.W. University Ave., Port St. Lucie,
as lead therapist for lymphedema treatments.
Ryan has extensive experience working with lymphedema and wound patients in their homes, the company
said in a news release. She provides education, sizing for custom garments, and demonstrates wrapping and
self management skills.
Linda Hanisak, director of professional services at Aloha, said in a news release, "I have worked with
Elizabeth and have watched her patients receive excellent results as well as return to more active lifestyle.
Elizabeth makes a difference in the quality of life for her patients."
To contact Ryan, or for information on lymphedema treatment, call 772-562-1559
August 13, 2011
Reveal release regain - Trinidad Guardian – by Michelle Loubon -
Suspended on wings, archangel Gabriel bursts through the clouds with sword in hand. Hindu deity Lord
Ganesh, the son of Shiva and Parvati, is easily recognisable by an elephantine countenance with a curved
trunk and big ears. These portraits are not hanging in a religious sanctuary. Instead, they add a pious touch
to the lab-clean Glencoe office of bio energy therapist Meera Jadoo. At a time when nerves are frayed due
to stressful daily activities, Jadoo is putting her faith in Scenar therapy and “crystal light balancing” to ease
the tension. Scenar is an acronym for Self Controlled Energo Neuro Adaptive Regulation. Although they are
not etched on the walls, Jadoo’s watchwords are “Reveal, Release, Regain.” It’s visible on her azure-
coloured buttons-up.
Against the backdrop of a pantheon of gods, Jadoo explained Scenar therapy hinges on the theory of
Chinese acupuncture. Acupuncture is defined as an alternative medicine that treats patients by insertion and
manipulation of needles in the body. Its proponents variously claim it relieves pain, treats infertility, disease,
prevents disease, or promotes general health. She depends upon healing hands—not needles. Jadoo said:
“Scenar therapy incorporates the technique of Chinese acupuncture to eliminate mental blockages. It’s done
using a small machine that energises the blocked pathways along the body. It would ensure the life-force
energy flows more efficiently. She added: “When we have blocked pathways, it creates illnesses and
diseases in the body. So Scenar therapy works on the theory of traditional Chinese medicine. We work on
the acupressure points, reflex zones, and meridians (the energy pathway itself). We have 14 different
meridians—mental, physical and emotional—in the body.”
In a nutshell, Scenar therapy is a non-invasive pain-free biofeedback therapy that fortifies and invigorates the
body’s natural healing ability which promotes health and vitality and re-establishes balance in the body.
Affirming the benefits to be derived from Scenar therapy, Jadoo said: “All diseases tell us what is going on in
the emotional and mental body. It’s good. It’s a step forward. It takes you forward.”
Crystal light balancing
Coupled with Scenar therapy, Jadoo engages in “crystal light balancing”. It employs chromotherapy
technique which utilises colour and light to bring about healing and balance to a person’s mental, emotional,
physical and spiritual body. Jadoo added: “It works on the emotional body by using light to clear the
meridians of emotional blockages. We are using different coloured lights according to the meridian and
dealing with the emotion that needs to be addressed and clearing it. We are working to calm the whole body
mentally and emotionally.” She added: “At the end of the therapy, we are trying to get the person whole in
terms of balancing, energising and harmonising. We are working on pain relief therapy for all kinds of
injuries; even those derived from sporting activities.”
Targets women, children
While Scenar therapy, which was developed by the Russian space programme in the ’60s, is intended to
empower people to take charge of their lives and get rid of their depression, Jadoo noted it was specially
targeted toward women and children. It was even more timely for victims of abuse. Jadoo added: “These
therapies are especially directed at women and children who experience abuse. They won’t feel life is
against them. It brings out the painful emotions and helps you deal with it. Once you understand what is
happening then you can go deeper and deeper into the depression and find ways to manage it and deal with
it.” Jadoo felt women and children should be well treated to create a more just and equitable society.
Carrying a burden for the children, Jadoo added: “Children are the future of the nation. We need to take
extra care of the young ones. We need to build positive people to lead our nation.”
Willing to help Nelson
Recently, Jadoo said she was moved by a Sunday Guardian report which highlighted lymphedema (massive
growths) affecting Valencia resident Marissa Nelson. She said: “To think she is only 28. She needs help. I
am willing to help her with Scenar therapy; Anything that would give her confidence and a reason to live.
People in such cases can be suicidal and suffer from low self-esteem.”
Back pains led to Scenar therapy
Jadoo had tested her techniques with positive results. Having graduated from City University, London,
Jadoo worked as an optometrist—specialising in eye examinations. She immersed herself in her work until
she began experiencing excruciating back pains in 2001. They increased in intensity and sleepless nights
dogged her footsteps. Reflecting on that period of misery, Jadoo said: “I suffered from back pain for many
years. I went to many specialists and I did MRI and nobody could figure out what was causing the pain. I
did physiotherapy.” The pain did not go away. Cringing, Jadoo added: “At times, I couldn’t get off the bed.
I tried anything people suggested. But still the pain was debilitating to the point where I couldn’t walk, eat or
sleep.”
Tries Scenar therapy
Frustrated and fed up, Jadoo sought the help of a homeopathic doctor in Canada in 2009. She employed
Scenar therapy which delivered her from the pains. Jadoo realised she was drawn to the therapy. She
attended homeopathic bio energy workshops hosted by Dr Sushilla Lalsingh in Canada. Jadoo said: “After
three weeks, the pain was almost gone. So now, that’s how I got into it; I ended up doing the courses with
it. I recognised how calming and how much it relieved the different pains.” Gushing over the discovery,
Jadoo said: “When you complete the therapy it tends to have a healing effect. It tends to allow the brain take
over the healing process within the body. It can also be used for people with mental disorders. It tends to
produce the good feelings hormones to calm them down. “It works with the mental, emotional and physical.”
Now that she has mastered Scenar therapy, she’s comfortable and optimistic about practising on other
people. Charity begins at home. Even her nephew Ardan, five, has been subject to Scenar therapy. “I try it
on Ardan when he had bumps and bruises. It is effective and pain-free. It is very comfortable for people.”
About Meera Jadoo
Jadoo lives at Tunapuna. She attended St Joseph’s Convent, St Joseph. She has a brother Rajiv and sister
Tara. Jadoo practised with Ferreira Optical until August 2010. For two years, she was a member of the
T&T Optometrist Association. Her work took her to Tobago where she spent a long time. Among her
hobbies are reading, solving crosswords, other puzzles and outdoor activities like walking, exercising and
going to the seaside—especially Maracas for bake and shark. Her parents are Raj and Sati Jadoo. She
admires their humanitarianism. Working alongside Rotary, Jadoo said her father had assisted in the
distribution of wheelchairs, hampers and helped people raise funds for heart surgery. He has even worked
on a campaign to eradicate polio. Jadoo said: “There is a strain that has come back.” She’s adamant about
carving her own niche. “My father is established. I left a steady job to do therapy. I am into this on my own.
I put my savings into this project. I heeded my inner calling.” But, like her parents, she’s not hesitant about
lending a helping hand to those less fortunate. “When I did optometry, I did charity and lectures on diabetes.
I helped with eye tests in remote places like Toco and Poole Village. I believe in helping where I can.”
August 15, 2011
Swollen arms and legs are a large - and treatable - part of a post-cancer treatment patient's world - London
Free Press - by By Marilyn Linton, QMI Agency –
Several years after her cancer treatment, Dr. Dianne Kipnes noticed serious and persistent swelling in her
lower limbs. "My legs and feet were swollen to the point where you could hardly see my knees," she says.
When it didn't go away and was finally diagnosed as lymphedema, Kipnes, a clinical psychologist and
president of the Dianne and Irving Kipnes Foundation in Edmonton, became increasingly frustrated: She
discovered there was no cure and very little available treatment to keep her condition under control.
She's not alone in that frustration. A 2009 study by the Canadian Lymphedema Framework found a lack of
standardized care for patients in Canada, no provincial health coverage, a lack of resources for assessment
and treatment and a real need to teach lymphedema prevention and self-management.
According to Dr. Anna Towers, who runs a lymphedema clinic at Montreal's McGill University Health
Centre, lymphedema is an accumulation of lymphatic fluids that occurs when there is removal of, disruption
or damage to lymph nodes or vessels, usually following surgery or radiation treatment for cancer.
"Wherever there are blood vessels, you have lymphatic vessels. They are everywhere," Dr. Towers explains.
The lymphatic system is made up of lymph fluid whose white blood cells help to fight infection; lymph nodes
to filter out toxins and germs; and lymph vessels which transport the lymph fluid.
"Myths about lymphedema include the impression that nothing can be done about it, that lymph treatments
don't work, and that lymphedema is benign and doesn't lead to serious health consequences," Dr. Towers
says. Some doctors dismiss it, and others don't realize that it can show up years after cancer treatment.
Dianne Kipnes' cancer was treated seven years ago, but her lymphedema began only two years ago.
At Dr. Towers' clinic, the first weeks include getting the swollen limb down to a normal size. This entails
teaching patients how to layer bandages which need refitting every other day. Patients have massage
treatments designed to help lymphatic circulation. Exercise and diet advice is given, as are compression
garments that are individually fitted and not just bought off a drugstore shelf.
"The most important thing people at risk need to understand is that early intervention and early detection is
critical to limiting the extent to which they will suffer," says Ian Soles, president of Edmonton's Salutaris
Centre for Lymphatic and Massage Therapy, a private clinic offering much-needed therapeutic services. Left
untreated, the condition can lead to cellulitis and other skin infections, some of them life-threatening.
Soles is a Vodder-certified registered massage therapist and that particular treatment, which he describes as
a technique which stretches the skin to stimulate lymph flow, is what helps Dianne Kipnes cope with her
lymphedema. "Sixty per cent of the lymph vessels are in the top two layers of the skin," explains Soles: The
gentle rhythmic massage used in the technique developed by a German doctor in the 1930s moves the fluid
and proteins out of the lymphatic system to properly drain.
Soles described the lymph system as "the sewer system of the body" in that it's the transportation component
of the immune system and gets rid of toxins, fat particles, viruses and large proteins. "Typically, the lymph
system dumps one to two litres of lymph fluid into the subclavian vein every 24 hours. Then the fluid runs
through the kidney, the waste goes to the bladder and is urinated out."
When this system is damaged, massage shifts the fluid to the body's healthier lymphatic system. His clinic
also tackles getting the swelling under control before advising patients to get compression garments, giving
them exercises and teaching them self-management.
"I can tell you I never had leg envy the way I have with lymphedema," says Dianne Kipnes. "It can be ugly.
