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Lymphland International Lymphedema Online
February 1, 2011 - A Spa Dedicated to Complementary Cancer Care - MD News –
Expanding upon its impressive array of services for cancer care, The START Center for Cancer Care in
San Antonio, TX, recently celebrated the opening of Inspiritas, an integrative wellness spa designed
specifically to meet the unique needs of cancer patients and their families.
“The development of Inspiritas has been several years in the making and serves as an important
complement to the first-class medical care that is provided to cancer patients through The START Center
for Cancer Care,” says Amy Lang, M.D., medical oncologist at The START Center for Cancer Care.
“Cancer is not just a physical disease — it affects a person’s physical, mental and spiritual well-being. We
knew that our patients were suffering in ways that medications were not able to address, so we made a
commitment as a group to create an integrative oncology wellness center that would address the whole
patient.”
Caring for Body, Mind and Spirit
Inspiritas is the only spa of its kind in South Texas. Designed to provide a tranquil and relaxing area for
cancer patients to be pampered, it features treatment rooms, changing rooms and showers, an outdoor Zen
garden, lounge, waterfall and a multipurpose studio designed for movement classes, yoga, guided imagery,
meditation, nutritional and other classes. The spa’s retail area offers paraben-free, fragrance-free organic
skin care products, inspirational books, soothing music and guided imagery CDs, nutritional supplements
and organic tea.
Mindful of the issues women face with hair loss and mastectomies, Inspiritas dedicated an area for wigs,
prosthetics, head coverings and other beauty products. Women in need of these services are seen by
certified prosthetic fitters and beauty consultants in the privacy of two beautiful rooms.
Based on the five domains of complementary and alternative medicine developed by the National Institutes
of Health — alternative medicine systems, mind-body interventions, biologically based therapies,
manipulative and body-based methods, and energy therapy — services include massage, meditation,
guided imagery, Reiki, acupuncture, spiritual counseling, nutrition counseling and free movement classes,
such as yoga and tai chi.
Staff members at Inspiritas have considerable experience caring for cancer patients. For example, the
nutritionist on staff is a certified oncology dietitian with more than 10 years of experience in the field. In
addition, all of the massage therapists employed by Inspiritas are certified oncology massage therapists.
“When developing Inspiritas, we surveyed our patients and found that many of them were seeking these
services elsewhere and, sometimes, not very safely,” says Dr. Lang. “For example, many of our cancer
patients were receiving massages to help with pain management. However, if a patient has cancer in their
bones, massage techniques must be adjusted to prevent harm. This same principle is also true for patients
who have had lymph nodes removed and are at increased risk for lymphedema. If they receive a massage
from a massage therapist who is not trained in oncology, the massage could exacerbate this condition.”
Complementary therapies, including guided imagery, spiritual direction and energy therapy, have shown to
increase quality of life for cancer patients as well.
Guided imagery helps empower patients to deal with the mental challenges of cancer and its related
treatments. This provides a way for patients to channel their inner strength to help manage anxiety,
depression and other disturbing emotions. When this is achieved, patients gain control over the stress
response that accompanies a cancer diagnosis.
“By providing guided imagery, patients are able to tap into their inner resources, which help them heal,”
says Ginger Kemmy, R.N., B.S.N., Director of Inspiritas. “Research has shown that addressing these
emotions can even help improve immune function.”
Spiritual direction helps patients work through any spiritual concerns that may arise due to their cancer
diagnosis, and energy therapy is ideal for patients who are suffering from severe pain that makes touch
uncomfortable.
An Evidence-Based Approach
Research has shown that cancer patients who have access to supportive services, including massage,
guided imagery and other integrative modalities, have better outcomes than patients who receive traditional
medical care only. In fact, a recent study published in The New England Journal of Medicine analyzed the
effectiveness of palliative care in patients with metastatic lung disease and showed that patients who
received palliative care and complementary medicine in addition to chemotherapy and other medical
modalities experienced increased quality of life, less depression and reduced need for aggressive treatment
measures. Patients who received palliative care also had an average survival that was two and a half
months longer than patients who did not.
“Patients who are engaged and participate in supportive care do better than patients who just see their
oncologists alone,” says Kemmy. “Because these services help address both the physical pain and mental
ramifications of cancer, patients experience less stress, an improved quality of life and enhanced immune
function.”
Providing Support for Family Members
Even though the services provided through Inspiritas have been designed with cancer patients in mind, all
services are open to the public. The facility offers a variety of classes that are free to the community.
Anyone who is interested in achieving better balance and enhancing his or her overall health can benefit
from the services available. For caregivers of cancer patients, this can be especially beneficial, as they often
experience stress and anxiety while caring for their loved ones.
“All of the services provided through Inspiritas can help caregivers manage the stress they experience,”
says Kemmy. “I recently conducted a guided imagery class, and a couple attended. The wife had breast
cancer, but the class was beneficial to her spouse as well because he was able to deal with his own
emotions regarding her diagnosis. Caregivers are also welcome to participate in our spa services, including
massage.”
Caregivers have access to the quiet room and Zen garden at Inspiritas. These areas provide a relaxing
environment for them while waiting for their loved ones to finish their treatments.
To learn more about the services provided for cancer patients, survivors and caregivers through Inspiritas,
please visit ?thestartcenter.com.
February 2, 2011 - SA has highest number of gunshot assaults - Primedia Broadcasting - Eyewitness
News – by Catherine Rice –
South Africa has the highest number of gunshot assaults in the world.
Local doctors treat gunshot wounds daily.
Seven hundred delegates have gathered at Cape Town International Convention Centre for a global wound
care conference, in a bid to educate primary healthcare workers about effective wound treatment and
exchange ideas on best practices.
Wounds International is hosting the event and hopes to leave a legacy by providing hands-on information
about the effective treatment of wounds.
The World Alliance for Wound and Lymphedema Care’s Secretary-General John McDonald said there
are significant consequences for patients if wounds are not treated properly.
McDonald said 70 percent of all leg amputations are done on diabetic patients, but this could be avoided
with proper prevention care.
February 2, 2011 - New Clinical Research Study Aims to Prevent Lymphedema in Women Treated for
Breast Cancer - HealthCanal.com –
Washington, D.C. – Pain and swelling in the arm or hand can occur as a side effect of breast cancer
surgery, but a new national clinical research study underway at Georgetown Lombardi Comprehensive
Cancer Center, part of Georgetown University Medical Center and Georgetown University Hospital, is
looking at ways that might prevent the onset of these symptoms called lymphedema.
“Lymphedema is a complication that many women dread. It can negatively impact a woman’s ability to
complete simple daily activities and can take a toll on her physical and emotional well-being,” says
Georgetown’s chief breast surgeon Shawna Willey, MD, director of the Betty Lou Ourisman Breast Health
Center and lead researcher of the study. “As we understand more about what triggers lymphedema, we’re
learning of possible ways to prevent it.”
Lymphedema can occur in some women who have lymph nodes removed from their underarm as part of
their breast cancer surgery. (Lymphedema can also occur with other cancer surgeries when lymph nodes
are removed such as with the removal of the prostate). Lymph nodes filter fluid as it circulates in the body
and help to mobilize this fluid throughout the body. Swelling and pain can occur when the fluid pools in the
arm or hand and isn’t able to be removed because of a decrease in the number of lymph nodes.
The Lombardi study looks at the impact that an education program has in preventing lymphedema
compared to education plus a customized exercise plan. Information about quality of life for these women
also will be gathered.
Women interested in the study sign up before having surgery for their breast cancer. If lymph nodes are not
removed during the study, then those women do not continue in the study because lymphedema is not likely
to occur. Those who have lymph nodes removed continue in the research program and are randomly
assigned to one of two groups: the education-only group or the group with education plus an exercise plan.
The women will be asked to participate in about four surveys throughout the two-year study.
“It’s possible that exercise can improve or even prevent the onset of lymphedema,” explains lymphedema
specialist Johanna C. Murphy, MS, PT, CLT, director of physical medicine and rehabilitation at
Georgetown. “Having a tailored exercise program, however, is important because there are activities that
might actually trigger the swelling and pain. For the women assigned to the education plus exercise, learning
the correct way of doing the exercises will be an important part of the study.”
In addition to exercise, women in this group will be fitted for a special sleeve and glove that apply light
pressure, which might also help prevent lymphedema when combined with the exercise plan. The education
program, exercise plan, and sleeve are offered without cost to the patient. Standard instruction and written
material about lymphedema will be provided for those choosing not to participate in the study.
“We don’t yet know if the exercise plan and sleeve will be better than education only to prevent the
symptoms,” Willey concludes. “We’re grateful to all of our study participants, past and present, as they
truly help in advancing our knowledge about this issue.”
Patients interested in learning more about this study should contact Ann Gallagher at alg@georgetown.edu
or call 202-687-7606.
The study is sponsored by the Cancer and Leukemia Group B, a cooperative group of cancer centers.
Willey and Murphy report no personal financial interests related to the study.
About Georgetown Lombardi Comprehensive Cancer Center
Georgetown Lombardi Comprehensive Cancer Center, part of Georgetown University Medical Center
and Georgetown University Hospital, seeks to improve the diagnosis, treatment, and prevention of cancer
through innovative basic and clinical research, patient care, community education and outreach, and the
training of cancer specialists of the future. Lombardi is one of only 40 comprehensive cancer centers in the
nation, as designated by the National Cancer Institute, and the only one in the Washington, DC, area. For
more information, go to http://lombardi.georgetown.edu.
About Georgetown University Medical Center
Georgetown University Medical Center is an internationally recognized academic medical center with a
three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is
carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of
cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and
the School of Nursing and Health Studies, both nationally ranked, the world-renowned Georgetown
Lombardi Comprehensive Cancer Center and the Biomedical Graduate Research Organization (BGRO).
In fiscal year 2009-2010, GUMC accounted for 79 percent of Georgetown University's extramural
research funding.
February 2, 2011 - Multiple Hurdles in Treating Lymphatic Filariasis in Haiti - Angels in Medicine – by
Zeena Nackerdien, PhD –
Lymphatic Filariasis in Haiti
Beset by the plagues of poverty, political instability and infectious diseases, Haiti remains on the world's
radar as a place of ongoing suffering. Headlines skim the surface of its promising origins as the world's first
black-led republic,[1] and linger on the more familiar tales of political violence under the leadership of past
presidents, notably the Duvaliers ("Papa" and "Baby Doc") and Jean-Bertrand Aristide. As if political
disasters were not enough, Haiti has had to deal with an alphabet soup of hurricanes, storms, earthquakes
and tsunamis, recorded as early as 1770.[1]
Compounding the country's problems is the lack of sanitation and an inadequate health infrastructure, which
have created a perfect breeding ground for infectious diseases. Among these scourges, lymphatic filariasis
(LF), a mosquito-transmitted parasitic disease, is known to be endemic to the region and is a leading cause
of permanent disability worldwide.[2,3] Viewed as a remnant of the slave trade, this disease occurs mainly
in Haiti in the Western hemisphere, where at least 10% of individuals are symptomatic. More than half the
population in high transmission areas could be asymptomatic carriers.[4]
Although the disease is seldom fatal, the passage and procreation of the roundworm, Wuchereria bancrofti,
wreaks havoc to the lymphatic system of affected individuals.[4] Threadlike worms lurk in their favorite
nesting areas (breasts, genitals and legs),[5] releasing millions of baby worms into the blood and causing
lymphedema in many affected individuals. The one-two combination of untreated parasitic disease and
accompanying microbial infection cause the debilitating and disfiguring condition of elephantiasis.
Fortunately, individuals and health organizations have waged an ongoing war against this emblematic
"disease of the poor." One such effort is the LF-elimination initiative directed by Father Tom Streit,
affectionately known as Pere Tom,[4] who directs the program under the auspices of the University of
Notre Dame (UND). Sarah Craig, the program manager, estimated that there are about 45 people
currently engaged in efforts in Leogane, a coastal town, as well as in offices and at the Hopital Sainte Croix
in the capital, Port-au-Prince.
The UND group, together with other researchers in Haiti, had determined that the only option for effective
LF elimination was mass drug administration to the local population for the duration of the worm life cycle
-- 5 years.[4] The UND initiative, in partnership with IMA World Health, and in support of the Haitian
government, achieved its goal of 5.2 million treatments per annum in the 2009/2010 treatment cycle. In
2008, 50 of the most at-risk 140 communities were treated for this disease using the WHO-recommended
approach of mass drug administration with drugs that target both LF and intestinal worms (S. Craig,
personal communication).
Aftermath of the 2010 Earthquake
Located on the western side of the island of Hispaniola, Haiti is perched on a fault zone predicted in 1979
to have the highest probability of rupturing into a big quake.[7] The date, January 12 2011, marks the one-
year anniversary of the devastating earthquake which hit this impoverished nation. Its painful consequences
unfolded in television images and stories of untold suffering and death. The earthquake killed as many as
300,000 people, toppled buildings and left 1.5 million homeless.[6] This disaster also slowed the LF
program and many other health initiatives in the country.
Moments before the event, UND workers and their collaborators were enjoying drinks on the fourth floor
of a Port-au-Prince hotel on that fateful day. Ms. Craig recalled feeling the building collapse until "we
ended up somewhere between the first and second floor with rubble beneath us." The survival of the
workers and heroic relief efforts by others are outlined in a Science article[4] and further described on the
UND website.[8]
By January 20, at least 52 4.5-rated aftershocks had been reported. Like other health initiatives in the
country, the program switched immediately from research to disaster management mode. Leogane,
eighteen miles away from Port Au Prince and near the epicenter of the quake, which registered 7.0 on the
Richter scale, counted 30,000 to 40,000 dead and 80-90% of its buildings completely decimated.[9]
Medical supplies rapidly dwindled as the staff treated thousands of hungry, dehydrated and wounded
Leogane residents. It was the UND staff on the ground who facilitated the transformation of a local
highway into a makeshift landing strip so that much-needed additional supplies could be flown in to save
lives. Against a distant backdrop of debris and growing refugee camps, a number of medical teams worked
feverishly to treat the traumatized residents. Similar stories of suffering and medical relief echoed across
Port Au Prince.