But it's more than a vanity issue. If you don't get treatment, you get complications." Adds Dr. Towers: "Up
to 25% of cancer patients get lymphedema. By catching it early, we could reduce it to 10 or 5%."
Body politics
"After cancer surgery, people should be monitored for the earliest sign of swelling," says Dr. Anna Towers.
"They should also become active as soon as it is safe as that helps drainage. But Canada needs programs to
prevent, diagnose and treat patients. People are diagnosed with cancer and the health system responds
immediately. Then they develop lymphedema and they find themselves abandoned."
What causes it?
Half of all lymphedema cases occur because of radiation treatment to cancers of the prostate, breast, colon,
cervix or uterus. The rest of lymphedema cases are related to heredity, hip surgery, obesity or varicose
veins. An increase in the number of cancer survivors coupled with obesity and an aging society means
lymphedema can't be ignored.
Symptoms
According to the Lymphedema Institute in Houston, TX, common symptoms include:
A chronic, heavy swollen limb
Localized fluid accumulation in other body areas
Discoloration of skin overlying the lymphedema
Deformity
Severe fatigue
Weighty limbs – CANOE –by: Marilyn Linton, QMI Agency
Several years after her cancer treatment, Dr. Dianne Kipnes noticed serious and persistent swelling in her
lower limbs. "My legs and feet were swollen to the point where you could hardly see my knees," she says.
When it didn't go away and was finally diagnosed as lymphedema, Kipnes, a clinical psychologist and
president of the Dianne and Irving Kipnes Foundation in Edmonton, became increasingly frustrated: She
discovered there was no cure and very little available treatment to keep her condition under control.
She's not alone in that frustration. A 2009 study by the Canadian Lymphedema Framework found a lack of
standardized care for patients in Canada, no provincial health coverage, a lack of resources for assessment
and treatment and a real need to teach lymphedema prevention and self-management
According to Dr. Anna Towers, who runs a lymphedema clinic at Montreal's McGill University Health
Centre, lymphedema is an accumulation of lymphatic fluids that occurs when there is removal of, disruption
or damage to lymph nodes or vessels, usually following surgery or radiation treatment for cancer.
"Wherever there are blood vessels, you have lymphatic vessels. They are everywhere," Dr. Towers explains.
The lymphatic system is made up of lymph fluid whose white blood cells help to fight infection; lymph nodes
to filter out toxins and germs; and lymph vessels which transport the lymph fluid.
"Myths about lymphedema include the impression that nothing can be done about it, that lymph treatments
don't work, and that lymphedema is benign and doesn't lead to serious health consequences," Dr. Towers
says. Some doctors dismiss it, and others don't realize that it can show up years after cancer treatment.
Dianne Kipnes' cancer was treated seven years ago, but her lymphedema began only two years ago.
At Dr. Towers' clinic, the first weeks include getting the swollen limb down to a normal size. This entails
teaching patients how to layer bandages which need refitting every other day. Patients have massage
treatments designed to help lymphatic circulation. Exercise and diet advice is given, as are compression
garments that are individually fitted and not just bought off a drugstore shelf.
"The most important thing people at risk need to understand is that early intervention and early detection is
critical to limiting the extent to which they will suffer," says Ian Soles, president of Edmonton's Salutaris
Centre for Lymphatic and Massage Therapy, a private clinic offering much-needed therapeutic services. Left
untreated, the condition can lead to cellulitis and other skin infections, some of them life-threatening.
Soles is a Vodder-certified registered massage therapist and that particular treatment, which he describes as
a technique which stretches the skin to stimulate lymph flow, is what helps Dianne Kipnes cope with her
lymphedema. "Sixty per cent of the lymph vessels are in the top two layers of the skin," explains Soles: The
gentle rhythmic massage used in the technique developed by a German doctor in the 1930s moves the fluid
and proteins out of the lymphatic system to properly drain.
Soles described the lymph system as "the sewer system of the body" in that it's the transportation component
of the immune system and gets rid of toxins, fat particles, viruses and large proteins. "Typically, the lymph
system dumps one to two litres of lymph fluid into the subclavian vein every 24 hours. Then the fluid runs
through the kidney, the waste goes to the bladder and is urinated out."
When this system is damaged, massage shifts the fluid to the body's healthier lymphatic system. His clinic
also tackles getting the swelling under control before advising patients to get compression garments, giving
them exercises and teaching them self-management.
"I can tell you I never had leg envy the way I have with lymphedema," says Dianne Kipnes. "It can be ugly.
But it's more than a vanity issue. If you don't get treatment, you get complications." Adds Dr. Towers: "Up
to 25% of cancer patients get lymphedema. By catching it early, we could reduce it to 10 or 5%."
Body politics
"After cancer surgery, people should be monitored for the earliest sign of swelling," says Dr. Anna Towers.
"They should also become active as soon as it is safe as that helps drainage. But Canada needs programs to
prevent, diagnose and treat patients. People are diagnosed with cancer and the health system responds
immediately. Then they develop lymphedema and they find themselves abandoned."
What causes it?
Half of all lymphedema cases occur because of radiation treatment to cancers of the prostate, breast, colon,
cervix or uterus. The rest of lymphedema cases are related to heredity, hip surgery, obesity or varicose
veins. An increase in the number of cancer survivors coupled with obesity and an aging society means
lymphedema can't be ignored.
Symptoms
According to the Lymphedema Institute in Houston, TX, common symptoms include:
A chronic, heavy swollen limb
Localized fluid accumulation in other body areas
Discoloration of skin overlying the lymphedema
Deformity
Severe fatigue
Learn more!
www.salutariscentre.com
www.lymphnet.org
www.lymphedemainstitute.org
www.vodderschool.com
www.lymphontario.ca
Learn How to Prevent Lymphedema - KEPR 19 –
A free Lymphedema prevention, education, and training class is being offered Tuesday, August 16th, from
1pm to 2pm at the Tri-Cities Cancer Center in the Resource Center. Sara Nelson, DPT, will teach this class.
Lymphedema affects both men and women and refers to the swelling that occurs most often in the arms or
legs due to a blockage in the lymph system, which prevents the proper drainage of lymph fluid. Following
certain types of surgeries, as many as 49% of people may develop secondary lymphedema. Understanding
early symptoms can help prevent severe discomfort and permanent damage.
Anyone who has had lymph nodes removed will benefit from the material presented in this class. Learn more
about the lymphatic system, lymphedema prevention, early symptom detection, use of compression, basic
self-massage, and when to seek professional treatment related to lymphedema. Dr. Nelson is an expert in
the field of lymphedema therapy.
To reserve a seat at the next class or for more information please call (509) 737-3427. The Tri-Cities
Cancer Center is located at 7350 W. Deschutes Ave., Kennewick.
The Tri-Cities Cancer Center is able to offer programs like this at no cost, thanks to generous contributions
from organizations like Therapy Solutions and others. Donations to the Tri-Cities Cancer Center Foundation
stay local and are used to provide valuable non-reimbursed cancer programs and services for patients, their
families and the community.
Senior community works to meet their residents “where they are now” - AnnArbor.com –
Tanum Ollila from Brookdale Place in Ann Arbor joined us on the show this past weekend. She has been
busy with many new residents moving to their senior community, located on Ann Arbor-Saline Road.
Brookdale Place has two “neighborhoods,” one for assisted living, and one for those receiving memory care.
Tanum talked about Clare Bridge, their memory care community, and how the staff work hard at “meeting
someone in their journey, where they are now.” If their resident believes it’s 1941, and they are taking the
train here from Kentucky, then that’s where their staff needs to be with them.
Brookdale Place completes a life history form for each of their new residents, to get to know and appreciate
the details of his or her background. Knowing residents' interests and what their lives have been like better
ensures the residenst receive the appropriate care and attention to optimize their quality of life.
When looking for a facility for your mom or dad, Tanum believes it is super important to visit the community.
How do you feel when you walk in the door? Look at the residents, and how they are being treated. Do you
see interaction with the staff? Do you see residents engaged?
Tanum’s biggest hurdle is getting families to come see the facility. So many people believe senior facilities are
still old-style nursing homes, dreary and depressing. Families are frequently shocked when they see how nice
a senior community can be.
Bill's Roundup: Grants, Drugs & College - Prescott eNews –
Dr. Penny Wills talks about the community and Yavapai College; and several grants have been received to
provide support services to local residents.
The Susan G Komen Phoenix affiliate has awarded a grant to Yavapai Regional Medical Center. YRMC
officials note the nearly $19,000 grant will help treat low and middle income women suffering from
lympedema, a painful condition that can occur as a result of cancer or cancer treatment, such as
mastectomy, radiation therapy or chemotherapy. Donna Hannah is the only lymphedema therapist serving
Yavapai County and accomplished Oncology Nurse Nancy Ledoyen will serve in that role at the new
Breast Care Center at YRMC’s East Campus in Prescott Valley. New Chief Nursing Officer Diane Drexler
will also help with the opening of the Center. During a recent tour of that facility, Komen Phoenix leaders
learned about key medical services the center will provide, including digital mammography, breast ultrasound
and stereotactic biopsy. The Center is scheduled to open this October.
Yavapai County Sheriff’s Office K-9 teams have received a $9000 grant award. This award comes from
the Yavapai County Community Foundation to help offset expenses involving the Sheriff’s Office K-9 Units.
Four Patrol K-9 Units are specifically assigned to drug interdiction on major interstates and County
highways. According to Sergeant Jeff Jaeger, a portion of the money will be used for training and equipment
including portable kennels, training toys and leashes. Search dog team handlers will use their portion of the
monies for training, K-9 first aid supplies and rattlesnake vaccinations, along with radio and GPS equipment.
Last Wednesday, a K-9 deputy working drug interdiction confiscated more than 3 and a half pounds of
marijuana following a traffic stop on Interstate 40 at Crookton Road in Seligman. Sixty-three year old
Oklahoma resident Tomie Adams was arrested for transportation of marijuana for sales.
The Dewey-Humboldt Board of Adjustment meets at 10 tomorrow morning. Newly appointed Board
members Judy and Frank Davidson will be sworn in to start the meeting and there will be an election of a
new Vice Chair. Bob Bowman currently serves in that position. The work study session will include a
presentation and discussion by former Mayor Len Marinaccio on recurring Open Meeting Law issues, with
an overview of the Law itself. There will also be a presentation on Robert’s Rules of Order and a review of
Riggin’s Rules.