Cholera: A Dire Blow to the Program
Taking care of the injured and providing humanitarian relief proved only to be the beginning of the new
challenges facing the UND initiative and other health programs operating in Haiti. Cholera, all too familiar in
developing countries as a disease transmitted mainly through contaminated water and food, provided an
unexpected new challenge. This disease, first reported on 21 October in the rural Artibonite region, far
away from Port Au Prince, spread rapidly through the country. As of December 2010, there have been
121,518 cases reported, resulting in 63,711 hospitalizations and 2,591 deaths.[10]
Crowded refugee camps, a population with no immunity against the microbe and a teetering healthcare
system provided the fuel for the cholera epidemic. Politics inevitably crept into containment efforts once the
microbe was genetically matched with a South Asian strain. UN peacekeeping troops from Nepal were
accused of being carriers of this virulent strain, precipitating riots against the UN and further impeding
medical relief efforts.[6] The rationale that the epidemic was imported flies in the face of expert opinion that
Vibrio cholerae likely spread via the environmental route.[11] This assessment is based on knowledge that
the microbe, normally resident in low numbers in brackish water or found in association with small
crustaceans in rivers and lakes, can proliferate in the presence of environmental stimuli such as increasing
water temperatures and nutrient levels, causing zooplankton blooms. Locals ingesting the water and poor
sanitation facilitate the spread of the disease.[11]
Regardless of debates about the origins of the epidemic, the reality is that the LF program faces a
formidable obstacle in cholera. Experts predict that cholera is likely to persist in Haiti, with the country
facing 100,000 cases in the next few years, given its low ranking on the socioeconomic development scale.
[11] The current global cholera vaccine supply of approximately 100,000 doses is inadequate to protect all
Haitian citizens. Since medications are consumed with local water to keep costs at a minimum, it is perhaps
understandable that the Haitian government has asked the LF program to halt medication distribution due
to the cholera outbreak. Thus, from a public health standpoint, cholera damaged the program far more than
the earthquake. One estimate given was that 5 to 10 years would be needed to put an infrastructure in
place to deal with the country's health woes. Post-election riots may prolong the journey towards
economic and health stability.
Dateline NBC featured the heroic efforts of Remote Area Medical to provide some Haitians with cholera
medicines. While these heroic efforts bear testament to the depths of human compassion, sustainable
solutions are being sought for the plight of the Haitians. Chlorinated water and innovative biosand filter
projects devised by the Clean Water for Haiti program may provide part of the answer, but each approach
is subject to the need for additional funding. Given its commitment and successful public health track record
in the country, the UND and its collaborators are seeking additional financial resources to expand the
scope of the neglected tropical disease program in order to improve the overall quality of life of the Haitian
people.
About the Author
Zeena Nackerdien, PhD is a microbiologist and writer and can be reached at nackerz@mail.rockefeller.
edu.
References
1. Haiti country profile, from the BBC.
2. WHO. World Health Report. Geneva: World Health Organization.
3. Beau de Rochars MV, Milord MD, St Jean Y, et al. Geographic distribution of lymphatic filariasis in
Haiti. Am J Trop Med Hyg 2004;71(5):598-601.
4. Roberts L. Relief among the rubble. Science 2010;327(5966):634-637.
5. Reynolds M. Blessed are the healers. Notre Dame Magazine, Summer 2001
6. Fraser B. Haiti still gripped by cholera as election looms. Lancet 2010;376(9755):1813-1814.
7. Kerr RA. Seismology. Foreshadowing Haiti's catastrophe. Science 2010;327(5964):398.
8. University of Notre Dame - Haiti Program
9. Demas N. Wes, Jean Marc and the Fighting Irish of Leogane!
10. Update on cholera --- Haiti, Dominican Republic, and Florida, 2010. MMWR Morb Mortal Wkly
Rep 2010;59(50):1637-1641.
11. Enserink M. Infectious diseases. Haiti's outbreak is latest in cholera's new global assault. Science 2010;
330(6005):738-739.
Links Related to This Article
University of Notre Dame Haiti Program
Sarah Craig
Program Manager
309 Brownson
Notre Dame, IN 46556
Phone: 574-631-3273
Fighting Poverty by Treating Parasites
by Zeena Nackerdien, PhD and Toni Nicholls, PhD
Neglected Tropical Diseases and Drug Donation Programs: Successes and Challenges
by Zeena Nackerdien, PhD
About Angels in Medicine
Angels in Medicine is a volunteer site dedicated to the humanitarians, heroes, angels, and bodhisattvas of
medicine. The site features physicians, nurses, physician assistants and other healthcare workers and
volunteers who reach people without the resources or opportunities for quality care, such as teens, the
poor, the incarcerated, the elderly, or those living in poor or war-torn regions. Read their stories at www.
medangel.org.
February 2, 2011 - Community Bulletin and Business Briefs - Winter Park/Maitland Observer –
Dr. Stuart Dropkin, DMD, of Winter Park participated in the TeamSmile clinic, Friday, Jan. 21.
Several hundred low-income kids from Orange County came in for free dental treatment.
The following students were named to the President’s or Dean’s List of their college or school at Mercer
University for the Fall 2010 semester: Justin D. Burchett of Winter Park and Bryan B. Danley of Maitland
Jonathan Hill, a resident of Maitland and a junior at Southern Methodist University in Dallas, is listed on the
honor roll with high distinction.
Chad Modomo of Winter Park has been named to the 2010 fall semester Dean’s List at West Virginia
Wesleyan.
The Metropolitan Opera National Council Auditions/Vocal Competition took place on Saturday, Jan. 22
at Trinity Prep School in Winter Park. “Thanks to donations collected from the audience, we were able to
send four winners to Atlanta instead of the usual three,” Swantje Knye-Levin and Kathleen Miller wrote in
an e-mail.
Tax-Aide volunteers, trained and certified by the IRS, will provide free income tax assistance at the Winter
Park Library, 460 E. New England Ave., from 11:30 a.m. to 3:30 p.m., Tuesday, Wednesday and
Thursday, through April 14. Visit aarp.org/taxaide or call 1-800-227-7669.
The Winter Park Chamber of Commerce recognized its members at the organization’s annual Membership
Awards Celebration on Friday, Jan. 21, at Full Sail. Florida House of Representatives Speaker Dean
Cannon was honored as the Winter Park Citizen of the Year. The Chamber
presented the first Chamber Hero award to Ronnie Moore, assistant director for Parks and Recreation for
the City of Winter Park. Visit WinterPark.org
Over 400 brave souls were “freezin’ for a reason” at Aquatica on Saturday, Jan. 22, for the second annual
Polar Plunge, benefiting Special Olympics Florida. The event raised more than $191,000!
On Jan. 26, Jewish Academy of Orlando held its annual Invention Convention. Students’ challenge was to
create a machine, using at least 15 steps and no form of electricity, to put a .5L water bottle into a
recycling bin. The students presented a short video presentation of the building process on iPads. Visit
JewishAcademyOrlando.org
The Dr. Phillips Center for the Performing Arts received a $1.5 million gift from Winter Park
residents Marc and Sharon Hagle, who previously pledged $1 million to the project in 2007. Visit
DrPhillipsCenter.org
Tickets are now on sale for CHOICES 2011, held March 16 at the Westin Lake Mary on International
Parkway. This annual event is the largest fundraising event for the Jewish Federation of Greater Orlando
Women’s Division. Call 407-645-5933 or visit jfgo.org
Registration is now open for the 31st Annual Conference of the Florida Native Plant Society. It will take
place at the Sheraton Orlando North in Maitland on May 19-22. Visit www.fnps.org/pages/conference or
for sponsorship opportunities or to receive information by mail, contact FNPS at 321-271-6702 or e-mail
info@fnps.org
The National MS Society Mid Florida Chapter is looking for anyone who wants to support their
community to take part in Walk MS 2011 and Bike MS: The Citrus Tour 2011. Visit MidFloridaMSwalks.
org and FLC.NationalMSsociety.org or call 813-889-8363.
The Orlando Garden Club is looking for new members. Monthly meetings are at 10 a.m. on the third
Friday of the month during Sept.-May, 710 E. Rollins St. Call 407-682-1726 or e-mail
Roses4Friends@aol.com
Seniors First is seeking drivers to deliver Meals on Wheels to elderly clients in Orange County. Contact
Lorraine Shumaker at 407-615-8982.
Business Briefs
Cocina 214 has leased the 10,000-square-foot building at 151 E. Welbourne Ave. for a Mexican
restaurant and bar, called Cocina 214. Formerly Apenberry’s, the building is owned by the Charles
Hosmer Morse Foundation. After a total reconstruction of the interior, opening is planned for Spring 2011.
Margarita Correa MD, Board Certified in Physical Medicine and Rehabilitation, announces the opening of
her new office, Physical Medicine Institute at Winter Park North Pointe Place, 2900 N. Orange Ave. Suite
205, starting on Friday, May 6. Services include cancer rehabilitation, lymphedema treatment, pain
medicine, EMG & NCS. For appointments, call 352-404-6959. Visit PhysMedi.com
Winter Park-based A.T. Thomas LLC, which owns and operates Kennedy’s All-American Barber Club in
Winter Park, has opened a new location in downtown Orlando. The new Kennedy’s Club is located at
716 E. Washington St. Suite C.
Fifth Third Bank’s 47 Central Florida branches recently collected more than $17,000 for the Camaraderie
Foundation, an Orlando-based nonprofit that provides counseling services at a discounted rate to veterans
and their families.
Posting 79 fourth quarter closings for $27.63 million, Fannie Hillman + Associates of Winter Park saw its
annual closings of existing homes increase by 6 percent over the previous year, a sign that company
officials feel bodes well for 2011. Visit FannieHillman.com
Full Sail University announced that eight of its alumni are nominated for this year’s Grammy Awards airing
live on CBS Sunday, Feb.13. A total of 74 Full Sail graduates worked on 53 nominated projects.
NAI Realvest recently completed a lease agreement for 9,675 square feet of office/industrial space at
Winter Park Commerce Center near downtown Winter Park.
Larry Vershel Communications, based in Winter Park, has added five new clients since the start of 2011
and projects major growth through the end of the year.
February 3, 2011 - Lymphedema Products Demonstrates Compassionate, Effective Lymphedema
Management – Benzinga –
Lymphedema Products has spent years promoting safe, ethical, and compassionate treatment for
lymphedema. Its expertise and track record show how lymphedema treatment should be supplied.
Matawan, NJ (Vocus/PRWEB) February 03, 2011
Bringing its industry-leading expertise and understanding of ethical and effective lymphedema treatment to
the supply of lymphedema treatment tools for more than ten years, Lymphedema Products has established
itself as a lymphedema supplies provider that prioritizes patient satisfaction. It emphasizes its staff's first-
hand knowledge of every phase of lymphedema and the importance of providing only the most medically-
safe, cutting-edge treatment tools, offering its clients the power to effectively combat the condition on their
own terms.
About Lymphedema Products' Founders
Lymphedema Products was established by Steve Norton, a Complete Decongestive Therapy Instructor,
Certified Lymphedema Therapist (CLT), and highly-regarded lymphedema educator. Steve is a renowned
authority in the field of lymphedema therapy who personally trained many of today's practicing
lymphedema therapists. His educational company, the Norton School of Lymphatic Therapy, is the leading
resource for comprehensive education in this medical specialty.
His vision for Lymphedema Products as a trend-setter in the industry, with product selections based on the
expertise of long-time lymphedema care experts, was inspired by his experiences treating the condition, his
extensive involvement in the field of lymphedema management and lymphedema care education, and his
passion for treating this condition with the utmost compassion and integrity.
Steve founded Lymphedema Products with the goal of providing the highest quality service to individuals
with lymphedema who have successfully completed lymphedema treatment, but continue to need the best
products and expertise available to manage their condition. As the leading exclusive supplier of
lymphedema treatment supplies, it carries only the most advanced and medically-responsible products
available for the safe and effective management of primary and secondary lymphedema, venous edema,
and other edemas. Steve and his team of lymphedema experts personally vet products based on years of
experience to assure that they are effective, safe, and appealing for customers.
In this way, Lymphedema Products harnesses the broad range of medical and technical expertise of its
founder and advisory staff, to the benefit of customers. When patients and medical professionals choose to
purchase their lymphedema supplies from Lymphedema Products, they are initiating a relationship with the
industry-leading resource for lymphedema-related treatment, knowledge, and expertise. Steve and his team
don't take this relationship lightly.
About Lymphedema Products' Commitment to the Cutting Edge
Lymphedema Products carries only the most current, ethically-sound, and medically-safe treatment tools
for lymphedema. It is constantly updating its catalogue with the newest in treatment tools to offer clients
more custom-tailored options to meet their needs and allow them to make managing lymphedema an easier
part of a normal life. All its products have been approved by many of the world's leading authoritative
organizations including the International Society of Lymphology (ISL), the National Lymphedema Network
(NLN), and many prominent educational institutions in the field of lymphedema management. Steve
believes that by holding all his lymphedema-related projects to the highest possible standard when selecting
product lines and lymphedema experts, he ensures that his customers will receive the best treatment
available. This is the philosophy that has made Lymphedema Products one of the most trusted leaders and
valued partners in the field of lymphedema management.
February 3, 2011 - Benefit planned for New Richmond businesswoman - Richmond-News – By Jackie
Grumish –
More than a year ago, Carla Kelley was tired of her shoes and clothes not fitting. She started dieting but
couldn’t shed the weight.
Last June, with swollen legs, she decided to consult a doctor. She tried a reduced diet, but it didn’t do the
trick. Eventually, she was diagnosed with lymphedema.
In September, the swelling progressed into pain — horrific pain.
In November, Kelley visited a specialist in St. Paul, Minn. After several tests, doctors discovered a
problem with her adrenal gland — which led to even more tests.
Eventually, Kelley was diagnosed with Cushing’s syndrome, a hormone disorder caused by high levels of
cortisol in the blood. When doctor’s discovered the cause of Cushings syndrome — a large, cortisol
producing tumor — Kelley’s diagnosis changed to adrenal cancer.
After being diagnosed and finding the tumor, things moved relatively quickly.
Major surgery was needed to remove the tumor; however, the tumor needed to be reduce before the
surgery. That’s when Kelley started an aggressive nine-day, seven dose chemotherapy routine.
Dawn Mahoney, Kelley’s sister, said Kelley has been in good spirits through the whole process.
“Here is my sister, actually choosing to look forward to shopping for a wig already as she collects them for
use in community theatre,” Mahoney said.