Following a lunch break at 12:15, there will be consideration of Board of Adjustment procedures and a
review of Board zoning regulations. A training date for new members on powers and limitations of the Board
is expected to be established and the date and time for holding meetings will be discussed. The work study
session will be held in Town Council chambers on south Highway 69.
A Cottonwood woman has been arrested after allegedly forging a prescription. The Pharmacy Manager at
the Walgreen’s Store on Main Street met with Police and told them a female subject presented a forged
prescription. He pointed out the quantity was changed from 30 to 80 pills of hydrocoden. The doctor who
wrote the prescription was contacted and she confirmed the quantity was 30 pills. Thirty-three year old
Therese Brady was not home when an officer went to her residence, but she was contacted by cell phone
and agreed to meet the officer at the Police Department. Brady was shown a copy of the forged prescription
and she was arrested for presenting a forged instrument that contains false information and for attempting to
obtain or procure the administration of a narcotic drug by fraud, deceit or misrepresentation.
Chino Valley residents need to be aware of increased traffic due to school being back in session. During a
recent live appearance on Talk of the Town on KQNA, Police Commander Mark Garcia explained both
Territorial and Del Rio Elementary Schools are located on side streets and in addition to increased traffic,
there are kids walking to and from school. Garcia says officers will also be checking to make sure motorists
are stopping for school buses. Since the first day was held last Wednesday, this week marks the first full
week of school in the District.
The Prescott Fire Department is hosting a Regional Mass Casualty Incident Exercise tomorrow morning.
The Interagency Exercise will consist of a simulated emergency involving 2 aircraft at the Airport with live
fire and up to 25 patients who will need to be treated by responding agencies. This simulated incident is
designed to assist regional providers in the use of multi-agency partnerships, response of area responses and
to provide strategies in resource management, fire suppression techniques, emergency transportation, airport
emergency operation techniques, hospital mass casualty capabilities and participating agency safety
practices. Some of the 25 regional agencies scheduled to participate include the Prescott Airport
Department, Prescott Police, the Regional Communication Center, the Central Yavapai, Chino Valley,
Mayer and Groom Creek Fire Districts; the Department of Public Safety, Yavapai College, the Trauma
Intervention Program and the Prescott Unified School District.
New Yavapai College President Penny Wills is looking forward to the start of the Fall Semester. Wills, the
former Northeast Iowa Community College President was named Yavapai College President last May and
she officially started on August 1st. Last Monday, the Governing Board held a transitional workshop with
the new President on the Policy Governance Model. Wills explains that meeting was proposed by former
College President Jim Horton and added that she appreciates the community support for the school.
Those who wish to meet Wills can do so at a Yavapai College Foundation reception at 5 this Wednesday
night at the College’s Sculpture Garden on East Sheldon Street. She was introduced during the Board’s
voting session on Tuesday and during the Prescott Valley Town Council’s voting session on Thursday night.
Tailored Strategies for DCIS Management - Cancer Network – By Sara H. Javid,-
Few areas in breast disease elicit as much controversy as the management of DCIS. The review by Sanders
and Simpson, “Can We Know What to Do When DCIS Is Diagnosed?” nicely highlights those
controversies. While the answers to this question may not be cut-and-dried (no surgical pun intended), we
endorse the authors' conclusion that there never will be a “one-size-fits-all” algorithm for DCIS treatment,
and that treatment should instead be carefully tailored to the individual patient.
The pathologic evaluation of DCIS within a surgical specimen is challenging and is a critical juncture that
impacts all subsequent treatment recommendations. Two key factors for determining breast conservation
candidacy are extent of disease (“size”) and surgical margin width, which along with tumor grade and
presence of necrosis are paramount to making decisions regarding whether re-excision, mastectomy, and/or
radiation is necessary. The authors suggest that to assess disease extent, all surgical specimens containing
DCIS should be processed with serial sectioning and sequential submission of the entire specimen (so-called
“serial sequential sampling”) so that the extent of DCIS can be measured in three dimensions. As surgeons,
we strongly endorse this concept, although in practice such extensive processing is labor-intensive and can
become impractical for pathologists to perform routinely. Acknowledging these limitations, the College of
American Pathologists (CAP) stipulates that any of four different methods for measuring the extent of DCIS
may be used: serial sequential sampling, nonsequential sampling, span measurement of DCIS on one slide,
and/or measured distance between two affected margins.[1] In practice, the measurement of DCIS extent
varies across institutions and is at best an estimate of disease burden.
The definition of a surgically “clear” margin is a hotly debated issue in DCIS management due to its
implications for whether radiation therapy is required. The National Surgical Adjuvant Breast and Bowel
Project (NSABP) B-17 randomized trial that led to the broad-scale adoption of radiation following breast
conservation for DCIS demonstrated that radiation reduced the local recurrence rate from 27% to 12%.[2]
Similarly, the randomized European Organisation for Research and Treatment of Cancer (EORTC) 10853
trial also demonstrated the efficacy of radiation in reducing risk of local recurrence; in this trial it was
reduced from 14% to 7% at 10-year follow-up.[3] However, both trials were limited in that 40% or more
of tumors were not measured pathologically for extent of disease. Furthermore, the surgical margins were
often unoriented and unmeasured in these early studies, making comparative assessment of surgical margin
width impossible to perform. In these trials, surgical margins were considered to be negative as long as
cancer was not present at the resection line (NSABP), or was at least 1 mm from that margin (EORTC)—
definitions that would generally be considered inadequate by modern standards. Given this variability, subset
analyses could not be conducted to identify select groups of patients for whom radiation therapy might not
be necessary.
We tend to disagree with the authors' suggestion that architectural pattern alone (ie, micropapillary DCIS)
should steer surgical recommendations away from an attempt at breast conservation. While micropapillary
DCIS tends to have a multifocal distribution within the breast (not unlike lobular carcinoma in situ), this is not
invariably true. Before recommending mastectomy, we verify with percutaneous sampling that the extent of
disease is truly widespread, rather than assuming this to be the case on the basis of histological subtyping. As
long as the patient is counseled appropriately about the risk of needing re-excision or possibly mastectomy
to attain clear margins (as all breast conservation patients should be), breast conservation should still be
offered regardless of the DCIS pathologic subtype.
Silverstein and Lagios have been the most outspoken in advocating against the universal need for post-
lumpectomy radiation for DCIS. Their Van Nuys Prognostic Index (which utilizes tumor size, margin width,
grade, presence or absence of necrosis, and patient age) purports to predict risk of local failure with
excision alone in order to elucidate who may avoid or benefit from radiation therapy.[4,5] Unfortunately, the
Van Nuys scale has not been consistently validated by independent groups. In contrast to Sanders and
Simpson's suggestion, we generally do not apply the Van Nuys algorithm to predict who may forgo radiation
therapy.[6,7] Instead, we take an individualized approach in which we perform the rigorous pathologic
(serial sequential sectioning of entire specimen) and radiographic examinations (specimen radiographs and,
when needed, post-lumpectomy mammogram to confirm absence of residual calcifications) and then make
individualized decisions based on the extent of disease and margin width, as well as consideration of the
patient's stated preferences and goals.
Since DCIS does not have significant metastatic potential, we believe there is more room for individualized
approaches to care than one might identify for invasive disease, for which mortality risk is a factor.
Silverstein's retrospective series demonstrated that when 10-mm margins were attained, radiation had no
benefit in reducing an already low 8-year local failure rate of 4%. If margin width was between 1 mm and <
10 mm, the addition of radiation therapy led to a nonsignificant reduction, and only when margins were < 1
mm did it yield a significant benefit.[8] However, 10-mm margins are viewed by most as excessive, if not
unattainable, and can often lead to marked cosmetic deformity, particularly in a modest-sized breast. It is
generally accepted that 1 mm is insufficient unless it is present at an anatomic breast boundary (eg, pectoralis
fascia) and that local recurrence risk decreases as margin width progressively increases from 1 mm to 10
mm. Having said that, we generally consider ≥ 2- to 3-mm margins to be negative. We do not require wider
(5-mm) margins for higher grade DCIS as Sanders and Simpson suggest, because this could lead to an
excessive number of re-excision surgeries. In our multidisciplinary approach, our pathologists carefully
sample and examine surgical margins, and when we see a narrow margin that is only focally present, our
radiation oncologists consider increasing the boost dose to this site.
Prospective trials have been conducted to analyze whether wider margins can replace the need for radiation
therapy for DCIS. One prospective trial of 158 patients by Wong et al failed to show that excision to ≥ 1-
cm margins alone was adequate for treatment of small (≤ 2.5 cm) low- or intermediate-grade DCIS.[9] The
study was closed prematurely because of a high local failure rate of 2.4% per year, or a 5-year projected
rate of 12%. The multi-institutional ECOG 5194 trial also prospectively evaluated whether excision alone
served as adequate treatment of DCIS, and this study did demonstrate a satisfactorily low 5-year local
recurrence rate of only 6.1% among patients with low/intermediate-grade DCIS.[10] Although all cases of
low/intermediate-grade DCIS ≤ 2.5 cm were eligible for the study, the median tumor size in this group of
565 patients was only 6 mm, with 76.5% of the tumors less than 10 mm. In addition, although margin width
of ≥ 3 mm was accepted as negative, nearly 50% of patients in this group had margins ≥ 1 cm and only
28% had margins < 5 mm. In light of these findings, we generally advise our patients that excision alone is
adequate for treatment of low/intermediate-grade DCIS with more minimal disease than the criteria
suggested by the ECOG study would accept—those patients with < 1 cm extent of low/intermediate-grade
DCIS with at least 5- to 10-mm margins. We do not recommend surgical excision alone for high-grade
DCIS, even when it is small (< 1 cm), given the high 5-year recurrence rate of 15% in this subgroup.
Regarding the role of sentinel lymph node biopsy (SLNB) for DCIS, we echo the authors' recommendation
that SLNB should be performed when there is pathologic suspicion of invasion (either parenchymal or
angiolymphatic) on core biopsy due to the high risk of upstaging to invasive carcinoma in this setting. We
also advocate for the use of SLNB in mastectomy for DCIS. However, the role of SLNB in “identifying
occult invasion in patients with pure DCIS on lumpectomy” is dubious and yields little useful prognostic
information at the cost of a 3% to 7% risk of chronic arm lymphedema. In addition, SLNB can be readily
performed subsequent to the initial lumpectomy if upstaging to invasive disease occurs, since high success
rates for SLNB have been demonstrated by several groups in this setting.[11,12] In fact, the National
Comprehensive Cancer Network 2010 clinical practice guidelines do not recommend SLNB in the setting
of lumpectomy for DCIS (regardless of grade); a joint committee of the American College of Surgeons, the
American College of Radiology, and the College of American Pathologists reached a similar conclusion.[13]
In summary, we support Sanders and Simpson's conclusion that the management of DCIS needs to be
individualized, depending on such factors as histologic grade, the extent of disease, and margin status.
However, we would argue that the subset of patients who can be successfully and confidently treated by
lumpectomy alone (DCIS < 1 cm, margins > 5 mm, low or intermediate grade) is far smaller than the
majority who still benefit from the addition of radiation therapy.
Financial Disclosure: The authors have no significant financial interest or other relationship with the
manufacturers of any products or providers of any service mentioned in this article.
Management of DCIS—A Work in Progress - Cancer Network – By Swati Kulkarni –
Improved screening practices have lead to a dramatic increase in the diagnosis of ductal carcinoma in situ
(DCIS) over the past 40 years. At present, it accounts for about 30% of newly diagnosed breast cancers.
[1] Our current understanding of the natural history of DCIS indicates that it is an immediate, nonobligate
precursor of invasive cancer. DCIS is confined to the breast parenchyma, but if it progresses to invasive
breast cancer, the potential exists for the development of distant metastasis and subsequent death. The
primary goal of treating DCIS is thus to prevent the development of invasive cancer. Treatment of DCIS is
successful for most women; however, the disease can recur, and half of all local recurrences present as
invasive breast cancer. At present, we still have a limited understanding of which cases of DCIS will
ultimately progress to invasion and which cases will be resistant to therapy. Therefore, tailored management
of DCIS is still a work in progress.
Key Studies of DCIS Treatment
The current treatment recommendations for DCIS are based on the findings from four prospective
randomized studies conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP B17
and NSABP B24), the European Organisation for Research and Treatment of Cancer (EORTC), and
DCIS trialists in the United Kingdom, Australia, and New Zealand (UK/ANZ).[2-5] NSABP B17
compared lumpectomy alone to lumpectomy and whole-breast radiation in women diagnosed with DCIS
who had negative surgical margins. The addition of radiation reduced the risk of both noninvasive and
invasive recurrence by 50%. NSABP B24 compared lumpectomy and whole-breast radiation to
lumpectomy, whole-breast radiation, and tamoxifen(Drug information on tamoxifen); it found that the
addition of tamoxifen further reduced the incidence of invasive in-breast recurrence by 44%. The incidence
of contralateral invasive breast cancer was also reduced by 52%.[6] In the two NSABP studies, negative
surgical margins were not required and some women received a radiation boost to the lumpectomy cavity in
addition to the whole-breast radiation. The two other studies found that radiation reduced recurrence by an
amount similar to that seen in the NSABP studies; however, no benefit was seen with the addition of
tamoxifen, and none of the studies demonstrated a survival benefit from the addition of radiation.[7] In these
original studies, the effects of histologic grade, margin width, and hormone receptor status on risk of
recurrence were not evaluated.
An update of the two NSABP studies was recently published by Wapnir et al. The goal of the update was
to evaluate long-term invasive ipsilateral in-breast recurrence outcomes in the two studies. The update
confirmed previous findings: mortality from DCIS is low regardless of treatment, and recurrence risk is
highest in patients who do not receive radiation therapy or tamoxifen.[6]
Prognostic Factors and Treatment Decisions
Since these studies were first published, a number of investigators have attempted to identify prognostic and
predictive factors that would enable clinicians to provide a more tailored approach to therapy for DCIS, to
insure that women are neither overtreated nor undertreated. The authors highlight appropriate specimen
processing and specimen imaging techniques for ensuring an adequate resection, and they note the
importance of margin status as a strong prognostic factor. In addition to obtaining specimen radiographs,
imaging of the breast after surgical resection but prior to radiotherapy should be done to ensure that no
residual calcifications remain. The effect of margin status on the risk of recurrence in DCIS has been
assessed in a number of retrospective studies.[8] There is a consensus that negative surgical margins (no
tumor at the ink) are associated with a reduced incidence of recurrence, but beyond that, there is little
agreement on what constitutes a negative margin for DCIS and how this information can be used to make
clinical decisions about adjuvant therapy. Among the reasons for this lack of consensus about margin status
in DCIS are the following:
• Margin widths in the operating room can differ significantly from margin widths found in pathology because
of the specimen compression that can occur as a result of specimen mammography after needle localization.
• Specimen processing can vary from institution to institution.
• It is difficult to study margin status prospectively.
The authors also include histologic grade and morphology as important factors that may impact the choice of
surgical therapy and adjuvant therapy. Caution should be exercised in interpreting studies because of the
different DCIS scoring criteria and the morphologic heterogeneity of DCIS lesions, which may not be
apparent on the core biopsy.[9] Particular attention has been focused on identifying clinicopathologic
variables that identify women who may forgo radiation therapy. Having margin widths greater than 1 cm has
been suggested as a potential criterion for omitting radiation.[10,11] Based on the findings from ECOG
5194, women with low-grade DCIS appear to have a lower incidence of recurrence when radiation is
omitted, but long-term follow-up data have not been reported.
Younger women are at increased risk of recurrence; at present, however, age alone should not sway the
choice of surgical therapy towards mastectomy in women motivated to undergo breast conservation.[12] In
addition, a number of tools that incorporate a range of pathologic and clinical factors—such as the Van
Nuys Prognostic Index[10] and the Memorial Sloan-Kettering Cancer Center nomogram[13]—have been
developed, although to date neither of these two tools has been validated in a prospective fashion.
Surgical Management of DCIS
Once the diagnosis of DCIS has been confirmed on core biopsy, the recommendation for surgical
management should be based on the extent of microcalcifications identified on diagnostic mammography.
MRI has been widely used at many centers in recent years to determine extent of disease. At present,
however, its role in management is controversial, and MRI may in fact be detrimental, since it increases the
number of women who undergo mastectomy.[14] Standard treatment for DCIS includes breast-conserving
surgery, often involving wire or radioactive seed localization; whole-breast radiation therapy; and tamoxifen
for localized DCIS. Simple mastectomy and sentinel node biopsy are recommended for extensive or
multicentric DCIS and for women in whom adequate cosmesis cannot be achieved because of breast size.
Women who undergo lumpectomy for pure DCIS do not require sentinel lymph node biopsy (SLNB) as
part of their procedure. If there is a question of microinvasion on core biopsy, an associated mass, or
extensive DCIS requiring mastectomy, then SLNB should be added. Some experts include the presence of
high-grade DCIS as a criterion warranting SLNB, since this is yet another characteristic associated with an
increased likelihood of finding invasive cancer. It should be remembered, however, that SLNB is an
additional surgical procedure with associated risks and morbidity, including seroma, infection, temporary
paresthesias, and lymphedema; thus, it should not be used as a tool for identifying the presence of occult
invasion in women with pure DCIS on core biopsy. SLNB cannot be reliably performed in the absence of
breast parenchyma; therefore, the rationale for performing SLNB in women undergoing mastectomy is to
avoid having to do an axillary dissection, with all of its associated morbidities, in the event that invasive
cancer is identified in the mastectomy specimen.
Current Status of Molecular Markers
Lari et al recently completed an extensive review of molecular markers in DCIS, and they concluded that for
the most part, the data on the prognostic and predictive value of these markers are contradictory.[15] A
greater understanding of the utility of estrogen receptor (ER) and HER2/neu status in DCIS will likely
emerge with the upcoming publication of multicenter randomized trials—NSABP-B35, which randomly
assigned women with DCIS to treatment with either tamoxifen or aromatase inhibitors, and B-43, which is
examining the effect on HER2-positive DCIS of adding trastuzumab(Drug information on trastuzumab)
(Herceptin) to the treatment regimen. Going foreward, more research clearly needs to be focused on
furthering our understanding of the biology of DCIS before we can comfortably stratify DCIS and offer
patients a more individualized approach.
Financial Disclosure: The author has no significant financial interest or other relationship with the
manufacturers of any products or providers of any service mentioned in this article.
August 16, 2011
"Integrative medicine" further evolves into "evidence-based complementary medicine. Nothing changes -
ScienceBlogs (blog) – by Orac -
One of these days I'm going to end up getting myself in trouble.
The reason, as I've only half-joked before, is that, even though I'm not even 50 yet, I'm already feeling like a
dinosaur when it comes to "complementary and alternative medicine" (CAM) or, as it's called more
frequently now, "integrative medicine" (IM). These days, we now have the National Center for
Complementary and Alternative Medicine (NCCAM), the Bravewell Collaborative, and a number of other
forces are conspiring to "integrate" quackery with real medicine. As part of that task, it's been necessary to
rebrand quackery, a process that's been going on for at least 20 years now. I described this evolution of
quackery in what was a bit of a facetious post that strikes me in retrospect as being a bit pretentious when I
reread it. Not that I'm incapable of pretentiousness; it's in my blood, and at times it has to come out.
In any case, near the end of that post, I pointed out that CAM was rebranded because the very name
contained the words "complementary" and "alternative," both of which imply (correctly, as it turns out) that
the quackery falling under the CAM rubric is inferior to science-based medicine, mere icing on the cake.
Where real medicine does the real work of curing the patient, CAM is merely "complementary"; i.e.,
unnecessary but helpful. Of course, CAM is not only unnecessary but most of it is not particularly helpful
(some of it can even be harmful). Calling it "integrative medicine" is a subtle change, but, I think, intentional.
If you "integrate" something, it implies more equality. Indeed, practitioners of IM even come out and say that
they're "integrating" the "best of both worlds." In reality, as I like to emphasize agains and again as something
that can't be repeated too often, IM is "integrating" quackery with medicine. I'll also repeat what I said a
couple of weeks ago after reading the words of a CAMster: CAM is indeed dead, but it is the CAMsters
themselves who killed it. The killing of CAM was deliberate and calculated, with CAM replaced by IM. I
speculated that it wouldn't be long before even the term "integrative medicine" wouldn't be enough.
I was more right than I realized.
So sayeth Barrie Cassileth, PhD, Chief of the Integrative Medicine Service at--depressingly--one of our
greatest cancer centers, Memorial Sloan-Kettering:
During the 1960s and 1970s, the concept of a holistic approach to treating disease that took into account
the body, mind, and spirit grew in patient popularity and morphed into two basic categories: alternative and
complementary, which later became known by its acronym CAM (complementary and alternative
medicine). However, because alternative therapy refers to unproven or disproven treatments that have no
place in legitimate cancer care, integrative medicine experts, including Barrie R. Cassileth, PhD, Chief,
Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center in New York, say the terminology
is misleading and confusing and needs to be abandoned. Even the term "integrative medicine" can be
misleading, said Dr. Cassileth, who instead uses a more accurate term to describe the practice of integrative
oncology: evidence-based complementary medicine.