The two actually went shopping in December, well before Kelley started losing her hair.
At one appointment, the family was able to see a 3D image of the tumor. That’s when the family realized
the “honkin’ big tumor” was actually a large cluster of tumors measuring roughly 10 inches long, 4.5 inches
wide and 4.5 inches deep. It’s believed the cluster started in the right adrenal gland, which sits on top of
the kidneys.
At the conclusion of Kelley’s chemo, doctors confirmed that the tumor mass had shrunk. The next step
was scheduling the “big surgery” for Jan. 24.
Five surgical teams were assembled to remove the tumor cluster, Mahoney said. The day started with a
laparoscopy to look for other clusters and ended eight hours later after surgeons removed part of Kelley’s
liver, right kidney and adrenal gland.
Kelley’s surgical team deemed the procedure a success and believe all tumors have been removed. Now,
Kelley is working to recover.
“To say we’re cautiously optimistic is true, but probably as far out on the limb as we’ll go right now,”
Mahoney said. “Recovery will be a steep climb with pain for a while. But she has made it through honkin’
chemo with flying colors and now this honking huge surgery.”
As most could imagine, a “honkin’ big tumor” creates equally big medical bills.
To help Kelley with the costs associated with numerous trips to Rochester, Minn., treatments, countless
prescriptions, hotel rooms and gas, friends and family are organizing a benefit.
The benefit is scheduled for Saturday, Feb. 12, at Ready Randy’s Sports Bar and Grill, 1490 131st St.,
just south of New Richmond.
A spaghetti dinner and silent auction will begin at 4 p.m. and end at 7 p.m. Dinner costs $10 per person;
kids younger than 3 eat free. At 7:30 p.m., Pete Neuman and the Real Deal will hit the stage.
Those who are unable to attend, but would like to contribute, can send donations to: First National
Community Bank, c/o Carla Kelley Benefit, P.O. Box 89, New Richmond, WI 54017.
“We’ve been going through a lot in a very short amount of time,” Mahoney said. “We’re still very much
grieving, healing, stunned and in a state of disbelief.”
February 4, 2011 - Business Notes - Brainerd Daily Dispatch –
Byland completes training for certified lymphedema therapist
STAPLES — Lakewood Health System occupational therapist Janet Byland recently completed intensive
training to become a certified lymphedema therapist.
To become a certified lymphedema therapist, attendance of 135 hours of instruction and successful
completion of written and practical examinations are required.
Lymphedema is a swelling of a body part, most often the extremities. Lymphedema may be present at birth
or develop later in life, and is often the result of surgery or radiation therapy for cancer.
February 5, 2011 - North State Marketplace: Feb. 5, 2011 - Record-Searchlight - By David Benda –
Tina, this is notification of a meeting that has now passed, sorry.
February 9, 2011 - Some breast cancer patients can get less surgery - Boston Globe (blog) – by Deborah
Kotz –
Treatment of breast cancer has been moving further and further away from the slash and burn tactics of the
last century. Most patients now get lumpectomies instead of mastectomies, less extensive radiation and less
toxic chemotherapy. And now some will be offered the option of not having their underarm lymph nodes
removed -- even if they contain cancer cells.
A new study published Tuesday in the Journal of the American Medical Association has found that women
with early breast cancer (stage 1 or 2) who have lumpectomies with radiation do just as well in terms of
cancer recurrence and survival regardless of whether they retain potentially-malignant lymph nodes.
The big upside to sparing the lymph nodes is fewer adverse effects like arm pain, frozen shoulder,
infections, and lymphedema, which is permanent swelling in the arm. Some 70 percent of the 446 patients
who were randomly assigned in the study to have their lymph nodes removed developed such
complications compared to 25 percent of the 445 patients who retained their lymph nodes.
"Lymphedema and quality of life become huge issues after breast surgery," says Dr. Mehra Golshan,
director of breast surgery at the Dana-Farber/Brigham and Women's Cancer Center who was not involved
in the study, "and it's a great thing to find that lymph node sparing surgery can provide the same shot at
survival with fewer complications."
Golshan says he and his colleagues at the various Harvard hospitals decided last fall to offer the lymph
sparing surgery to some women with one or two positive nodes after hearing the study presented by the
researchers at a spring cancer meeting.
Until then, Harvard surgeons removed just a few nodes to see if they contained cancer and would only
leave the rest of the nodes intact if that first node was cancer-free -- which has been standard practice in
the U.S. for the past decade.
While the majority of cancer patients are diagnosed early before the cancer has spread to the lymph nodes,
up to 20 percent have an early stage cancer with some lymph node involvement. Those who opt for
lumpectomies with radiation, rather than mastectomies, can now be offered the lymph sparing surgery since
the radiation could kill any cancer cells left in the nodes, Golshan says.
Oncologists at other Boston hospitals, however, may differ somewhat in how they change their practice as
a result of the new finding. "This is exciting data, but it certainly doesn?t apply to everyone," says Maureen
Kavanah, a surgical oncologist at Boston Medical Center.
She says oncologists at her institution often like to know the extent of lymph node spread to determine
whether to use radiation on that area or to offer the option of an experimental treatment. Also, oncologists
might be more willing to spare lymph node removal in those who have "estrogen-receptor" positive cancers
that can be treated with anti-estrogen drugs like tamoxifen. These drugs could destroy any remaining cells
in the lymph nodes.
And even with the new study finding, surgeons aren't comfortable leaving potentially positive nodes in
women who had mastectomies without radiation -- since they weren't included in the study -- nor in those
who have enlarged lymph nodes that can be felt on a physical exam.
A study now being conducted in Europe that involves 4,000 breast cancer patients will answer the question
as to whether it's safe to spare cancerous lymph nodes in women who don't get radiation.
While doctors up-to-date on the latest research may be eager to spare patients unnecessary side effects,
they may have a tough time convincing some women that it's okay to leave potentially cancerous lymph
nodes in the body.
Golshan says he saw two patients yesterday who had a single positive node and early stage cancer. He
offered both the lymph node sparing surgery but only one took him up on it.
February 9, 2011 - Toronto Physiotherapy promotes awareness, education, and treatment of chronic
swelling called Lymphedema – by rdavey –
Toronto , Ontario - February, 2011 - Toronto Physiotherapy, a leading provider of healthcare in Toronto,
is providing free Lymphedema services to individuals in financial need, and offering on-line education
resources to promote disease awareness.
Lymphedema is a serious condition caused by a failure of the lymphatic system to maintain the proper
balance of fluid in an affected tissue. The resultant accumulation of lymphatic fluid, usually in an arm or leg,
can be painful, disabling, and disfiguring. In extreme cases, Lymphedema can lead to serious infection or
even a rare form of cancer called lymphangiosarcoma. Lymphedema frequently arises in cancer patients
(in particular breast cancer) following surgical lymph node removal or radiation treatment, but can also
occur congenitally. Although Lymphedema is a chronic disease, with proper symptom management and
prevention individuals with Lymphedema can enjoy a normal and active lifestyle.
Unfortunately, many individuals with Lymphedema are unaware of simple self-management practices, or
the availability of effective tools to combat the disease including compression garments and manual
lymphatic drainage therapy. “To further compound this problem, proper Lymphedema education and
therapy is often unavailable or too costly for individuals with limited financial resources” says Clinic
Director Lindsay Davey, “as a consequence, patients with Lymphedema tend to withdraw from normal
activities due to discomfort, physical restrictions, or embarrassment”.
To combat the lack of awareness and treatment of Lymphedema, Toronto Physiotherapy is developing
educational tools including online resources and self-management video
(http://www.torontophysiotherapy.ca/services/toronto_lymphedema_treatment.html), as well as offering
Certified Lymphedema Physiotherapy services including a complimentary service for individuals with
limited financial resources.
To assist low-income individuals, Toronto Physiotherapy provides a complimentary assessment of the
patient's Lymphedema case history, as well as education on effective self-management techniques and
other treatment options available including the suitability of compression garments. Toronto Physiotherapy
is also a Certified Compression Garment Authorizer through the Government of Ontario’s Assistive
Devices Program (ADP), and can recommend and authorize therapeutic garments to Lymphedema
patients so that they can access the ADP subsidization.
About Toronto Physiotherapy
Toronto Physiotherapy (http://www.torontophysiotherapy.ca) is a leading Toronto-based provider of allied
health care services including traditional Orthopedic Physiotherapy and Massage Therapy, as well as a
suite of specialized services that includes Neurological Physiotherapy, Nutrition Counseling, Acupuncture,
Manual Lymphatic Drainage and Home Care Physiotherapy. Toronto Physiotherapy is certified in
Combined Decongestive Therapy for Lymphedema and is also a Certified Compression Garment
Authorizer.
Contact:
Lindsay Davey
Clinic Director
416-792-5115
741 Broadview Ave., Suite 206
Toronto, Ontario, Canada, M4K 3Y3
info@torontophysiotherapy.ca
http://www.torontophysiotherapy.ca
February 9, 2011 - Will Treatment For Early-Stage Breast Cancer Change? - Wall Street Journal (blog) -
By Katherine Hobson –
New research published in the Journal of the American Medical Association — on top of previous studies
— should change how certain early-stage breast cancer patients are treated, the New York Times reports.
The study subjects were breast cancer patients with early-stage tumors and cancer in one or two lymph
nodes in the armpits but no further spread. These women were treated with a lumpectomy followed by
radiation and chemo or other drug treatment. (About 20% of breast cancer patients fit that bill, the NYT
says.) The study found that these patients don’t benefit from having the cancerous lymph nodes — as well
as others — removed (beyond the initial biopsy, that is).
Given the breast surgery and other treatments, you might think that taking out a few lymph nodes is no big
deal, but that’s not true. There can be painful complications, including lymphedema, a debilitating swelling
of the arm. An author of an editorial accompanying the study tells the paper that he has a feeling “we’ve
been doing a lot of harm” by taking out so many nodes as a matter of course.
But the story raises the question of how quickly surgeons will change their practice. The paper says
Memorial Sloan-Kettering Cancer Center changed its own guidelines already, based on an early peek at
this study, but that “more widespread change may take time, experts say, because the belief in removing
nodes is so deeply ingrained.”
A study author and Sloan-Kettering physician tells the NYT that it’s much easier for doctors and patients
to accept a study pointing to an increase in cancer treatment rather than a decrease.
February 9, 2011 - Consults: Q. & A.: Breast Cancer and Lymph Nodes - New York Times (blog) –
An article in Wednesday’s Times describes how a routine procedure for the treatment of early breast
cancer — the surgical removal of cancerous lymph nodes from the armpit — has been found unnecessary
for many patients. The finding turns 100 years of standard medical practice on its head.
Today the author of the article, Denise Grady, is taking questions about the finding and its implications.
Please post your questions in the Comments box below.
Q.From what I understand, removing even only one or two lymph nodes can result in chronic swelling of
the arm. How certain is it that taking fewer nodes will result in a measurable reduction in the risk of
developing lymphedema?
— Claudia Boyle, Mount Prospect, Ill.
A.There is still a risk of lymphedema even after only a few nodes are taken for sentinel biopsy, but the risk
is much lower than when many nodes are removed.
Q.Is there any information on the advisability of not doing the lymph node removal for women who had a
mastectomy, chemotherapy and radiation rather than lumpectomy?
— Donna Landerman, Bloomfield, Conn.
A.The results apply to women whose condition is like those in the study: stage T1 or T2 tumors (less than
two inches across), no palpable lymph nodes, no metastases to other parts of the body and no more than
two positive lymph nodes on the sentinel node biopsy. A woman with these characteristics who is having a
mastectomy and the other treatments would seem to fit the bill, but the ultimate decision has to be made
with a surgeon and an oncologist.
Q.My breast surgeon told me that lymph node ratio is also important, and I’ve seen studies to support it.
They’ve shown that a person who has 1 positive lymph node out of 20 removed does better than a person
who had 1 out of 5 who does better than the person who had 1 out of 1. This implies that that there is
some survival benefit to the patient who has more nodes removed. Can you find out from your sources:
what about the studies that show that lymph node ratio is important? Does this new study trump them, and
if so why? Also, what about the length of follow-up in this study?
Breast cancer can recur at any time — even 25 years after initial diagnosis. I’m very glad for all these
treatments that improve 5-year survival rates, but are they just pushing back our relapses to a later date? If
so, the results of this study may be premature. Are they planning to continue following-up on these patients?
— Breast Cancer Patient, NYC
A.There is evidence that a higher number of positive nodes is associated with a worse outcome, because it
may mean that the cancer is more advanced or spreading more quickly. In the past, the number was used
to help plan what kind of chemotherapy to give. But the doctors interviewed for the article published on
Wednesday said that in most cases nowadays, the number of lymph nodes does not determine the
treatment. Women with any positive nodes are advised to have chemotherapy or hormone-blocking
treatment, or both, and the chemotherapy is the same regardless of the number of nodes.
As the article states, the researchers considered the follow-up time long enough to detect a difference in
local cancer recurrence rates, meaning in the armpit, because those tend to occur fairly early. There was no
difference. A local recurrence is not trivial: It would require more treatment, and 20 to 25 percent of
women who have local recurrences ultimately die from the cancer.
It is true that cancer can return at any time. More follow-up time would be more reassuring. I don’t know
whether there will be continuing follow-up of these women, but I will ask and post the answer.
Q.My niece has Stage 3C melanoma. She recently had a number of lymph nodes removed. She originally
had two nodes removed that were diagnosed as positive. Thereafter, she had additional nodes removed
that were negative. Does the data you’ve written about, as it pertains to lymph nodes, translate to specific
cancers other than breast cancer?
— Dave Collopy, Hilo, Hawaii
A.No, the data really applies only to patients with breast cancer, and only to breast cancer patients like the
women in the study.
Q.I am curious about your opinion of reaching a negative conclusion based on a statistical sample. First of
all, the type of error that may be associated with such a conclusion — i.e. that there is in fact a difference
that was not detected — is typically not controlled and therefore can float to unknown values.
Second, there is little discussion in the newspapers about the fact that your or any metanalysis is no more a
guarantee than any initial study, but merely a statistical evaluation of the likelihood of having detected (or
not detected) a real effect.
— Dr. S, Valhalla, N.Y.
A.The New York Times did not reach a conclusion. We are reporting the conclusion that the authors of a
peer-reviewed journal article reached, that the editorialist in the journal supported, and that cancer centers
are already putting into practice. We did ask two independent experts on medical statistics at two different
universities to evaluate the study. They had some quibbles, but nothing serious enough to throw the findings
into question. This was not the first study in this area; there have been others in the past, all pointing in the
same direction — to the idea that at least some patients can be spared axillary dissection and the serious
complications that it can cause.
Q.I have not seen raised in this discussion the issue of genetic findings related to the familial propensity for
breast cancer if that diagnosis is a part of the clinical picture. How are suspected lymphatic involvement
and possible surgical intervention influenced by genetic findings? Thank you.
— MJM, Shenandoah Valley, Va.
A.We asked this question of Dr. Monica Morrow, an author of the study and chief of the breast service at
Memorial Sloan-Kettering Cancer Center in Manhattan. Her reply:
Genetic breast cancer doesn’t influence how we treat the nodes. Due to the increased risk of second
breast cancers, many of these women chose mastectomy. Women with mastectomy require axillary
dissection if the nodes are involved.
Q.Surgeons have been removing lymph nodes from the armpits of breast cancer patients for 100 years.
Why has it taken so long to find out that not every patient needs this surgery?
A.The procedure is a holdover from the era of the radical mastectomy, before radiation treatment and
chemotherapy existed and when the only hope for controlling cancer was to try to cut it all out. Removing
lymph nodes became part of the standard of care, because the nodes might harbor cancer cells that could
spread around the body.
Before the sentinel node technique was developed, there was no way to find which nodes were most likely
to be the ones where cancer cells would land; to be on the safe side, the only thing surgeons could do was
to take out as many nodes as possible. Women suffered from side effects, like lymphedema, that could be
severe, but the prospect of a cancer recurrence was worse, so doctors and patients alike were afraid of
what would happen if the nodes were not removed. Only when it became apparent that the sentinel node
biopsy was reliable did it become possible to ask the next question: If just one or two nodes are positive,
do they all have to come out? The answer seems to be no.
Part of what makes it possible to leave the nodes alone is that there are now more effective combinations
of chemotherapy and radiation, which can wipe out microscopic traces of disease that might be left behind.
Q.Which women still need to have their lymph nodes dissected?
A.Surgeons say that the lymph nodes must come out if they are big enough to feel or show up as cancerous
on imaging. Surgeons will also remove nodes if there are three or more positive sentinel lymph nodes
(sentinel lymph node biopsy is described in the article).
Surprises can also turn up in the operating room, doctors say. Occasionally, the sentinel node biopsy will
give a false-negative result, which means failing to find cancer even though it is present. That can happen if,
for instance, the sentinel node is very cancerous and the lymphatic vessels that feed it are choked off and
do not pick up the dye. Then, the dye may go to a different node, one that does not have cancer. Knowing
this is possible — and knowing that the sentinel node biopsy, though highly reliable, is not infallible —
surgeons look and feel around in the armpit carefully during the operation and make judgment calls about
what to remove and what to leave alone.
Q.Why are the study findings said to apply only to women who have whole-breast irradiation, and not
partial breast irradiation?
A.Whole-breast irradiation hits part of the armpit, and therefore some of the lymph nodes. This is what the
women in the study received, and researchers think it may have wiped out any cancer in the nodes that
were left behind. They say they are also unsure about whether the findings would apply to women who
have irradiation while lying prone, on their stomachs. In that position, the radiation may not reach the armpit.
Q.The study findings apply to 20 percent of patients — about 40,000 women a year in the United States,
according to your article. What about the other 80 percent?
– Brandon, Berkeley, Calif.
A.Here is a further explanation: First of all, 20 percent (the estimate of the study’s lead author, Dr.
Armando E. Giuliano) refers to 20 percent of all the newly diagnosed cases of invasive breast cancer each
year. This does not include noninvasive breast cancer, or DCIS, ductal carcinoma in situ. The total is about
207,000, so 20 percent is roughly 40,000 women. That is about how many women would match those in
the study, in terms of tumor status, affected lymph nodes and course of treatment.
To answer the question about the other 80 percent, we need to look at how many women get a breast
cancer diagnosis at various stages. The figures from the American Cancer Society indicate that 60 percent
of all patients have “localized” breast cancer. That means they do not have affected lymph nodes. They do
not have to worry about extensive axillary dissection, as lymph node removal is known; their sentinel node
will be clean. Another 33 percent of women have “regional” disease, meaning that the cancer has reached
lymph nodes. These are the patients who might match those in the study.
By Dr. Giuliano’s estimate, about two-thirds of these women will match the study criteria, and one-third
will not, so for that one-third, about 10 percent of breast cancer patients over all, node dissection may be
needed. Another 5 percent of all patients have “distant” disease at the time of diagnosis, meaning the
cancer has already spread to organs or bones. I don’t know if lymph node surgery is of use or benefit to
women whose disease is already advanced. In the remaining 2 percent of cases, the stage of the disease at
diagnosis is not known.
February 9, 2011 - Lymphedema Awareness Day is March 6th - Wire Service Canada (press release) –
by LymphedemaDepot –
The 17th annual Lymphedema Awareness Day will be observed across Canada and the US on March 6,
2011. Lymphedema is a condition of chronic swelling that affects a limb or other body part due to an
accumulation of lymph fluid.
Lymphedema Depot, the importer and distributor of Solaris lymphedema care products in Canada, is
helping to promote Lymphedema Awareness Day this year.
February, 2011--- Lymphedema Awareness Day will be observed across Canada and the US on March
6, 2011. Lymphedema Awareness Day is meant to bring public attention to this medical condition.
Lymphedema Depot, the importer and distributor of Solaris lymphedema care products in Canada, is
helping to promote Lymphedema Awareness Day this year.
“As a therapist and clinician, I have been in a position to hear from patients firsthand how frustrating it is to
try to get treated for lymphedema,” says Lymphedema Depot Clinical Specialist John Mulligan, a
Registered Massage Therapist and Certified Lymphedema Therapist.
“Lymphedema is diagnosed more than it used to be, but it is still under-treated. There are not enough
practicing lymphedema therapists,” said Mulligan. “I would hope that with increased public awareness of
lymphedema more therapists would be moved to get trained in lymphedema therapy. It is a fascinating
field.”
Lymphedema is a condition of chronic swelling that affects a limb or other body part due to an
accumulation of lymph fluid. You can be born with lymphedema or it can be acquired after a traumatic
injury, severe infection or surgical removal of lymph nodes. Lymph nodes are often removed for the staging
of cancer, to determine if cancer cells are spreading to the lymph system. In sub-tropical countries
lymphedema can be acquired from parasites.
Lymphedema is not curable, but it can be managed through a blend of therapy techniques that do not
involve surgery or drugs.
In North America, lymphedema has become known as the most-feared complication of cancer, and yet
those who fear it know very little about it. Lymphedema Awareness Day is a chance to share information
about lymphedema, clearing away some of the mystery and helping to raise awareness of the condition and
the need for effective treatment, funding for treatment and further research.
In Germany lymphedema treatment became reimbursable by national health insurance in 1974, based on
research done throughout the 1960’s by Dr. Johannes Asdonk and others. The treatment for lymphedema
is called Complex Decongestive Therapy and consists of manual lymph drainage, multi-layer compression
bandaging, exercise and meticulous skin care. In Canada, Complex Decongestive Therapy is not
reimbursable by any private, federal or provincial funding source, although separate aspects of the protocol
can be reimbursable on their own.
This lack of comprehensive reimbursement causes real hardship to many lymphedema patients. This is a
condition that involves expert treatment, with costs being incurred by the need for hands-on therapy and
education. The patient requires hundreds of dollars’ worth of compression bandaging supplies in addition
to compression garments for day and night use. Without comprehensive coverage for therapy the patient
must seek funding for each aspect of lymphedema care separately, and often they must pay for some parts
of this complex therapy out of their own pockets.
In Canada lymphedema patients must navigate a patchwork of payment sources in order to obtain therapy.
These payment sources are typically a mix of third party health insurance and cash out of the patient’s own
pocket. Patients without health insurance or the means to pay privately will simply not get the therapy they
need. This means living with a progressively swelling limb. Untreated lymphedema leads to an increased
risk of cellulitis infections, the most serious and common of lymphedema complications. The cost of treating
patients with these infections can be greater than the cost of proper, timely treatment.
In observance of Lymphedema Awareness Day on March 6, 2011, we encourage you to print this article
and give copies to your doctor, friends, MP or anybody who might be interested in the treatment of
lymphedema and associated costs and risks.
To learn more about lymphedema, see the Lymphedema Depot’s page of links, a clickable list of
lymphedema resources: http://www.lymphedemadepot.com/links
To learn more about Lymphedema Awareness Day please visit our website at http://www.
lymphedemadepot.com and click on the Lymphedema Awareness Day logo.
To contact Lymphedema Depot directly email info@LymphedemaDepot.com
February 10, 2011 - health calendar - Washington Post –
Tina, this is announcing stuff that has now happened, sorry
February 10, 2011 - Cancer Treatment: Breast Cancer Surgery Could Become Less Invasive – ThirdAge
– By Nina Sen –
Breast cancer treatment could become less invasive, according to a new study.
According to a new study published in the Journal of American Medical Association, some women may
not need to have a painful procedure called axillary lymph node dissection. This procedure aims to remove
nodes around tumors that could also be cancerous. However, it is often painful and could cause infection
or lymphedema.
“Women really dread the axillary dissection,” said chief investigator Dr. Giuliano, head of surgical oncology
at the John Wayne Cancer Institute at St. John’s Health Center in Santa Monica, Calif., according to the
New York Times. “They fear lymphedema. There’s numbness, shoulder pain, and some have limitation of
motion. There are a fair number of serious complications. Women know it.”
The study examined more than 800 patients with early-stage tumors. All the patients had only part of their
breast removed in a lumpectomy. Additionally, they had radiation therapy and some had chemotherapy.
February 10, 2011 - Pharmacy boutique focuses on needs of breast-cancer patients – ModernMedicine -
By: Christine Blank –
An independent drugstore recently expanded its boutique section for breast-cancer patients to include a
wide variety of medical products and clothing.
Lehan Drugs and Home Medical Equipment in DeKalb, Ill., now includes a 2,500-square-foot Women's
Health Department and Boutique that boasts 3 private dressing rooms and 3 certified lymphedema garment
fitters.
The Lehan family, which includes owners Tim and Ann Lehan; their daughter-in-law and pharmacist son;
Tim's brother, Patrick; and his sister, Terri Lehan Hettel, first added women's health products to the drug-
and medical-equipment store 7 or 8 years ago, after cancer patients visiting the store asked for
lymphedema compression socks. "We wanted to be certified fitters in lymphedema garments, and it
became obvious to us that we needed to start looking into being a mastectomy fitter," said Lehan Hettel,
who manages the store. Many specialized products followed.
Today's expanded Women's Health Department and Boutique features products for all women. "We do
bra fittings for everyone, and we have everything from 'hot flash pajamas' to scarves to hats with built-in
sun protection," Lehan Hettel said.
More than 90 area doctors refer their breast-cancer patients to Lehan's. And because it is the only
drugstore in the community to offer this service, new patients consistently seek out Lehan Drugs.
February 10, 2011 - New Breast Cancer Treatment: Don't Remove Lymph Nodes – NewsTabulous –
posted by Mary –
For years if you had breast cancer, then doctors would remove your lymph nodes which can cause
extreme swelling, pain, and even Lymphedema. New studies show that in early stages of breast cancer the
lymph nodes do not have to be removed.
This may come as a shock to most women and families. Before this discover, when ever you were thought
to have breast cancer the doctors would take a sample of the sentinel lymph nodes. These are the first
nodes that they find in the channel of lymph nodes, and then test them to see if they were positive or
negative for cancer. If you were positive they would just remove all of the lymph nodes.
This was thought to be the best way to help to prevent the spread of the disease into other parts of the
body including the liver and brain. New studies show that if you are in the early stages of breast cancer
and your tumor isn’t more than 1 1/2 – 2 cm, then you don’t have to have these lymph nodes removed.
The reason, Dr. Cynara Coomer, says: “it doesn’t effect survival rates or reoccurrance rates” and it “doesn’
t help cure breast cancer”. Dr. Cynara Coomer, says that this is only for about 20% of women with breast
cancer. It’s important to catch the cancer in the early stages, have a small tumor, and minimal disease in
sentinel lymph nodes.
Women who have been diagnosed with breast cancer still need radiation and chemo treatment.
Dr. Cynara Coomer, is a Fox News medical contributor who is fighting thyroid cancer and is undergoing
Radioactive Iodine Treatments and is playing a big part in these new findings and in getting the word out.
It’s estimated that 207,000 women were diagnosed with breast cancer in 2010 and that there is 2.5 million
breast cancer survivors living in the United States alone. About 1 in 4 cancers are breast cancer. This will
be a nice alternative for many breast cancer patients that are looking for an alternative breast cancer
treatment.
February 11, 2011 - New Study Supports Less Surgery for Breast Cancer - Huffington Post (blog) – by
Dr. Elaine Schattner –
A new report in the Journal of the American Medical Association may influence -- and reduce -- surgical
treatment for many women diagnosed with breast cancer. The key finding is that for women with
apparently limited disease before lumpectomy and what's called a positive sentinel node, taking out all the
cancerous nodes from the axilla (armpit) has no survival advantage after five years.
I've reviewed the study in more detail, elsewhere. It's got a lot of strengths: it's randomized, Phase III and
multi-institutional -- meaning that the trial was carried out by many surgeons caring for patients at a variety
of medical centers. In total, 891 women were enrolled, all of whom had clinically small tumors and a
positive sentinel node. Half of the patients underwent complete axillary lymph node dissection; the others
did not. Nearly all got chemotherapy; some received endocrine treatments.
What the researchers found is that removing additional glands didn't improve survival in women who had
positive (involved) sentinel nodes upon lumpectomy. This finding supports that for breast cancer patients
with small tumors who will undergo radiation and chemotherapy, it's OK for surgeons to leave malignant
lymph nodes in place rather than remove those by more aggressive surgery.
Why this matters:
For women with apparently limited (stage I or II) breast cancer at the time of diagnosis, approximately 20
percent will turn to have a positive lymph node. Up until now, the usual care of those patients has included
a complete axillary lymph node dissection. During that part of surgery, typically 10 to 25 lymph nodes are
removed. This procedure can lead to lymphedema, a condition of chronic arm and hand swelling that can
be painful and disabling.