One wonders, one does, why Dr. Cassileth doesn't eliminate the name "integrative medicine" from her own
service at MSKCC, given that she's the chief of the service, if she really thinks that the term is now
outmoded. Of course, "Evidence-Based Complementary Medicine" Service would be kind of a clunky
name, but I suppose it could be shortened to EBCM, which reminds me of ICBM, which reminds me of
nuclear explosions. Sorry, I just can't help it. I was, after all, raised during the Cold War and still remember
the fallout shelter and air raid drills we had in grade school. Younger farts than this old fart probably won't
make such associations.
It is, of course, also interesting that Dr. Cassileth doesn't choose to use the term "science-based
complementary medicine." I've discussed the difference between science-based medicine and evidence-
based medicine before, and Dr. Cassileth seems to be perpetuating the difference. Remember, evidence-
based medicine downplays prior plausibility based on basic science, relegating basic science considerations
to the lowest rung on the evidence hierarchy, whereas science-based medicine does consider prior
plausibility. I know I use the example of homeopathy often in trying to illustrate this, but it's just so perfect an
example. Homeopathy, as you recall, posits that (1) like cures like (i.e., you use a substance that causes a
symptom in order to eliminate that symptoms) and (2) diluting such a remedy to the point of nonexistence (as
in many orders of magnitude more than Avagadro's number) makes it stronger. It's pure magical thinking,
invoking the ancient principles of sympathetic magic. Even so, because of the limitations in randomized
clinical trials and the fact that, by design, at the very minimum 5% of such trials will be false positives
because of where scientists choose by convention to set their measure of statistical significance, there are a
number of false positive trials of homeopathy. Also, as John Ioannidis has shown us, in actuality it's more
than 5% of clinical trials that produce false positive results. Because evidence-based medicine fetishizes
randomized clinical trials above all else, it just won't allow scientists to reject homeopathy, because there are
always equivocal trials to which woo-meisters can point as "evidence" that there might just be something to
homeopathy. Contrast this to science-based medicine, where, because the principles of homeopathy violate
well-established laws of physics, homeopathy can be relegated to being impossible; that is, until homeopaths
produce evidence for it at least as compelling as all the evidence from physics, chemistry, and biochemistry
that say homeopathy can't work.
Here's a hint: Equivocally "positive" clinical trials are not enough.
I realize that I just digressed into fairly well-trodden territory, but I felt I had to do it, because Dr. Cassileth
said something in this interview that actually partially made sense:
By making the term evidence-based complementary medicine more commonplace, Dr. Cassileth is hoping
to educate both medical professionals and patients about the helpful, appropriate complementary therapies
that are available, and distinguish them from the all-too-available questionable approaches.
"If promoted techniques are found to be worthless or if they are patently absurd, such as homeopathy, they
should be avoided. The medical world is in turmoil around these issues, and the public typically cannot tell
the difference between viable interventions and quackery. I spend half my time studying whether
complementary approaches relieve patients' specific physical and emotional symptoms and the other half
trying to get rid of quackery. It's not an easy task," said Dr. Cassileth.
Did Dr. Cassileth just characterize homeopathy as "patently absurd" and "useless"? Shockingly, she did! It's
rare indeed for an advocate of CAM/IM to characterize any alternative medical system as absurd. True, it's
completely appropriate to characterize homeopathy as absurd. It's even refreshing to hear. There's just one
problem. As you might recall, Dr. Cassileth herself supports alternative medicine modalities every bit as
ridiculous as homeopathy, having done a number of studies of acupuncture, including for hot flashes. When
the study was negative, she tried to spin it as being due to acupuncture that was "not optimal." She's also
proud of a study she's doing on acupuncture right now:
We are also enthusiastic about our acupuncture research program, and we're about to complete a study of
acupuncture treatment for lymphedema. We first conducted a small pilot to make sure that acupuncture was
safe. It was. The study had a stopping rule: achieving at least a 30% reduction in lymphedema in a minimum
of 40% of patients. The study stopped very quickly. Now we are embarked on a larger pilot with a
mechanism component.1 The regimen is two acupuncture treatments a week for 4 weeks and then monthly
follow-up phone calls to make sure that no adverse late events occur. These are important areas of research
for us.
I would argue that Dr. Cassileth is rather selective in what she considers to be "patently absurd" and that the
principles of acupuncture are pretty darned absurd, arguably as absurd as those of homeopathy. Think
about it. What's the idea behind acupuncture? Basically, it's vitalism, in which it is believed that sticking
needles into certain parts of the body somehow "unblocks qi," which is basically "life energy" or "vital force."
This qi flows through pathways known as meridians, which (of course) do not correspond to any known
anatomic structures, no matter how much acupuncturists try to convince us that they do. What is less
"patently absurd" about acupuncture than homeopathy? I'm having a hard time thinking of anything, other
than the fact that acupuncture involves the insertion of actual needles into the skin and can therefore cause
actual complications.
In any case, I went and looked up Dr. Cassileth's study, A safety and efficacy pilot study of acupuncture for
the treatment of chronic lymphoedema. First off, it didn't help that the study was published in Acupuncture in
Medicine. CAM journals tend to be--shall we say?--not particularly rigorous. Dr. Cassileth's paper fits right
in. Basically, it's an uncontrolled study of acupuncture in women with lymphedema due to breast cancer
surgery. Practitioners of traditional Chinese medicine on staff at MSKCC treated nine women with
lymphedema, and these were the results:
Study goals were met after nine subjects were treated: four women showed at least a 30% reduction in the
extent of lymphoedema at 4 weeks when compared with their respective baseline values. No serious
adverse events occurred during or after 73 treatment sessions.
Now hold on there, pardner.
I realize that this study was designed only to assess safety, but without a control group the 40% of women
showing at least 30% decrease in lymphedema is a meaningless number. For one thing, four weeks is far too
short a time period. Lymphedema can wax and wane over time; that several women at four weeks doesn't
mean much at all; doing nothing could well have yielded a similar result. There's no way to know. Similarly,
because lymphedema can wax and wane, single measurements are not particularly informative. Repeated
measurements over time are needed. Finally, the most accurate way to measure lymphedema is not arm
circumference, but rather water displacement. (The patient sticks her arm in a long bucket of water, and the
amount of water displaced is measured.)
More importantly, when I looked at Table 2, which showed the characteristics of the women who had a
"response" to acupuncture, I noticed something right away. The baseline difference in centimeters between
the unaffected arm and the lymphedematous arm was much smaller in the responders (2.2 cm) than in the
non-responders (6.4 cm). In other words, the women who "responded" to acupuncture had mild
lymphedema, which is the sort of lymphedema that's more likely to wax and wane. Basically, as far as telling
us anything other than that they didn't have any complications in nine patients; the study tells us little or
nothing about acupuncture for lymphedema. Based on physiology and science alone, however, it's incredibly
implausible that acupuncture would do anything for lymphedema anyway.
Basically, Dr. Cassileth is trying to have it both ways. First, she's trying to paint herself as a proponent of
science, an enemy of quackery, even, describing a recent IM conference:
At the other end of the spectrum, in Europe and in other parts of the world, purveyors of bogus "treatments"
have taken over the term "integrative medicine." In Europe especially, integrative medicine and integrative
oncology have become synonymous with quackery.
An important issue that emerged at this conference was the extent to which quackery is a huge problem
throughout Europe and in other parts of the world. In the United States, where quackery has been
prominent for many decades, it is a $40 billion-a-year business.
All of which makes me wonder how Dr. Cassileth defines "quackery," when she believes that acupuncture
works. She does realize, however, the power of language, as she laments the association of "integrative
medicine" with quackery:
It also makes it very difficult for health-care professionals because they're not always sure what the terms
integrative medicine and integrative oncology imply. Words have meaning, and they can have a detrimental
as well as clarifying impact. We fought very hard to get away from the term "alternative therapy" because
there are no viable alternatives to mainstream cancer care. We have to clarify the terminology, and I am now
referring to complementary therapies as "evidence-based complementary medicine."
Dr. Cassileth's right. Words have meaning, and language has power. That's the very reason that "quackery"
morphed into "alternative medicine," "alternative medicine" morphed into "complementary and alternative
medicine," and "complementary and alternative medicine" morphed into "integrative medicine." It's the same
reason that "integrative medicine" is now morphing into the clunkier, less sexy, "evidence-based
complementary medicine." The problem is that evidence is as evidence does, and the evidence being used to
support quackery like acupuncture is no better than the evidence homeopaths use to try to support their
woo. I'm glad to hear that Dr. Cassileth is worried about quackery; I'm not so glad to see that the main
reason she's worried about it is because she wants to protect the quackery she believes in from being tainted
with all the other quackery. I would suggest that Dr. Cassileth needs to reassess exactly what it is that she
means by "evidence-based complementary medicine" and consider adding some actual basic science
considerations to the mix. I realize that she's trying to be one of the good guys, but she's become part of the
problem.
se Training & Consulting to Provide Breast Cancer Rehabilitation Training September 10 – 11 in Pittsburgh,
Pennsylvania - SBWire (press release) –
Lafayette, CO -- (SBWIRE) -- 08/16/2011 -- Klose Training & Consulting, a lymphedema certification
and education company, will provide professional training for Breast Cancer Rehabilitation at LifeCare
Hospital (formerly HealthSouth) in Monroeville, Pennsylvania, September 10-11, 2011. The educational
program is designed to provide essential knowledge of outpatient therapeutic approaches in breast cancer
care.
Klose Training’s breast cancer rehabilitation course totals 16 hours of instruction. Course curriculum
includes a comprehensive review of current diagnostic, surgical, radiation, reconstructive and medical
oncologic management for breast cancer.
The course instructor is Jodi Winicour, PT, CMT, CLT-LANA, MLD/CDT Instructor. Jodi is a 1993
graduate from Indiana University’s Physical Therapy program and obtained her massage therapy
certification in 1997 from Michigan’s Health Enrichment Center. Since 2000, Jodi has served as a class
instructor for Klose Training & Consulting’s Lymphedema Therapy Certification course. She is the author
and instructor for one of Klose Training’s most successful continuing education courses, “Breast Cancer
Rehabilitation.”