Lymphedema affects a small but significant fraction of the growing ranks of women --approaching 3 million
in the U.S. -- who are alive after breast cancer treatment. So if the axillary lymph node dissection can be
eliminated from the standard breast cancer surgery process, that would spare a lot of women from an
uncomfortable, compromising situation.
The implications bear on costs and risks of breast cancer care, apart from the lymphedema effects. There
would be less time in the O.R. and reduced costs of pathology (think of examining one lymph node instead
of 20 in 100,000 to 200,000 surgeries per year in the U.S.). There'd be less time under anesthesia. With
fewer lymph nodes removed, the risk of infection in a woman's hand or arm diminishes.
An irresistible aside to this story is that the findings should lessen the "costs" side of any mammography
equation: With the application of these results, expenses and potential complications of breast cancer
treatment will be reduced.
Why aren't the results surprising?
Breast cancer treatment, and our understanding of breast cancer biology, has advanced steadily in the past
25 years. Now it's routine to give treatments -- like chemotherapy, hormone modulators or antibodies like
Herceptin -- that target breast cancer cells wherever they reside in the body. The whole point of adjuvant
therapy is to destroy malignant cells remaining after surgery. If there are residual lymph nodes with
malignant cells in the armpit region after surgery, those would likely be destroyed by chemotherapy and
other treatments, combined with radiation to the affected chest and underarm area.
What are the study's limitations?
What's not adequately addressed in the paper and editorial, I think, is the situation of women who undergo
mastectomy and don't get radiation to the region, as is standard after lumpectomy. As much as I'm drawn
to the "less is more" approach to cancer therapy, I don't know that we can extrapolate these data to the
circumstances of women who don't get radiation.
Another limitation is the study's relatively short follow-up of just over five years. This is a valid concern in
any study of breast cancer survival, but my own opinion is that the axillary node intervention is unlikely to
result in a big difference later. That's because in 2011 what matters most for treatment decisions in breast
cancer, after diagnosis and initial surgery, is the nature -- in terms of genetic and molecular features -- of
the malignant cells.
General implications:
When I studied oncology, the dogma was that the prognosis in breast cancer rests on the size of the tumor
and the number of lymph nodes involved. But that was 20 years ago. Now we know that tumor markers --
if the cells express estrogen or progesterone receptors, HER2, as well as other factors including genetic
mutations that affect the malignant cells's aggressiveness and responsiveness to treatment -- are at least as
important in determining outcome. So although some physicians will express concern that we need the full
lymph node pathology results to establish the prognosis and formulate treatment recommendations, I think
in 2011 we can do better using molecular, modern predictors of disease responsiveness.
Finally, there's a suggestion in some of the coverage that doctors and patients may have a hard time
accepting "less" as better treatment for this disease. I don't really think that's the case anymore, at least not
for patients. From my experiences as an oncologist, as a breast cancer patient and knowing so many
women who've undergone debilitating treatments, I expect most patients will accept this development as
progress and a sound reason to avoid extra surgery. It may be the physicians who need be persuaded that
taking out all the lymph nodes does not improve a breast cancer patient's prognosis.
Toronto Physiotherapy, a leading provider of healthcare in Toronto, is providing free Lymphedema
services to individuals in financial need, and offering on-line education resources to promote disease
awareness.
Toronto, Canada, February 11, 2011 --(PR.com)-- Lymphedema is a serious condition caused by a
failure of the lymphatic system to maintain the proper balance of fluid in an affected tissue. The resultant
accumulation of lymphatic fluid, usually in an arm or leg, can be painful, disabling, and disfiguring. In
extreme cases, Lymphedema can lead to serious infection or even a rare form of cancer called
lymphangiosarcoma. Lymphedema frequently arises in cancer patients (in particular breast cancer)
following surgical lymph node removal or radiation treatment, but can also occur congenitally. Although
Lymphedema is a chronic disease, with proper symptom management and prevention individuals with
Lymphedema can enjoy a normal and active lifestyle.
Unfortunately, many individuals with Lymphedema are unaware of simple self-management practices, or
the availability of effective tools to combat the disease including compression garments and manual
lymphatic drainage therapy. “To further compound this problem, proper Lymphedema education and
therapy is often unavailable or too costly for individuals with limited financial resources,” says Clinic
Director Lindsay Davey, “as a consequence, patients with Lymphedema tend to withdraw from normal
activities due to discomfort, physical restrictions, or embarrassment.”
To combat the lack of awareness and treatment of Lymphedema, Toronto Physiotherapy is developing
educational tools including online resources and self-management video (http://www.torontophysiotherapy.
ca/services/toronto_lymphedema_treatment.html), as well as offering Certified Lymphedema Physiotherapy
services including a complimentary service for individuals with limited financial resources.
To assist low-income individuals, Toronto Physiotherapy provides a complimentary assessment of the
patient's Lymphedema case history, as well as education on effective self-management techniques and
other treatment options available including the suitability of compression garments. Toronto Physiotherapy
is also a Certified Compression Garment Authorizer through the Government of Ontario’s Assistive
Devices Program (ADP), and can recommend and authorize therapeutic garments to Lymphedema
patients so that they can access the ADP subsidization.
About Toronto Physiotherapy
Toronto Physiotherapy (http://www.torontophysiotherapy.ca) is a leading Toronto-based provider of allied
health care services including traditional Orthopedic Physiotherapy and Massage Therapy, as well as a
suite of specialized services that includes Neurological Physiotherapy, Nutrition Counseling, Acupuncture,
Manual Lymphatic Drainage and Home Care Physiotherapy. Toronto Physiotherapy is certified in
Combined Decongestive Therapy for Lymphedema and is also a Certified Compression Garment
Authorizer.
Contact:
Lindsay Davey
Clinic Director
416-792-5115
741 Broadview Ave., Suite 206
Toronto, Ontario, Canada, M4K 3Y3
info@torontophysiotherapy.ca
http://www.torontophysiotherapy.ca
February 12, 2011 - Cape docs: Aggressive breast cancer surgery likely reduced – TMCnet –
Feb 12, 2011 (Cape Cod Times - McClatchy-Tribune Information Services via COMTEX) -- Doctors
expect a decline in the number of Cape patients who undergo extensive lymph node removal to combat
early-stage breast cancer, following a new study on the efficacy of the surgery.
The study, which appeared Wednesday in the Journal of the American Medical Association, said there
was virtually no difference in the survival rates of early-stage breast cancer patients who had all their lymph
nodes removed and those who had only a few nodes removed.
"We kind of knew it was coming," said Dr. David Lovett, a medical oncologist at the Davenport-Mugar
Cancer Center at Cape Cod Hospital.
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"We were probably doing too much surgery on folks with breast cancer," he said.
Annually, about 75 out of 300 newly diagnosed breast cancer patients at Cape Cod Hospital have a
procedure called axillary lymph node dissection, which removes all the lymph nodes found in the armpit,
said Dr. Robyn Sachs, breast surgeon at the Hyannis hospital.
She expects that number to go down by about 50 patients because the new study shows the benefits of
less radical surgery.
Researchers studied women who had undergone a lumpectomy to remove a breast cancer tumor as well as
radiation and, in some cases, chemotherapy.
By removing a few lymph nodes through a process called sentinel lymph node dissection they identified
890 women whose cancer had spread to one or two "sentinel" nodes, to which fluid first drains from the
breast.
Of these women nearly half -- 446 -- were randomly selected to receive the more extensive axillary
surgery.
After following the women for just more than six years, researchers found mortality and five-year survival
rates were virtually the same in both groups of women, as was the rate at which women were disease-free
after five years. But those who experienced the more radical surgery had higher rates of swelling, called
lymphedema, as well as tingling, numbness, pain and wound infection.
The complication rate was 25 percent among those who'd just had a few nodes removed but 70 percent
among axillary patients.
"This leaves patients with all kinds of problems," Nancy Ferzoco, breast care nurse at Falmouth Hospital,
said of the more radical surgery.
Lymphedema can become a lifelong issue, she said. "It's painful. The arm can swell up to three times its
normal size," requiring breast cancer survivors to wear a special compression sleeve.
Women have 10 to 40 lymph nodes under their armpits. Balls of fluid the size of an orange, called seromas,
also can collect under the armpit and need to be aspirated, Ferzoco said.
Some patients complain for years about damage to sensory nerves, she said.
Now, the standard practice of going after all or most of the lymph nodes after getting a positive cancer
reading on one node will end, Lovett said.
Most of the time, the cancer in one or two "simple" sentinel nodes has not spread, Sachs said. She said that
patients with aggressive tumors and a large amount of disease in the surrounding lymph nodes will still need
the axillary procedure.
The new information is part of the evolutionary refinement of breast cancer treatment, which has gone from
mastectomy as the mainstay of treatment to the less invasive use of lumpectomy, Lovett said.
Some patients may need a measure of convincing that the less radical treatment is just as good.
Jane Mullenhour of Mashpee had a double mastectomy and 17 lymph nodes removed from the area
around her right breast five years ago and says she is happy with that decision.
"How do they know if it has gone into the lymph nodes if they don't take the lymph nodes?" she asked,
adding that she insisted on early treatment for her lymphedema symptoms.
"I would rather be safe than sorry." To see more of the Cape Cod Times, or to subscribe to the
newspaper, go to http://www.capecodonline.com. Copyright (c) 2011, Cape Cod Times, Hyannis, Mass
February 12, 2011 - Strength training does more than bulk up muscles - Los Angeles Times – By Jeannine
Stein –
It may reduce depression, give older people better cognitive function, boost good cholesterol and more.
Strength training has strong-armed its way beyond the realm of bodybuilding.
A growing body of research shows that working out with weights has health benefits beyond simply bulking
up one's muscles and strengthening bones. Studies are finding that more lean muscle mass may allow
kidney dialysis patients to live longer, give older people better cognitive function, reduce depression, boost
good cholesterol, lessen the swelling and discomfort of lymphedema after breast cancer and help lower the
risk of diabetes.
"Muscle is our largest metabolically active organ, and that's the backdrop that people usually forget," said
Kent Adams, director of the exercise physiology lab at Cal State Monterey Bay. Strengthening the muscles
"has a ripple effect throughout the body on things like metabolic syndrome and obesity."
Historically, strength training was limited to athletes, but in the last 20 years, its popularity has spread to the
general public, said Jeffrey Potteiger, an exercise physiologist at Grand Valley State University in Grand
Rapids, Mich., and a fellow of the American College of Sports Medicine. "One can argue that if you don't
do some resistance training through your lifespan, you're missing out on some benefits, especially as you get
older or battle weight gain," he said.
When we hit middle age, muscle mass gradually diminishes by up to about 1% a year in a process called
sarcopenia. Women also are in danger of losing bone mass as they age, especially after the onset of
menopause. Some studies have shown that moderate to intense strength training not only builds skeletal
muscle but increases bone density as well.
Strength training often takes a back seat to cardiovascular training, but it can benefit the heart in ways that
its more popular cousin can't.
During cardio exercise, the heart loads up with blood and pumps it out to the rest of the body: As a result,
Potteiger said, "the heart gets better and more efficient at pumping."
But during resistance training, muscles generate more force than they do during endurance exercises, and
the heart is no exception, Potteiger said. During a strength workout, the heart's muscle tissue contracts
forcefully to push the blood out. Like all muscles, stress causes small tears in the muscle fibers. When the
body repairs those tears, muscles grow. The result is a stronger heart, not just one that's more efficient at
pumping.
Another big advantage of working out with weights is improving glucose metabolism, which can reduce the
risk of diabetes. Strength training boosts the number of proteins that take glucose out of the blood and
transport it into the skeletal muscle, giving the muscles more energy and lowering overall blood-glucose
levels.
"If you have uncontrolled glucose levels," Potteiger said, "that can lead to kidney damage, damage to the
circulatory system and loss of eyesight."
The benefits don't end there. A 2010 study in the Clinical Journal of the American Society of Nephrology
suggested that people on dialysis can benefit from building muscle. Researchers found that kidney dialysis
patients who had the most lean muscle mass — a measurement derived from the circumference of the mid-
arm muscle — were 37% less likely to die than the patients who had the least.
"This is something that has an impact on survival," said Dr. Kamyar Kalantar-Zadeh, a principal researcher
at the Los Angeles Biomedical Research Institute and coauthor of the study. "It's not just about having
more muscle and looking better — we're talking about life and death."
Even people who already have chronic kidney disease could benefit from strength workouts. Germany
began to incorporate modified exercise equipment into dialysis treatment centers in 1995, and a 2004
study in the American Journal of Kidney Diseases examining that policy found that exercise may improve
the efficiency of dialysis by increasing blood flow through the muscle and improving phosphate removal.
The brain may get a boost from the body's extra muscle as well. A 2010 study in Archives of Internal
Medicine found that women ages 65 to 75 who did resistance training sessions once or twice a week over
the course of a year improved their cognitive performance, while those who focused on balance and tone
training declined slightly. One reason for the improvement, researchers believe, may be that strength
training triggers the production of a protein beneficial for brain growth.
This study was triggered by another that looked at resistance training as a way to reduce the risk of falls in
older people, said coauthor Teresa Liu-Ambrose, a researcher at the University of British Columbia's
Centre for Hip Health and Mobility in Vancouver. As the study progressed, she said she noticed that
participants "were able to take on new tasks, like taking the bus by themselves. They were able to prepare
and plan for things and execute them."
Strength training could be easier for people with mobility problems who might find it easier to navigate a
stationary weight than a moving treadmill.
"It's never too late to start," Adams said. "The benefits are great."
February 13, 2011 - Women With Early Breast Cancer May Not Need Surgery - Care2.com (blog) -
posted by: Amelia Thomson-DeVeaux –
According to new research findings, many early breast cancer patients won't have to have the painful lymph
node removal surgery that has, for over a century, been routine. This was because the women in the study
had chemotherapy and radiation, which most likely removed disease from the nodes, despite the previous
assumption that once these nodes are cancerous, they have the potential to spread to vital organs and can
only be removed by surgery.
According to the new results, does not improve the patient's chance of survival or decrease the likelihood
that the cancer will return. And the surgery has significant complications, like infection and lymphedema, a
chronic swelling in the arm. It's not clear, though, whether the results are the same for women who don't
have chemotherapy or radiation.
The study is especially newsworthy because it should change medical practice for many patients. And it
may take a while for doctors and patients to adjust to the idea that surgery is not the best option. "This is
such a radical change in thought that it’s been hard for many people to get their heads around it,” said Dr.
Monica Morrow, one of the study's authors. According to her, people find it easier to accept the idea of
more treatment instead of less, even if the data supports decreased intervention.
In the New York Times, Denise Grady points out the recent trend toward less invasive treatments for
breast cancer; mastectomy rates have dropped since the 1980's, and doctors now remove large, dense
tumors while using radiation to destroy smaller traces of the disease.
Although it's good that doctors are responding well to the new research, this is a reminder that medical
authority is not infallible. That's why it's so crucial that studies like this continue, and that we don't
unquestioningly accept doctors' advice. One study co-author admitted that, by removing large numbers of
nodes, "I have a feeling we’ve been doing a lot of harm." And it does seem that if women have been
having these surgeries unnecessarily, they suffered through infection and lymphedema, in addition to
chemotherapy and radiation, for nothing. But we can't expect medicine to be perfect. And so in that
sense, a study like this is ultimately encouraging, if it means that women in the future will be spared a painful
surgery.
February 13, 2011 -Toronto Physiotherapy Promotes Awareness, Education, and Treatment of Chronic
swelling called Lymphedema - PR-USA.net (press release)
Lymphedema is a serious condition caused by a failure of the lymphatic system to maintain the proper
balance of fluid in an affected tissue. The resultant accumulation of lymphatic fluid, usually in an arm or leg,
can be painful, disabling, and disfiguring. In extreme cases, Lymphedema can lead to serious infection or
even a rare form of cancer called lymphangiosarcoma. Lymphedema frequently arises in cancer patients (in
particular breast cancer) following surgical lymph node removal or radiation treatment, but can also occur
congenitally. Although Lymphedema is a chronic disease, with proper symptom management and
prevention individuals with Lymphedema can enjoy a normal and active lifestyle.
Unfortunately, many individuals with Lymphedema are unaware of simple self-management practices, or
the availability of effective tools to combat the disease including compression garments and manual
lymphatic drainage therapy. “To further compound this problem, proper Lymphedema education and
therapy is often unavailable or too costly for individuals with limited financial resources,” says Clinic
Director Lindsay Davey, “as a consequence, patients with Lymphedema tend to withdraw from normal
activities due to discomfort, physical restrictions, or embarrassment.”
To combat the lack of awareness and treatment of Lymphedema, Toronto Physiotherapy is developing
educational tools including online resources and self-management video (http://www.torontophysiotherapy.
ca/services/toronto_lymphedema_treatment.html), as well as offering Certified Lymphedema Physiotherapy
services including a complimentary service for individuals with limited financial resources.
To assist low-income individuals, Toronto Physiotherapy provides a complimentary assessment of the
patient's Lymphedema case history, as well as education on effective self-management techniques and
other treatment options available including the suitability of compression garments. Toronto Physiotherapy
is also a Certified Compression Garment Authorizer through the Government of Ontario’s Assistive
Devices Program (ADP), and can recommend and authorize therapeutic garments to Lymphedema
patients so that they can access the ADP subsidization.
About Toronto Physiotherapy
Toronto Physiotherapy (http://www.torontophysiotherapy.ca) is a leading Toronto-based provider of allied
health care services including traditional Orthopedic Physiotherapy and Massage Therapy, as well as a
suite of specialized services that includes Neurological Physiotherapy, Nutrition Counseling, Acupuncture,
Manual Lymphatic Drainage and Home Care Physiotherapy. Toronto Physiotherapy is certified in
Combined Decongestive Therapy for Lymphedema and is also a Certified Compression Garment
Authorizer.
Contact:
Lindsay Davey
Clinic Director
416-792-5115
741 Broadview Ave., Suite 206
Toronto, Ontario, Canada, M4K 3Y3
info@torontophysiotherapy.ca
http://www.torontophysiotherapy.ca
February 13, 2011 - Lymphedema Awareness in Ontario - Wire Service Canada (press release) – by
LymphedemaDepot –
Lymphedema is a permanent condition of chronic swelling that is not difficult to treat. Unfortunately, patient
access to treatment is limited.
February, 2011---On March 6, 2011, lymphedema therapists, patients, patient advocates and others will
observe Lymphedema Awareness Day. While it is known that the condition of lymphedema is under-
diagnosed and under-treated, it is very difficult to find statistics on how many patients in Canada suffer with
lymphedema. In 2004, the Lymphedema Association of Ontario arrived at an estimate based in part on
data from Cancer Care Ontario:
Over 63,000 children and adults* live with primary or secondary lymphedema in Ontario.
246,000 Ontario cancer survivors** are at a lifetime risk of developing lymphedema.
Currently, Ontario has just over 100 certified lymphedema therapists.
<>Some parts of Ontario have little or no access to a certified lymphedema therapist.
* Lymphedema Association of Ontario estimate (2004).
** Based on Cancer Care Ontario data (2004).
At this time, this is the best estimate we have for how many people in Ontario have lymphedema.
Lymphedema is a condition of chronic swelling that affects a limb or other body part due to an
accumulation of lymph fluid. You can be born with lymphedema or it can be acquired after a traumatic
injury, severe infection or surgical removal of lymph nodes. Lymph nodes are often removed for the staging
of cancer, to determine if cancer cells are spreading to the lymph system. In sub-tropical countries
lymphedema can be acquired from parasites.
Lymphedema is not curable, but it can be managed through a blend of therapy techniques that do not
involve surgery or drugs. This technique is known as Complex Decongestive Therapy (CDT).
Unfortunately, many physicians are not familiar with CDT, and, as a result, proper treatment is under-
prescribed.
If you know a cancer survivor, then you know someone who is at risk for developing lymphedema. You
may be able to help them understand this risk. Please learn more about this condition by following the links
provided below, and by talking about what you have learned.
Lymphedema Depot, the importer and distributor of Solaris lymphedema care products in Canada, is
helping to promote Lymphedema Awareness Day this year.
To learn more about lymphedema, see the Lymphedema Depot’s page of links, a clickable list of
lymphedema resources: http://www.lymphedemadepot.com/links
To learn more about Lymphedema Awareness Day please visit our website at http://www.
lymphedemadepot.com and click on the Lymphedema Awareness Day logo.
February 14, 2011 - Breast cancer treatment in Minn. already following new study guidelines - Minnesota
Public Radio – by Lorna Benson –
St. Paul, Minn. — Breast cancer care in the Twin Cities is rapidly moving toward less aggressive surgery
for the disease when it has migrated to a woman's lymph nodes.
Doctors at several metro-area cancer centers say they have already dialed back their surgical policies after
learning about a stunning new study. The data showed there is no difference in survival between women
who had more of their lymph nodes removed and those who did not.
Breast cancer patients say they're thrilled to have a less invasive treatment option, that's equally effective.
The study, published in the influential Journal of the American Medical Association, captured news
headlines across the nation last week.
But as early as last September, breast cancer surgeon Todd Tuttle remembers reading some preliminary
results from the study in another, smaller journal, the Annals of Surgery. That article prompted a lively
discussion among Tuttle's colleagues at the University of Minnesota's Masonic Cancer Center.
"This is a practice-changing study. Breast centers all across the country are deciding what to do with the
results of this study," said Tuttle. "We've had the same discussions here. And it has dramatically changed
our practice."
Tuttle says almost immediately after reading the study last fall, he and his colleagues agreed they would no
longer remove additional lymph nodes in early-stage breast cancer patients who had microscopic disease in
their lymph nodes.
Doctors at the Piper Breast Center in Minneapolis made the same decision in December, after bringing one
of the study's authors to their center to answer questions about the data. Margit Bretzke is a surgeon at
Piper.
"Whenever we present a lumpectomy option to a patient now, and their nodes ... appear to be negative,
we talk about this study," said Bretzke.
Restraining their surgical approach wasn't as easy as it sounds. Bretzke says there's a long tradition among
breast cancer surgeons of removing lymph nodes with any sign of cancer. But she says the results of the
study are just too compelling to ignore.
There was no difference in recurrence of disease or survival between the women who had the lymph node
procedure and those who did not.
For many patients, the change in treatment means they will have a much lower risk of developing
lymphedema -- a painful condition that causes swelling and numbness in the arm.
"That was really comforting to know that I might not have to have more invasive surgery," said Lucille, one
of Dr. Bretzke's patients. "I was very aware of the possible outcome, and I know people who have had
lymph nodes removed and who suffer from lymphedema."
MPR news agreed not to use Lucille's full name because she hasn't told all of her family members about her
cancer diagnosis.
Lucille, 53, says she feels fortunate that she received her diagnosis in time to take advantage of the study.
Without it, she probably would have had her lymph nodes removed unnecessarily.
"It's fantastic," she said. "It's wonderful that there's so much research going on. And that the research
continues to provide treatments that are less invasive."
But patients should not assume that all breast cancer surgeons will be familiar with the new data.
Margit Bretzke at the Piper Breast Center says patients may need to advocate for themselves.
"I would tell women that when they're talking to their surgeon, to bring it up to see if they're in fact a
candidate for avoiding a node dissection," said Bretzke. "They need to challenge their surgeon and ask the
question. I would say if their surgeon doesn't seem to know what they're talking about, they ought to get a
second opinion."
Women who are most likely to qualify for a less invasive breast cancer surgery must have small breast
tumors with no obvious sign of significant cancer in their lymph nodes on imaging scans or during a physical
exam.
Candidates must be willing to undergo a lumpectomy, followed by whole breast radiation and possibly
chemotherapy or hormone therapy to destroy any remaining cancer cells.
Women who receive mastectomies without radiation or chemotherapy where not part of the study, and
therefore, not considered good candidates for this treatment option.
February 14, 2011 - Breast cancer finding to greatly change treatment - The Republic – By Lindy
Washburn –
HACKENSACK, N.J. — Many women with breast cancer will no longer face a potentially devastating
side effect of their cancer surgery, as the conclusions of a newly published study about the need to remove
underarm lymph nodes are taken to heart by breast surgeons.
"This was a celebratory day for me," said Dr. Laura Klein , medical director of The Valley Hospital's
breast center. "It's practice-changing. I personally will no longer be performing axillary node dissections" on
women who match the study criteria.
At Holy Name Medical Center in Teaneck, N.J. , Dr. Erika Brinkmann , director of the breast center, said
she would act on the study results "immediately."
"It will influence not only my practice but everyone's practice," said Dr. David Pearlstone , chief of breast
surgery at Hackensack University Medical Center . The medical center's breast-cancer team, including
surgeons, radiologists, medical oncologists and nurse practitioners, will discuss the findings at its next
weekly meeting on Wednesday, he said.
The study, published Wednesday in the Journal of the American Medical Association , found that women
who underwent lumpectomies for tumors of less than 2 inches and whose lymph nodes did not have
obvious signs of disease, showed no difference in survival if many lymph nodes were removed or if only
their sentinel nodes were removed.
Surgeons will still remove one to three sentinel nodes, the first nodes that drain lymphatic fluid from the
breast, to see if the cancer is spreading beyond the breast. Finding cancer in those nodes indicates that
disease cells have migrated and could cause metastases elsewhere. Such patients almost always are treated
with chemotherapy.
But until now, a finding of cancer in the sentinel node had led surgeons to remove more nodes — either at
the same time as the lumpectomy or with a return to the operating room later — to try to make sure that no
cancer cells remained in the body. The study showed that this makes no difference in terms of cancer
recurrence in the same breast, disease-free survival, or overall survival.
With or without the additional surgery, called an axillary node dissection, more than 90 percent of the
women survived for five years. With or without it, the chance of a cancer recurrence in the same breast
was less than 4 percent.
That conclusion upends one of the most closely held beliefs about cancer surgery, that it is best to "get it all
out."
"As cancer surgeons, it's anathema to us to know we leave cancer behind," Pearlstone said. "But here's a
study that says, hey, it doesn't matter."
"We always have felt that the role of the surgeon is to cut it all out," Brinkmann said. "It's very hard not to
fall into that hole. But we have to look at the data and the studies that have been done. This will be the
standard of care now" for women who match the study criteria.
The findings further the trend toward less-invasive breast cancer treatment. In recent decades,
lumpectomies, when combined with radiation treatment, have been shown to be as effective as
mastectomies for many women. And sentinel-node biopsies have replaced wholesale initial excision of
lymph nodes.
Knowing how many additional lymph nodes contain cancer does not change decisions about whether to
use chemotherapy and what type of chemotherapy to use, said the study, by Dr. Armando Giuliano of the
John Wayne Cancer Institute in California and others.
Oncologists increasingly base their chemotherapy treatment on the specific characteristics of the patient's
tumor, including the cells receptivity to estrogen and progesterone and their molecular composition.
The study is significant because for many women, the worst side effects of breast-cancer surgery result not
from the breast incision, but the lymph node removal. "A few women suffer medical problems from having
a sentinel node removed," Pearlstone said. "But many, many, many suffer medical problems from having a
whole lot" of nodes removed.
"There's a lot going on in that area," under the arm, said Carolyn Monroe , a nurse-practitioner in the
surgical breast practice at Hackensack, N.J. "It's the junction from your arm to your torso and shoulder
and neck." Many muscles and nerves join and intersect.
Side effects may include pain, tingling, numbness, weakness, tightening or a cord-like feeling that can
extend down the arm, and lymphedema, a permanent swelling that can limit motion and for which there is
no cure.
Recovery after surgery is expected to be easier, too, because women will not require underarm drains for
weeks if they have not had multiple lymph nodes removed.
Some surgeons said their patients were asking how the study conclusions would affect them.
"I had two new cancer consults (Wednesday)," Pearlstone said. "Both asked me about it. On the way
home I got three personal calls about it. Then my wife asked me if I'd seen the 'Today' show about it."
Klein, at Valley in Ridgewood, N.J. , received several calls from patients whose operations are on her
calendar. "They said, 'We're not going to do an axillary lymph node dissection, are we?'" she said. Women
embrace the findings because of their worry over developing lymphedema.
For one patient, the study was published at the perfect time. She won't have to go back for further surgery
to remove more lymph nodes, even though the sentinel node was positive for cancer.