About Klose Training
Klose Training & Consulting provides Lymphedema Therapy Certification Courses internationally and
throughout the U.S. They are dedicated to providing individual attention to each participant during the initial
training, and offer ongoing support and education throughout the careers of their graduates. For more
information about Lymphedema Certification Courses, please visit http://www.klosetraining.com
New business aids in fight against breast cancer - Berkshire Eagle – New business aids in fight against
breast cancer
Berkshire Eagle - By Amanda Korman –
PITTSFIELD -- After several years in Philadelphia, a family-owned business selling fashionable medical
devices for breast cancer survivors is moving to the downtown Pittsfield space previously occupied by the
now-defunct Berkshire Living magazine.
Planning to open at 7 North St. on Sept. 6, LympheDIVAs sells lightweight, stylish compression sleeves and
gloves that address lymphedema, an arm-swelling condition associated with breast cancer treatment.
The company, founded by Rachel Levin Troxell in 2006, continued on under the leadership of her parents,
Dr. Howard and Judy Levin, after Troxell died from breast cancer in 2008 at age 37. Troxell's brother, 35-
year-old Josh Levin, is now president and precipitated the company's move to Pittsfield to make good on a
long-held desire to live in the Berkshires.
"I thought it would be a great place to live and to work," said Levin, who is bringing two employees from
Philadelphia and hiring two more in the Berkshires.
Manufactured in North Carolina, the compression sleeves and gloves will be dyed and packaged at the
Pittsfield location. The company sells online and to distributors.
Troxell began LympheDIVAs with two business partners after she had a number of lymph nodes removed
during breast cancer treatment and contracted lymphedema. The only option on the market at the time was a
thick, hot, ACE-bandage-like sleeve, but Troxell wanted something more comfortable and fashionable.
Five years later, the company sells about 18,000 thin, sweat-resistant, colorful pieces annually. Pairs of
sleeves and fingerless gloves sell for between $100 and $145. LympheDIVAs operates with a budget
between $500,000 and $1 million each year, Howard Levin said, and began turning a profit last year. Levin
estimated that LympheDIVAs makes up about 0.1 percent of the compression sleeve market, but he and his
family hope to see that amount increase to about 10 percent in the future.
At bottom, the family says their business is about giving breast cancer survivors options.
"At its core this is a mission-driven business," said Howard Levin.
For women who want to minimize the sleeve's visibility, there are 30 different skin tones. For those who'd
prefer to show off a style item, there are patterns from leopard skin to paisley to tattoo.
As in any fashion business, the company's seven employees confer twice a year about their spring/summer,
fall/winter and sports lines.
"[Rachel] wanted them to have something that was fun -- it's not lemonade out of lemons, but it's sort of like
that," said Judy Levin. "It just makes them feel good, and that was very important to Rachel."
In black and hot pink, the packaging, too, says "boutique" rather than "drug store," another element that
Levin said was significant to her late daughter.
"This is Rachel's legacy, and we made a promise that we would try to make it a success," Judy Levin said.
"Basically, this is what she wanted, and we feel she is living on in this."
For more information on LympheDIVAs: www.lymphedivas.com, 1-866-411-3482.
August 18, 2011
Health dept to check filaria cases - Times of India –
ALLAHABAD: Besides creating awareness on malaria, the health department has deputed teams to
prepare the blood slides of patients having symptoms of filarial. The teams, equipped with filarial detecting
kits, will meet the people between 10pm and 12 midnight. They will be led by the district malaria officer
(DMO). This would be done because many patients have complained that they have fever only during night.
The teams would comprise doctors and basic health workers including ASHAs and ANMS.
Filaria or filariasis is an infectious disease caused by threadlike worms called roundworms. Swelling of arms,
breasts and legs are its major symptoms. This swelling is called lymphedema because of the name lymphatic
filariasis. Filaria also causes damage to the lymph system which leads to fluid collection. The swelling also
increases the risk of bacterial infection.
Deputy chief medical officer Dr Kalim Akmal told TOI: "As the threat filarial infection also looms large,
health department has instructed the medical officers and para-medical staff to take care of patients having
symptoms of filarial." He added: "We have advised medical teams to make blood slides of patients suffering
from fever to ascertain whether they are filaria positive or not."
Free cancer information service helpful to 830 in Ontario Northeast region - Sault This Week – By Ontario
Press Service press release –
Fear, anxiety, helplessness, anger – these are some of the often overwhelming feelings that people can
encounter when dealing with cancer. When faced with a cancer diagnosis, knowledge is power. In early
August, the Canadian Cancer Society celebrated helping one million Canadians answer their cancer-related
questions. Since 1996, this free service has provided information on all types of cancer, diagnostic tests,
treatments, side effects, and clinical trials. In 2010, the service responded to more than 23,000 inquiries in
Ontario and of this number 831 inquiries were from Ontario Northeast region, which includes Sault Ste.
Marie, Sudbury, North Bay and Timmins.
Kim McColl of Napanee, Ont. contacted the service numerous times since receiving a breast cancer
diagnosis back in 2007. "The Cancer Information Service is one of the many reasons I think I'm still here,"
said McColl. "Their information is accurate and compassionate. They go out of their way to send you more
information. Nothing is ever too much trouble."
Now four years later, the retired music teacher is living cancer-free but side effects of the breast cancer
surgery she endured remain. Even now, McColl doesn't hesitate to call the Cancer Information Service
when she has any questions. In June of this year, she contacted the service about lymphedema, a common
condition that affects many breast cancer patients and survivors.
"People often feel overwhelmed when dealing with a cancer diagnosis and treatment," says Janet MacVinnie
who manages the Cancer Information Service in Ontario. "Our Cancer Information Service has been proven
to reduce stress and anxiety for patients because the service helps them get a better understanding of their
type of cancer, treatment options and find services in their community."
If you know someone who is facing cancer, either as a patient or caregiver, the Cancer Information Service
can be reached at 1 888 939-3333 (TTY 1 866 786-3934) or cis@ontario.cancer.ca. Assistance is
available in more than 100 languages through a professional interpreter service
August 16, 2011
Lymphedema Depot Presents Re-Designed Solaris ReadyWrap - Wire Service Canada (press release) –
Solaris Inc has redesigned the ReadyWrap line of compression binders to create a versatile full-leg, low
profile, low stretch compression garment. ReadyWrap medical binders are the perfect alternative to elastic
compression hosiery. With standard-sized foot, calf, knee, and thigh units, you can get an off-the-shelf full-
leg solution that offers a custom fit.
The low-stretch materials ReadyWrap is made from work with the venous and lymphatic systems to
naturally improve fluid movement, enhancing the calf's natural muscle pump and producing low resting and
high working pressures. ReadyWrap's easy Velcro™ closure system also allows for easy donning and
removing. This is especially helpful for individuals who have difficulty putting on elastic compression
garments.
Where previously only the foot and calf pieces were available in standard sizes, the knee and thigh pieces
have now been added to the standard-sized line.
Design improvements have been made in each of the separate ReadyWrap units. The foot piece is now left-
right specific and offers increased compression around the ankle. This is a simple, easy to don foot
compression device that does not involve any wrapping or troublesome extra pieces to manage. It is thin
enough to often be worn inside regular street shoes.
The straps on the calf and thigh units have been re-designed to offer smooth gradation of pressure and an
ability to accommodate irregularly shaped limbs, all without gapping of the individual straps.
The knee piece goes on last for easy adjustment as needed. The whole leg system can be used in cases of
primary or secondary lymphedema, chronic venous insufficiency, lipedema and related disorders. The full leg
system is optional; if the patient only needs compression in the lower leg then individual pieces can be utilized
to create the compression device that is needed.
Lymphedema Depot distributes ReadyWrap in Canada, in addition to the Solaris Tribute, Caresia and Swell
Spots. Learn more about ReadyWrap and all the Solaris products at http://LymphedemaDepot.com.
Lymphedema Depot can be reached at info@lymphedemaDepot.com.
August 18, 2011
Industry Leaders Hinson and Friel Join Wright Therapy Products - PR Newswire (press release) –
PITTSBURGH, Aug. 18, 2011 /PRNewswire/ -- Wright Therapy Products, Inc. announced today that
Michael Hinson has been appointed President and Chief Executive Officer of the company. The company,
based in Oakdale, PA, manufactures and sells pneumatic compression devices targeted for the treatment of
lymphedema, venous insufficiency and the sports medicine markets. Hinson joins Wright Therapy after
holding senior financial and sales leadership positions at MEDRAD, Inc, a global leader of diagnostic and
therapeutic devices.
"I'm very excited to join a company like Wright Therapy," said Hinson. "The company is well-positioned to
serve our growing senior population, the group primarily afflicted with these terrible diseases. I know I
speak for everyone at Wright when I say we're proud to provide solutions that help these patients live
normal lives." Hinson will also serve on the company's Board of Directors.
Wright Therapy additionally announced that John Friel, former President & CEO of MEDRAD, Inc. has
joined the company's Board of Directors. Friel orchestrated MEDRAD's global strategies for two decades.
During his tenure, Friel sparked the innovation and commitment to excellence that drove significant growth at
MEDRAD and solidified the company as a global leader. "I am very honored to join Wright Therapy's
Board of Directors and am excited about the potential manufacturing job growth the company brings to the
Western PA region," he said. "Given that I have lymphedema myself, I value the positive impact Wright's
innovative technology and products have on patients like me."
Jim Liken, chairman of Wright's Board of Directors commented, "We're extremely pleased to add Mike and
John to our leadership team. Their backgrounds working with a high-growth medical device company will
be very useful as we complete our current investor funding activities and look to fuel our growth in the U.S.
market."
About Wright Therapy Products
Wright Therapy Products is a leading provider of Compression Therapy Systems. In 2011, we will
celebrate 28 years of excellence, innovation, and quality. Our expertise in compression technologies is
helping medical professionals provide solutions so their patients can live life to the fullest. Improving quality
of life for patients is the core of our commitment. Our vision of the future commits resources and expertise to
the development of new cost effective treatments that provide solutions to real pressing healthcare needs.
www.wrighttherapy.com
SOURCE Wright Therapy Products, Inc.
August 23, 2011
King City district sued over discrimination - Monterey County Herald – By CLAUDIA MELÉNDEZ
SALINAS
Former teacher says disability was ignored
Former King City photography teacher Kathryn Beilby was diagnosed with chronic lymphedema and
osteoarthritis in 2002, which made her limbs swell up and walking painful.
Nonetheless, she continued working until 2006, when she asked the King City Union School District to give
her accommodations under the American with Disabilities Act: Namely, she wanted to park closer to her
classroom and she wanted the classroom to be closer to an accessible restroom.