Surgeons cautioned, however, that the study does not affect all women with breast cancer. There is no
data about women who undergo mastectomies, for example, or who have larger tumors. And everyone in
the study received "whole-breast radiation," which also irradiates the underarm area.
They were not treated with partial radiation, and they did not lie prone for their radiation treatments, two
recent innovations.
For these women and others, more research is needed.
========================
February 15, 2011 - Susan G. Komen for the Cure® Awards Grants to Memorial - WDEF News 12 –
The Susan G. Komen for the Cure Foundation awarded four grants to Memorial Health Care System
totaling more than $87,000.
Lymphedema Treatment Assistance – The foundation awarded $14,500 to Memorial to provide support
for women newly diagnosed with breast cancer. The MaryEllen Locher Breast Center has dedicated itself
to providing support every step of the way beginning with education and a review of the lymphatic system
and signs and symptoms of lymphedema. The MaryEllen Locher Breast Center also provides assistance
with the garments necessary for lymphedema patients who do not have insurance and would be burdened
by purchasing them.
Access to Mammograms – More than $52,600 was awarded to help provide access to mammograms.
The grant will help fund Memorial’s Mobile Coach outreach breast health education program which
provides mammograms for insured and uninsured women.
Breast Health Day – A grant totaling $20,000 will help fund a series of breast health educational programs
and mammogram screenings to diverse populations with sensitive language and cultural concerns.
February 15, 2011 - Restorix Health hyperbaric chamber leads to space-age medical research - Issaquah
Press – By Laura Geggel –
Mention hyperbaric chambers, and most people start thinking about pressurized rooms where scuba divers
afflicted with the bends go to recover.
But the chambers can be used for much more, and Issaquah’s Restorix Health plans to participate in
hyperbaric treatment and research to find other medical uses for the pressurized chambers.
“We think there is great potential nationwide for what they’re doing and what they started in Issaquah,”
Issaquah Chamber of Commerce CEO Matt Bott said, congratulating it for receiving one of the chamber’s
three Innovation in Issaquah awards.
Restorix Health, which opened in Issaquah in December, has grand ambitions for its comprehensive health
care delivery system. With six hyperbaric chambers, it has the largest collection of large monoplace
chambers in the country. The chambers deliver oxygen with an increased atmospheric pressure, and can
help heal patients with diverse maladies, including diabetic patients who have dying tissue deprived of its
regular dose of oxygen.
“By putting your whole body under pressure, we dissolve oxygen into the liquid part of your body,”
Medical Director Tommy Love said.
Increased oxygen levels can stimulate different responses in the body, including faster healing and increased
stem cells, Medical Director Latisha Smith said.
Hyperbaric chambers are approved for 14 treatments, and by opening 15 to 20 new clinics along the West
Coast in the next five years, Restorix Health will contribute to research looking for more uses.
“Hyperbaric therapy is another tool we can use to help heal wounds,” Love said. “We think hyperbaric
therapy can be beneficial in more things.”
A handful of local health care centers have hyperbaric chambers, but their chambers are often used for
paying patients, not research, Love said. Restorix Health staff can easily schedule patients and also have
room for research participants, which will be double-blind studies in which neither the patient nor the
doctor know who is getting hyperbaric treatment in the chamber.
The company’s nonprofit foundation is raising money to help pay for the research, Love said. Much of the
research will be done in concert with other hyperbaric facilities across the country.
Some of the studies will address concussions from vehicle accidents and sports injuries, and traumatic brain
injuries sustained in the U.S. armed forces.
The company frowns on other hyperbaric companies that might “prey on desperate people” looking for
miracle cures, Love added.
At Restorix Health, one health care worker monitors two chambers, and can use a phone to communicate
with the patients in the giant, clear tubes. Some patients watch TV, others read and a few fall asleep during
their two-hour treatments, Love said.
“A lot of times you forget you’re in a vessel,” he said.
In addition to its hyperbaric chambers, the clinic will also treat patients with lymphedema, a disease that
happens when a person’s lymphatic system is blocked and their leg or arm swells from the increased fluid.
The clinic has rooms dedicated to massage — so the patient’s lymphatic fluids can start moving again —
and has other rooms with wide doors so patients on stretchers can easily enter and transfer to the
examination chair.
A spacious room with cushy chairs, wood floors and tall windows waits for lymphedema patients receiving
IV infusions. A nurses’ station is located behind a glass window, giving health care workers the opportunity
to monitor patients while entering information into electronic medical charts.
Past the nurses’ station is the pharmacy, a room where Restorix Health pharmacists can prepare their own
drugs. A room nearby serves as a dressing room for patients using the hyperbaric chamber — they can’t
wear polyester because its friction can cause sparks, a bad idea in a highly oxygenated environment.
Restorix Health does not plan to replace family doctors; it wants to work in tandem with them on a referral
basis, Smith said.
Bott praised Restorix Health for its innovative ideas and encouraged it forward with its research.
“Some of the criteria that really stood out with them included the potential that we felt they had with wound
treatment, and the company’s affiliation with the research foundation,” he said. “We felt that was an
innovative model to drive wound treatment in this area.”
February 16, 2011 - Lymph Node Study May Revolutionize Breast Cancer Care - Citizens Report –
A recent study finds that women with early breast cancer do not need to undergo a painful procedure long
thought to be mandatory: removal of cancerous lymph nodes from the armpit. The news impacts 40,000
women a year in the United States for whom the surgery has no advantage.
Although the treatment is standard, it can also cause complications that include infection and lymphedema,
a chronic swelling in the arm. Removing cancerous lymph nodes isn’t always necessary, researchers say,
because women in the study already had chemotherapy and radiation. These treatments may eliminate
disease in the nodes.
The study included 891 patients at the median age of mid-50s, followed for a median of 6.3 years. After
the initial node biopsy, the women were randomly assigned to either have 10 or more additional nodes
removed, or to leave the nodes alone. The nodes were cancerous for 27 percent of the women studied,
but the two groups had no difference in rates of survival. More than 90 percent survived over five years.
February 16, 2011 - Surgeons optimistic on lymph node study - Daily American Online – Somerset —
Local surgeons are cautiously optimistic about a new study that finds that many women with early stage
breast cancer do not need a procedure that has long been routine: Removal of all cancerous lymph nodes
from the armpit.
“This is a major change,” said Dr. Dianna Craig, breast surgeon at Windber Medical Center. “Research is
getting us to be less and less invasive. This is a big step along that pathway.”
Dr. Gerard Garguilo, general surgeon at Memorial Medical Center, Johnstown, said a lot of people had
been calling into question the value of the more radical surgery.
“It’s a notion that a lot of us were thinking — more radical surgery was not necessary,” he said. “These are
quality of life issues.”
Surgeons have been removing lymph nodes from under the arms of breast cancer patients for many years,
believing it would prolong women’s lives by keeping the cancer from spreading or coming back. Removal
of nodes can cause infection and lymphedema, a chronic swelling in the arm.
Now researchers report that for women who meet certain criteria, taking out nodes has no advantage.
“This is what we have to caution readers about — it is very limited, not for everybody,” Craig said.
The criteria include women whose tumors were found at an early stage, five centimeters or smaller, which
is less than 2 1/2 inches across. Biopsies of one or two nodes had found cancer, but the lymph nodes were
not enlarged enough to be felt during an exam and the cancer had not spread anywhere else. The women
had lumpectomies. Most also had radiation to the entire breast or chemotherapy or both. An estimated 20
percent of patients, or 40,000 women a year in the United States, fit that criteria.
“The study didn’t look at women who had mastectomies, radiation of the partial breast or chemotherapy
prior to the surgery,” Craig said. “It was a very limited population, but there was no difference in survival
rates. We don’t have long-term data — that will come over time.”
After armpit surgery, 20 to 30 percent of women develop lymphedema. Radiation increases that to 40 to
50 percent.
“Women who develop lymphedema have arm pain, they have to limit the motion of the shoulder, they have
swelling, they have to make lifestyle changes,” Garguilo said.
Craig said there is no cure for lymphedema, but it can be managed.
“The key is catching it early and using compression bandages and massage therapy,” she said. “You don’t
lose the use of your arm, but it’s not fun to deal with.”
Another thing to be cautious about is that the study only included 891 patients and they were followed for
just over six years.
“That is not as many women as they would have liked to have had in the study,” he said.
Dr. Armando E. Giuliano, lead author of the study, is the chief of surgical oncology at the John Wayne
Cancer Institute at St. John’s Health Center in Santa Monica, Calif. The study was published this month in
the Journal of the American Medical Association and in the Annuals of Surgery. The National Cancer
Institute paid for the study.
The new findings are part of a trend to move away from radical surgery for breast cancer, Craig said.
Rates of mastectomy, removal of the whole breast, began declining in the 1980s after surgeons found that
for many patients, survival rates after lumpectomy and radiation were just as good as those who had
mastectomies.
In the 1990s, surgeons developed a technique called sentinel node biopsy, in which they injected a dye into
the breast and then removed just one or a few nodes that the dye reached first. The theory was that if the
tumor was spreading, cancer cells would show up in those nodes.
The new study doesn’t cancel out the need for chemotherapy.
“The great equalizer is chemotherapy,” Garguilo said. “It’s very effective in treating nodes that have not
been removed. Radiation covers part of the nodes as well. These keep the risk of a reoccurrence (of
cancer) low.”
He believes that as more studies are done it will lead to the demise of more radical surgery.
“To me, this is the next big advance in treating women,” Garguilo said.
Craig agrees that there have been a lot of changes in treatment of breast cancer in the last decade.
“This is a step in the right direction,” she said. “Right now, it’s a very limited recommendation. Women
who have a diagnosis of breast cancer must discuss options with their physicians. We’re enthusiastic about
the study, but cautious in going forward.”
February 17, 2011 - Re-teaching daily living at IOOF therapy center - Mason City Globe Gazette – By
KRISTIN BUEHNER –
MASON CITY — A new Community Therapy Center at the IOOF Home in Mason City provides a
larger, more convenient area for therapy patients from the IOOF Home and the community.
Located on the southeast end of the IOOF Home care center at 1037 19th St. S.W., the facility includes a
fully equipped therapy gym, two private treatment rooms and a full kitchen and bathroom used for re-
teaching activities of daily living, said IOOF Home Marketing Director Pam Klukow.
“We’ve been gradually utilizing the space since Dec. 3,” Klukow said. Residents can access it from inside
and there’s public access from a parking lot.
Therapeutic services are provided by Therapeutic Advantage of Hampton. Physical therapy, occupational
therapy, speech therapy and lymphedema therapy are available. Lymphedema is a condition that results in
tissue swelling and fluid retention.
Residents benefit by having a mix of people from the outside using the center, said IOOF Home
administrator Deb Haugen.
“Skilled-care patients know they’re still part of the community,” she said.
After the patients return home, they will find the center easily accessible to continue their therapy if
needed, Klukow said.
“It’s gorgeous,” said Glenna Putney of Clear Lake, who comes to the center for lymphedema therapy. “It’s
very handy.”
Wilma Schriver, a resident of the IOOF Home, said she enjoys the larger space and the new equipment.
“It looks like a gym,” she said.
The 3,000-square-foot addition cost approximately $650,000 to build. It was designed to blend in with the
existing facility, which was built in 1994 and remodeled in 2009.
Groundbreaking for the new addition was in April.
Bergo Construction of Mason City was general contractor. Skott & Anderson Architects of Mason City
provided architectural services.
Regular hours are 8 a.m. to 5:30 p.m. Monday through Friday.
A ribbon-cutting ceremony will be at 1:30 p.m. Thursday, Feb. 24, at the IOOF Home.
A public open house will be 1:30 to 3:30 p.m. Saturday, Feb. 26.
February 17, 2011 - Head and Neck Lymphedema is Common; Help is Available - Wire Service Canada
(press release) – LymphedemaDepot –
Lymphedema of the head, neck and face is more common than you might think.
If you do any research on head and neck lymphedema following cancer-related surgery you may come
across this statement;
“...approximately half of patients treated for head and neck cancer develop lymphedema.” (Cancer.net)
Lymphedema is a chronic, incurable swelling condition that requires lifelong management.
Even postsurgical swelling following cosmetic procedures can take months to resolve.
Once swelling develops, what resources are available to the patient?
Lymphedema Depot is proud to carry the Solaris line of custom-made Tribute lymphedema garments.
These therapeutic garments can be tailored to help resolve chronic or acute edema in the head neck and
face regions. These garments are comfortable and work while you sleep to soften and reduce swelling.
These Tribute garments are available in several styles including a neck piece, a facial garment and an eye
mask for addressing swelling around the eyes. On the facial or neck garments allowances can be made to
accommodate a tracheotomy .
While comfortable and relatively simple, the Solaris Tribute garments are the most advanced garment-
based therapy available for head, neck and face edema or lymphedema. Chipped foam sewn into quilted
channels gently sinks in to the proteins and fluid that make up the swelling, breaking down fibrosis and
guiding fluid away from saturated areas. The custom manufacture of each garment insures a comfortable
and effective fit.
These garments are also adjustable to help manage fluctuations and reductions in swelling without the need
for a new garment. They can be worn comfortably overnight while sleeping. And because each one is
measured to the patient’s exact measurements, the fit is custom and comfortable.
For more information about Solaris head, neck and facial Tribute units available through Lymphedema
Depot, see our website at http://www.lymphedemadepot.com and look under Tribute to see the head neck
and face garments.
For more information, contact Lymphedema depot at info@LymphedemaDepot.com
February 17, 2011 - Family spreads awareness of Turner syndrome - Richmond-News – By: Jackie
Grumish –
When Jozie Lewis was born with severely swollen hands and feet, her doctors thought it was just because
of the way she was positioned in the womb.
Derek and Linda Lewis, Jozie’s parents, weren’t so sure.
“My brother’s step-son’s nephew’s daughter has Turner syndrome,” Linda said. “When I asked the
doctor if that’s what it was, his jaw dropped open.”
Not many people know about Turner syndrome, Lewis said. If it wasn’t for the case knowledge in the
family and the Lewis’ knowledge about the disease, it’s unlikely Jozie would’ve been diagnosed so early in
life.
Turner syndrome is a non-inherited chromosomal condition that affects one in 2,000 female births. About
50 percent of girls with Turner syndrome are not diagnosed until their pre-teen or teenage years, when
puberty never kicks in.