Instead the district gave her a golf cart, which allowed her to move about, even ride to the restroom.
A year after State Administrator John Bernard took over the district, the golf cart was gone.
"The first day he saw me going toward the bathroom in it, I saw that look on his face that said 'This isn't
gonna be going on,'" Beilby said. "It went downhill from there. He decided last August when I came back to
school he did not think I was disabled at all."
Beilby is now suing Bernard and the district for employment discrimination, failure to prevent discrimination
and harassment, failure to accommodate her disability, retaliation and infliction of emotional distress. Beilby
is seeking damages, restoration of all her employment benefits, loss of future earnings and other unspecified
damages.
Beilby declined to say how much she's seeking. A call to her attorney was not returned.
It is the second lawsuit that has been filed against Bernard in recent weeks. Last month, the King City
Teachers Association sued Bernard for eliminating the district's long-held practice of allowing teachers to
give a better grade to those students who did well on state standardized tests.
Bernard is under fire for several practices he's implemented since taking over the district in 2009, when the
district was bankrupt and received an emergency loan from the state. In previous interviews and at an
Assembly hearing on school takeovers last week, Bernard said that change brings discomfort, and that the
district was in need of many changes.
On Monday, Bernard declined to comment for this story.
"I'm not able to respond to the lawsuit since it's a personnel matter," he said. "We'll resolve this using the
legal process."
A photography teacher since 1982, Beilby was reassigned to teach art for the 2010-11 school year as part
of Bernard's district re-organization. She was given a bigger classroom — which meant more walking. By
October, she had to take a week off due to increased pain in her knees, she said.
"I was supposed to have knee surgery in December, it got postponed to March, so I had one knee done in
March and one in May," Beilby said. "I missed going to family functions, birthdays, just because (Bernard)
decided I didn't need a golf cart."
Beilby also asked for an accessible bathroom, so a "Port-O-Potty" was parked outside her classroom — a
humiliating experience, Beilby said.
"Defendant's installing of the 'Port-O-Potty' was demeaning to plaintiff, unsafe and inappropriate for
plaintiff's use, and unacceptable in the presence of high school-aged students and others on campus," the
lawsuit reads.
Attorneys for Bernard and the district have filed an answer to Beilby's complaint denying all the charges, and
indicating they intend to mount an affirmative defense, which means they'll argue the district was excused or
justified in its behavior.
For instance, the answer alleges Beilby was careless and negligent, that she has not exhausted all
appropriate administrative remedies, and that, if there was any injury or damage, they were caused by third
unknown parties.
Claudia Meléndez Salinas can be reached at 753-6755 or cmelendez@montereyherald.com.
August 24, 2011
Seven years of swollen limbs – Trentonian - By Emily Mountney
John Glover really misses square dancing.
He also misses driving, among other things.
The 55-year-old Trenton resident has suffered with a disease called bilateral lymphedema for seven years.
"It all started with a fall down some concrete stairs," said Glover.
In June of 2004, while carrying the lumber needed to build shelves into a friend's apartment, he slipped on
some concrete steps and fell. Within 45 minutes, his feet, ankles and legs had swollen.
The swelling has never gone away — in fact, the circumference of his feet at one point reached 37 inches.
Jogging pants and pyjama pants are his only pant choices — nothing else can fit around his legs. The only
shoes he can wear are a pair of knitted slippers, made by his cousin. His friend, Donna Pearce, took the
slippers to a shoe repair business and got them to attach a rubber sole onto the shoe. She then crafted an
insole for the slipper, to make it more like a shoe.
Pearce is a retired multi-skilled hospital worker.
She helps Glover on a daily basis, preparing food, his pills, washing the dishes, doing the cleaning, shopping
for him and even helping him in the bathroom.
"I'm like his Jack of all trades," she said.
Glover also suffers from arthritis in his knees, which often "give out" due to the arthritis combined with the
weight of his legs.
He also suffers from epilepsy and Dupuytren's contracture. He said he has seen more doctors in the past
seven years than in his entire life.
Currently there is no known cure for bilateral lymphedema.
Glover has been told by specialists his swelling is caused by the albumin in his blood.
Everyone has albumin in their blood, but his is at a low level.
"It is a protein used to pull fluids from the body for discharge at a later time. My albumin seeps through the
vein walls and into the flesh," he said.
There could be a solution to his plight, Glover said, but he has been unable to access it.
Glover said that a machine called a Lympha Press is often used to help lymphedema sufferers control the
swelling in their limbs.
Through a series of pneumatic sleeves, it pushes the albumin back into the veins so it can be discharged from
the body.
The machine costs upward of $8,000 and can only be purchased by a doctor from stores in Oshawa or
Kingston.
"The one thing I really need, I can't get it," said Glover. "I'm willing to use it every day."
"My understanding is that there is also a man in the surrounding area that has a need for the use of this same
machine," Glover said. "He may be able to use it after I have no need for it."
Glover said the machine is used daily and could take up to two years for full results.
"At least my legs would go back to their normal size," he said.
Glover hopes to acquire the machine, although he said he doesn't know how to go about it.
He has tried contacting local agencies for help, but said he has been unsuccessful so far.
He said he has had no response from MP Rick Norlock's office. The office of MPP Lou Rinaldi told him
they had forwarded Glover's information to the Minister of Health.
While there are other alternatives for treatment, finances and transportation keep Glover from accessing
them.
A Kingston clinic offers therapy for lymphedema, but transportation is $70 per day — $1,400 per month —
which Glover can't afford.
Recently, Glover and Pearce took a trip to the YMCA for him to try out the treadmills.
After walking just a few minutes, Pearce said she noticed a slight decrease in the size of his legs.
"I would pay for the membership, but I have no way to get there," said Glover, adding he can't drive himself,
and cabs would become too costly.
"He can't stand outside and wait for the bus by himself," said Pearce. "His knees could give out and he could
fall and there would be no one there to help him."
Physiotherapy Associates Opens New Physical Therapy Clinic in Golden, CO - PR Newswire (press
release) –
Clinic offers a comprehensive range of physical therapy services
RED ROCKS, Colo., Aug. 24, 2011 /PRNewswire/ -- Physiotherapy Associates, the nation's foremost
provider of outpatient rehabilitation services, recently opened a new physical therapy clinic in Golden, CO.
The clinic offers a comprehensive range of services, including: orthopedic physical therapy, sports
medicine/injury rehabilitation, vestibular rehabilitation, oncology rehabilitation, lymphedema management,
Healthy Partner Programs, geriatric programs, injury prevention and women's health.
Clinic director Marcey Gibson, MPT, CLT, is a graduate of the University of Colorado. She has been
practicing for over seven years in Evergreen and along the Front Range. She is an oncology specialist
certified in the Vodder technique for lymphedema management. Ms. Gibson has extensive experience
managing balance and gait impairments, as well as neurological impairments.
Ms. Gibson stated, "I look forward to providing the highest level of clinical expertise and personalized care
in the Red Rocks area. The ultimate goal for all my patients is to achieve the highest level of functional
independence with their daily and recreational activities using an evidence-based approach."
Steve DiPaola, PT, OCS, Area Vice President, stated, "We are thrilled to open this new physical therapy
clinic in the Golden community inside the Red Rocks Medical Center. The state-of-the-art cancer care
center offers medical oncology, radiation oncology, a breast care clinic of excellence and a cancer care
advisory facility. We are proud to be a part of this premier health center that offers a holistic and
individualized approach to patient care."
Pete Grabaskas, PT, COO of Physiotherapy Associates, stated, "We continue to open clinics like this Red
Rocks facility to reach patients that want to lead healthy lives. This clinic will offer the residents of Golden a
broad range of outstanding physical therapy services."
The clinic offers three compelling reasons to visit: one-on-one care; treatment programs that are overseen by
licensed physical therapists; and successful patient outcomes.
The new clinic is located at 400 Indiana Street, Suite 280 in Golden, CO. There is ample parking with easy
access to the therapy center.
For more information or to schedule a consultation at the clinic, call 720.398.0999 for appointments. The
clinic can be found online at: www.physiocorp.com/facility/60633.
About Physiotherapy Associates
Physiotherapy Associates is the nation's foremost provider of outpatient rehabilitation services.
Physiotherapy Associates employs an industry-leading team of physical therapists and healthcare
practitioners who are dedicated to high-quality patient care. The company provides physical therapy,
industrial rehabilitation and orthotics and prosthetics services to thousands of patients across the United
States. With more than 650 clinics, Physiotherapy Associates is national in scope, local in care. For more
information, visit www.physiocorp.com, follow us on Twitter (@physiocorp) or become a Physio fan on
Facebook.
SOURCE Physiotherapy Associates
August 26, 2011
September events at Gilda's Club Delaware Valley - phillyBurbs.com -
Gilda's Club Delaware Valley is a warm and welcoming place dedicated to building social and emotional
support for men, women and children living with cancer or who have a loved one with cancer. The club also
offers bereavement counseling after the loss of a loved one to cancer. All workshops, sessions and services
are free.
Gilda's Club Delaware Valley is located in Warminster at 200 Kirk Road. Please call 215-441-3290 (www.
gildasclubdelval.org) to become a member or to register for a program or activity.
Here's a list of events happening at the club in September:
"Dinner and Lecture: Talking about Lymphedema with Gina," Sept. 28, 6:30-8 p.m. -- Lymphedema is a
very real concern for many people and in many ways it can be prevented! Gina Smith is a Physical Therapist
for Cancer Treatment Centers of America and is certified as a Lymphedema Therapist.
August 28, 2011
Boat race on lake benefits paddlers, 2 charities - BlueRidgeNow.com - By Jessica Goodman
LAKE LURE
There was the steady pounding of the drum on Lake Lure as 10 paddlers, with direction from a steersman
and a drummer, paddled their way to victory Saturday during the Lure of the Dragons boat race.
“This venue is growing,” said organizer Tom McKay with Pinnacle Sotheby's International Realty. Ten
teams from across the state, from Raleigh to Charlotte, competed in the games.
The boat race supported two charities, according to Carole McKay, including Camp Lure Crest for
Christian youth and the Hickory Nut Gorge Outreach, which provides food and money in Rutherford
County.
“We started this (boat race) four years ago,” Tom McKay said.
A few of the teams featured cancer survivors, including the Healing Dragons of Charlotte. The team was
started in 2009 and has traveled from Washington, D.C., to Florida to compete in dragon boat races.
Jan Kuhn, a member of the team and breast cancer survivor, said the exercise she gets paddling helps her
condition. She has lymphedema in her arm after having cancer and losing her lymph nodes. The exercise
with the dragon boats forces the fluid out of her arm and reduces the swelling associated with lymphedema,
she said.
“It's better than it ever was,” Kuhn said.
“It's really cool to be part of a team at this part of my life,” fellow member Sherry Latten said.
“It's so much fun. It's a great challenge. It's a full-body exercise,” Kuhn added.
The race was part of the seventh annual Hickory Nut Gorge Olympiad, a three-day, family sports festival.
The festival will conclude today with the Race to the Rock starting at 7 a.m. with a 25-mile bike race and
5K, and a medal ceremony for all events at 10 a.m. at Chimney Rock Park.
For more information about the Olympiad, visit www.hickorynutolympiad.com or call 828-429-9011.
August 29, 2011
Tina, needed to join something to read this and I don’t want to join things now, sorry:
Lymph Drainage Massage May Help Edema in Systemic Sclerosis – Medscape –
This is the first study to assess manual lymph drainage in patients with SSc, although the technique has been
used to relieve lymphedema in women who had ...
Lymphedema Support Group Meeting - Ventura County Star –
Your lymphatic system is crucial to keeping your body healthy. But when lymph vessels are unable to
adequately drain lymph fluid, usually from an arm or leg, Lymphedema, a swelling, occurs.
Lymphedema is caused by a blockage in your lymphatic system, an important part of your immune and
circulatory systems. The blockage prevents lymph fluid from draining well, and as the fluid builds up, the
swelling continues.
While there's no cure for Lymphedema, it can be controlled through diligent care of your affected limb. And
having a support system comprised of healthcare professionals and others with Lymphedema has proven to
be an excellent way to share information on its challenges and to receive information on the latest ways to
live a quality life with Lymphedema.
A Lymphedema Support Group, facilitated by Catherine Hines, P.T., C.L.T., a certified Lymphedema
therapist and physical therapist on staff at Los Robles Hospital, meets the last Wednesday of every month
from 7:00 p.m. to 8:30 p.m. at The Lymphedema Treatment Center at the East Campus of Los Robles
Hospital. in the small conference room near the cafeteria, 150 Via Merida, Westlake Village, CA 91362.
Lymphedema patients, their loved ones and caretakers are invited to attend. To make a reservation or for
further information, please call 805-370-4001
August 31, 2011
Berks business log - PennLive.com –
Reading Eagle
St. Joseph Medical Center's Wound Care program added a second outpatient location with a new facility at
Keiser and Broadcasting roads in Spring Township.
It is in the building owned by Berks Family Practice, which relocated there after its building in Kenhorst was
destroyed by a fire in 2010.
Other services at the Spring Township facility include laboratory, physical therapy and lymphedema
management.
The hospital will continue to operate the wound care and hyperbaric medicine program at Sixth and Walnut
streets.
The new location will provide care to patients with hard-to-heal and chronic wounds, including venous
ulcers, diabetic ulcers and pressure sores.
???
Peter Olfs, former head of corporate communications at International Siemens AG, Munich, Germany, will
present "Is There a Way Out for Old Industrialized Nations? Chances To Catch up with Global Realities"
Sept. 9 from 1 to 2:15 p.m. in Luerssen Building 5 at Penn State Berks.
The lecture is part of the fall engineering, business and computing division research interest group series and
is free and open to the public.
Olfs theorizes that as a society, we live above our means, the poor keep getting poorer, our values are
vanishing and as the blood toll rises, our species is dying out.
His presentation focuses on tasks for developed and developing nations, the future role of universities and
practical solutions to combat the issues facing our world.
For more information, contact Dr. Jui-Chi Huang, chairman of the EBC-RIG and assistant professor of
economics, at JXH74@psu.edu.
???
Women2Women and Count Me In will hold its first pitch party Sept. 7 from 6 to 8 p.m. at the Greater
Reading Chamber of Commerce & Industry's Center for Business Excellence, 49 Commerce Drive,
Spring Township.
The purpose is to help women business owners and entrepreneurs practice their business pitches and
receive professional feedback.
Those interested also can use the party to prepare for M3 1000, the Make Mine a Million $ Business
contest, on Sept. 25 and 26 in Philadelphia.
???
The TriCounty Area Chamber of Commerce has Chamber member job openings listed on its website.
Job seekers can visit www.tricountyareachamber.com and find job openings from Chamber member
businesses and organizations.
The new feature is the result of a survey to the membership which indicated a need for the service. Chamber
members can email their job opening information to jeff@tricountyareachamber.com.
Job seekers are welcome to drop resumes off at the Chamber office or send them via email.
For more information, visit www.tricountyareachamber.com or call 610-326-2900.
???
Lehigh Valley Restaurant Group Inc., a franchisee of Red Robin Gourmet Burgers, Inc., is looking for more
than 150 workers to fill slots at the new Red Robin in Tilden Ridge, 125 Wilderness Trail, Tilden Township.
The restaurant is opening in early October. Michael Coleman is the general manager.
For more information, visit the hiring trailer on site to apply in person at 125 Wilderness Trail, off Cabela
Drive.
August 24, 2011
Physiotherapy Associates Opens New Physical Therapy Clinic in Golden, CO - PR Newswire via Yahoo!
Finance
Clinic offers a comprehensive range of physical therapy services
RED ROCKS, Colo., Aug. 24, 2011 /PRNewswire/ -- Physiotherapy Associates, the nation's foremost
provider of outpatient rehabilitation services, recently opened a new physical therapy clinic in Golden, CO.
The clinic offers a comprehensive range of services, including: orthopedic physical therapy, sports
medicine/injury rehabilitation, vestibular rehabilitation, oncology rehabilitation, lymphedema management,
Healthy Partner Programs, geriatric programs, injury prevention and women's health.
Clinic director Marcey Gibson, MPT, CLT, is a graduate of the University of Colorado. She has been
practicing for over seven years in Evergreen and along the Front Range. She is an oncology specialist
certified in the Vodder technique for lymphedema management. Ms. Gibson has extensive experience
managing balance and gait impairments, as well as neurological impairments.
Ms. Gibson stated, "I look forward to providing the highest level of clinical expertise and personalized care
in the Red Rocks area. The ultimate goal for all my patients is to achieve the highest level of functional
independence with their daily and recreational activities using an evidence-based approach."
Steve DiPaola, PT, OCS, Area Vice President, stated, "We are thrilled to open this new physical therapy
clinic in the Golden community inside the Red Rocks Medical Center. The state-of-the-art cancer care
center offers medical oncology, radiation oncology, a breast care clinic of excellence and a cancer care
advisory facility. We are proud to be a part of this premier health center that offers a holistic and
individualized approach to patient care."
Pete Grabaskas, PT, COO of Physiotherapy Associates, stated, "We continue to open clinics like this Red
Rocks facility to reach patients that want to lead healthy lives. This clinic will offer the residents of Golden a
broad range of outstanding physical therapy services."
The clinic offers three compelling reasons to visit: one-on-one care; treatment programs that are overseen by
licensed physical therapists; and successful patient outcomes.
The new clinic is located at 400 Indiana Street, Suite 280 in Golden, CO. There is ample parking with easy
access to the therapy center.
For more information or to schedule a consultation at the clinic, call 720.398.0999 for appointments. The
clinic can be found online at: www.physiocorp.com/facility/60633.
About Physiotherapy Associates
Physiotherapy Associates is the nation's foremost provider of outpatient rehabilitation services.
Physiotherapy Associates employs an industry-leading team of physical therapists and healthcare
practitioners who are dedicated to high-quality patient care. The company provides physical therapy,
industrial rehabilitation and orthotics and prosthetics services to thousands of patients across the United
States. With more than 650 clinics, Physiotherapy Associates is national in scope, local in care. For more
information, visit www.physiocorp.com, follow us on Twitter (@physiocorp) or become a Physio fan on
Facebook.
September 5, 2011
Gene mutation shown to cause leukemia and lymphedema - Science Daily –
Researchers have discovered a gene that when mutated can cause lymphedema (swollen limbs due to a
failure of the lymph system), immune abnormalities, deafness and leukemia. The identification of the gene
responsible for causing this rare combination of medical conditions, known as Emberger syndrome, could
allow earlier identification and treatment of those at risk.
This study, which is published online in the journal Nature Genetics on Sept. 4, showed that it is caused by a
mutation in the GATA2 gene.
Mutations in this gene have very recently been associated with the development of leukemia and
immunodeficiency but had not previously been linked to lymphedema.
The study was led by a team at St George's, University of London and St George's Hospital. The
researchers recruited eight patients with Emberger syndrome, two of whom had a family history of the
condition. In collaboration with colleagues at Kings College London, they carried out Next Generation
Sequencing (a new technique which can rapidly sequence all the genes in the human genome) on these
patients to identify any genetic patterns that could provide clues about the disease. All eight patients had a
mutation in the GATA2 gene.
Consultant geneticist, Dr Sahar Mansour, who led the study with Professors Steve Jeffery and Peter
Mortimer, said: "Emberger syndrome affects only a handful of people in the UK. However, little is known
about the development of both the lymphatic system or leukemia This gene obviously has a crucial role in
both and is an important piece of the jigsaw puzzle. It may lead to a better understanding of why these
problems develop and eventually target treatment for both."
The identification of a mutation in GATA2 adds to the increasing number of genes responsible for causing
Primary Lymphedema. It is the fourth gene to be associated with the condition to be identified at St
George's, which runs the UK's only specialist clinic for primary lymphedema.
Professor Mortimer who runs this specialist clinic said: "The genetic causes of lymphedema are important
developments in the understanding of both cause and mechanism for lymphatic disorders which are a
neglected area of clinical practice. Gene testing is already changing the means by which lymphedema is
categorised and diagnosed. In the future it will lead to treatment through drugs acting on molecular targets."
Story Source:
The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by
University of St George's London.
Journal Reference:
1. Pia Ostergaard, Michael A Simpson, Fiona C Connell, Colin G Steward, Glen Brice, Wesley J
Woollard, Dimitra Dafou, Tatjana Kilo, Sarah Smithson, Peter Lunt, Victoria A Murday, Shirley Hodgson,
Russell Keenan, Daniela T Pilz, Ines Martinez-Corral, Taija Makinen, Peter S Mortimer, Steve Jeffery,
Richard C Trembath, Sahar Mansour. Mutations in GATA2 cause primary lymphedema associated with a
predisposition to acute myeloid leukemia (Emberger syndrome). Nature Genetics, 2011; DOI: 10.1038/ng.
923