Part of the problem with diagnosis is that most cases are different and the symptoms can vary from girl to
girl.
For example, other than Jozie’s lymphedema in her lower arms, hands, lower legs and feet and her low set
ears, she has no other apparent characteristics symptoms.
“She doesn’t have anything abnormal,” Linda said. “No one is able to look at her and know. Even her
lymphedema is mistaken for chubby.”
Each case is different and some girls experience different characteristics and symptoms than others, Lewis
said.
“Jozie has really been lucky that way,” Lewis said.
Jozie, who is just 18 months old, was an early walker and is verbally advanced. She also doesn’t suffer any
social issues that some girls can experience. She is a very outgoing little girl.
The same can’t be said about everyone with the syndrome.
Common symptoms of the syndrome include heart defects, learning difficulties, kidney and liver concerns,
hearing loss, prone to ear infections and social difficulties. Physical traits include a short stature, and can
include many moles, low-set ears, a triangular face and a webbed neck among other things.
The most common and usually the most obvious symptom of Turner syndrome is the stunted growth.
Most women with Turner syndrome only reach 4 feet 8 inches tall, Lewis said.
“Some girls take growth hormones just to reach five feet,” she said.
It’s too early to know whether Jozie will be one of those girls, she said.
“Turner syndrome girls who take growth hormones are prone to heart issues and dilation of the heart,”
Lewis said. “Medicine is always changing so we’ll just have to see where it’s at when she gets older we are
faced with making this decision for her.”
Jozie currently falls in the 30th percentile for girls her age, but when compared to other children girls with
Turners syndrome, she falls in the 80th percentile range, Lewis said.
Also working against Jozie is family genetics, Lewis said with a laugh.
“The women on her dad’s side are all very short to begin with, it may not be in her genetics to reach five
feet anyway” she said.
Right now the Lewis family’s biggest concern is Jozie’s blood pressure, which measured in the 90th
percentile of normal at her last wellness visit.
“If it’s 90 percent when she’s calm and happy, you know it’s off the chart when she’s upset,” Lewis said.
“That’s our biggest concern right now.”
Because high blood pressure could be an indicator of kidney or heart problems, Jozie underwent a kidney
ultrasound on Friday. Luckily, the results came back normal.
“Great news about her kidneys!” Linda said.
In the future, it’s likely Jozie will have to undergo hormone therapy to push her through puberty, Lewis said.
“Without it she wouldn’t develop the womanly curves, develop breasts or get her period,” she said.
“Overall she’s a really happy little girl,” Lewis said. “She just needs to be monitored a little more closely.”
The Lewises try their best not to fret about Jozie’s condition.
“You can sit there and wait and worry or you can go with the flow and deal with it,” Lewis said. “We just
try to do as much preventatively as we can and take it one day at a time as it comes to us.”
Lewis said she’s thankful that she knew a little bit about the syndrome when Jozie was diagnosed. Not
many people — even doctors — know a lot about Turner syndrome, she said.
That’s why the family recently decided to participate in the Turner Syndrome Society of the United States’
awareness campaign.
February has been deemed National Turner Syndrome Month because it’s the shortest month of the year,
Lewis explained. The campaign’s slogan is “Short Happens!”
“We were pretty scared when we found out she had Turner syndrome,” Lewis said. “We just hope that by
sharing Jozie’s story that we can help another family. If someone else gains at least some knowledge
through our story it may help them. We were so thankful my nephew and his wife shared their story and we
want to pay it forward. It’s also likely that there is a small girl out there undiagnosed at this point. The
doctors might be telling the parents that she’s just small and she really has TS. We hope someone might
read Jozie’s story and get help if they think that their daughter may have TS”
Along with sharing her story, Jozie also participated in a “Positive Exposure” photo shoot. The goal of the
shoot, done by former fashion photographer Rick Guidotti, is to educate people and show the beauty of
the people behind various syndromes.
“(Guidotti) was in town talking to medical students at the U of M and trying to get them to see the people
behind their patients,” Lewis said. “While he was here, the Turner Syndrome Society of the United States
got Jozie and a group of girls and women with Turner syndrome together for the photo shoot.”
Eventually Jozie’s picture — along with others — will be on display in an art gallery to promote the
awareness of TS.
“If it can help someone else down the road that would be the greatest gift we could give,” Lewis said
February 18, 2011 - Breast Cancer Patients May Say Goodbye To Lymphedema - About - News &
Issues –
Lymph node status is part of your breast cancer diagnosis - and many patients have had large numbers of
nodes surgically removed - so these can be examined for the possible spread of cancer. Having the
greater the number of lymph nodes removed via axillary lymph node dissection results in a swelling called
arm lymphedema. But a new study shows that patients with early stage breast cancer - tumors less than 2
inches and lymph nodes that appear unaffected - can safely opt for sentinel node biopsy: the removal of
only two or three lymph nodes.
This Phase 3 trial study was designed by The American College of Surgeons Oncology Group and was
set at 115 different locations across America. Patients had similar diagnoses and treatments: lumpectomy,
and whole-breast radiation. One group had axillary lymph node dissection and the other group had
sentinel node biopsy. Patients in both groups had similar 5-year overall survival rates. The study
concluded that Sentinel Node Biopsy is all that is needed for early stage breast cancer.
Axillary lymph node dissection (ALND) and arm lymphedema will not go away altogether. For breast
cancer patients with tumors over two inches, or with swollen lymph nodes, the removal of extra lymph
nodes will be needed to determine the risk of metastasis.
This news will change the way that breast surgeons and oncologists diagnose and treat early-stage breast
cancer. While some surgeons already confine lymph node removal to a targeted 2 or 3 nodes, it has long
been standard surgical practice to remove between 15 and 40 nodes - putting patients at higher risk for
arm swelling. Women who have arm lymphedema must take special care of their arm for the rest of their
lives - using compression garments, preventing cuts, even small burns, and sometimes requiring lymphatic
massage to get relief. Now that more patients may be able to avoid the risk of arm lymphedema, dealing
with breast cancer survival will become easier.
February 19, 2011 - In breast cancer treatment, less underarm lymph-node removal may be better
Los Angeles Times – By Jill U. Adams –
Removing many underarm nodes instead of just a few may not improve long-term survival, a study says.
Sometimes less is more in breast cancer treatment; so says a study that made headlines earlier this month:
The finding, published in the Journal of the American Medical Assn., reported that surgically removing
multiple cancer-containing lymph nodes under the arm in women with small tumors — instead of just one
or two — may cause more harm than good.
The finding seems to fly in the face of what most people believe — that cancers must be treated
aggressively for the best odds of recovery and survival.
But, in fact, many breast cancer surgeons say the study puts solid evidence on what was already becoming
a trend in practice — moving away from the more radical surgery in certain patients. "It's not a revolution,
it's an evolution," says Dr. John Glaspy, an oncologist at UCLA's Jonsson Comprehensive Cancer Center.
It's still unclear whether the advice from the study will be broadly accepted as the new standard of care —
and how long that will take.
"Many changes in medicine — believe it or not — take 17 years to take hold," wrote Dr. Len Lichtenfeld,
deputy chief medical officer of the American Cancer Society, on his blog after the JAMA report came out.
Here's a look at the pros and cons of removing underarm lymph nodes in breast cancer and who will be
affected.
The study subjects were women with breast tumors up to two inches across and evidence of cancer cells
invading at least one nearby lymph node but not more than two, as determined by a procedure called
sentinel lymph node biopsy. In this procedure, a dye is injected near the tumor and the first lymph nodes to
which the dye travels are removed and biopsied for cancer cells.
All 891 patients received lumpectomy and radiation therapy, and a majority of them also underwent
chemotherapy. In addition to the one or two sentinel lymph nodes removed for diagnosis of invasive
disease, one group of women also underwent what surgeons call axillary lymph node dissection, which
means surgical removal of at least 10 lymph nodes from under the arm.
Survival rates were statistically similar in the two groups, with more than 90% of women surviving and
more than 80% remaining disease-free for five years after treatment.
These findings suggest that removing a bunch of lymph nodes from under the arm doesn't make a difference
in the long-term prognosis of breast cancer patients. Doctors say this makes sense, because there are many
paths by which cancer can escape the breast and spread.
February 21, 2011 - Study challenges need for lymph node removal in cancer patients - Las Vegas
Review – Journal - By Paul Harasim –
When the news broke about a study that found many women with early breast cancer need not have all
their underarm lymph nodes removed -- even if they contain cancer cells -- Christine Wunderlin was both
happy and disappointed.
She is happy that more women will be able to escape the lymphedema, a chronic, often painful swelling in
the arm caused by the retention of lymph fluid, that she has experienced as a result of the excision of 11
nodes.
But she can't help being disappointed about ever having to go through the major lymph node removal in
the first place.
"Exactly a year after I have my procedure done, they come out with this," she said Tuesday. "My breast
surgery has been easier to deal with than the lymphedema."
Wunderlin, who runs a career counseling business, must regularly visit Dr. Richard Hodnett's Lymphatic
Center of Las Vegas, where a specialized therapist massages her arm to disperse the lymph fluid through
pathways in her body that are still functioning.
And she must wear a compression garment on her left arm for the rest of her life or the lymphedema may
well become disabling.
"If I don't keep it in check, even being able to wear a blouse can be problematic," she said.
According to the study published in the Feb. 9 Journal of the American Medical Association, researchers
found that removing lymph nodes in women with early stage breast cancer -- the disease strikes about one
in eight women -- did not improve their chances of a recurrence or surviving when compared with leaving
the nodes behind during breast cancer surgery.
Women in both groups had about a 92 percent chance of survival.
on the cutting edge
Dr. Josette Spotts, a 54-year-old breast surgeon affiliated with Comprehensive Cancer Centers of
Nevada, was not at all surprised by the findings of the study that promises to change what has been
standard medical practice for decades.
"I've stayed on top of the research and for the last several years have given my patients who fit the proper
profile the option of not having their lymph nodes removed," she said. "I just hate to see women go through
lymphedema unnecessarily. It can be debilitating and the literature shows there's about a 17 to 20 percent
risk (of suffering from lymphedema) when you remove many of a woman's lymph nodes."
Two of her breast cancer patients who opted not to have lymph node removal as far back as four years
ago, Patricia Hovey and Christine Santiago, sat in the physician's Henderson office last week and
discussed why they chose to forgo excision when the standard of care at that time was to have the lymph
nodes removed. Both are now cancer free.
"In a way I realize it was a leap of faith," said the 56-year-old Santiago, who was trained as a registered
nurse and works in risk management administration for the Clark County Administration Department. "But
I was impressed with Dr. Spotts' knowledge of the research and I also know that medicine is sometimes
slow to change the legal standard of care. I'm obviously happy that the study validated my faith."
The 61-year-old Hovey, who has been laid off from her job as a sales manager for Mexicana Airlines, said
Spotts carefully explained all the possible pros and cons. "When she said I was a candidate for not having
the removal of the lymph nodes, it came down to the fact that I trusted her."
Nearly 1,000 women, with a median age in the mid-50s, were involved in the study carried out at more
than 100 medical centers throughout the United States. The women were followed for a median of 6.3
years.
About 20 percent of breast cancer patients meet the criteria of the study, where tumors are less than 2
inches across and cancer has not spread outside the nodes.
Spotts, a graduate of the Wayne State University School of Medicine in Detroit, had told the women that
the research she studied -- later borne out by the study -- found that removing the cancerous lymph nodes
proved unnecessary because the standard therapy today in addition to a lumpectomy, radiation and
chemotherapy likely killed the disease in the nodes.
Lymph nodes, small bean-shaped glands, help eliminate bacteria and viruses and are needed to drain and
regulate the flow of lymphatic fluid. Spotts said that until research and technology proved otherwise, it
made sense to remove lymph nodes as part of breast cancer surgery because the breast tissue lies close to
the lymph nodes and lymph can harbor wayward cells that travel out of the original tumor into other parts
of the body.
"We keep making advances, and as a physician you want to make sure your patients get the best care in as
timely a fashion as possible," Spotts said. "For a long time we only did mastectomies (removal of the entire
breast) and then we found out that lumpectomies (removing only part of the breast) followed by radiation
have basically the same survival outcomes."
mapping the nodes
Both Hovey and Santiago were found to have cancer in their lymph nodes when Spotts did a procedure
known as sentinel node mapping as part of their breast cancer surgery.
The sentinel node is the first lymph node or nodes to receive drainage from a cancer-containing area of the
breast.
Generally, about an hour before a woman enters the operating theater for breast cancer surgery, she is
injected with a radioactive tracer that is used for the mapping. Soon after the patient is on the table, the
surgeon uses a handheld Geiger counter that sounds off as it finds the radioactive tracer in the lymph nodes.
A blue dye helps the physician get visual confirmation of the sentinel node on a monitor.
With an incision in the armpit, the surgeon takes out the node, sending it to a pathologist to be checked for
cancer. The lumpectomy follows.
"In the past, if the sentinel node was cancerous, we'd do another surgery later for the other nodes," Spotts.
"Now, fortunately, we often don't have to go through that. The chemo and radiation will kill the disease in
the nodes."
Spotts has known that she was taking a risk by telling some of her patients that she believed they could opt
out of lymph node removal surgery.
"If it recurred because of that when the standard of care was removal, I could have financial liability," she
said. "But I feel an obligation to my patients to give them an opportunity for the best care that research
shows is available.
Dr. Theodore Potruch, another Las Vegas breast surgeon who has given his patients the benefit of such an
option, agrees with Spotts.
"It is imperative that we stay on top of the research for our patients," Potruch said, noting that he hopes to
start a trial therapy soon where cancerous breast lumps are rendered impotent through freezing rather than
excision.
"It's important that what we do leaves women scarred as little as possible both physically and emotionally."
Though research may indicate that a new treatment option is possible, Spotts said she is never surprised
when some women refuse it. Nor is she surprised that some doctors are reluctant to change what seems to
have worked.
It is much easier for both patients and doctors to accept more cancer treatment on the basis of a study
rather than less. Given that breast cancer kills 40,000 American women a year, it can be frightening to try
what may seem, at first blush, less aggressive care, Spotts said.
"It's hard for some people to get their arms around the fact that less can actually be more," she said.
Some women not only favor lymph node removal regardless of research, but also mastectomies rather than
lumpectomies "because they think it's better to be safe than sorry."
"The fear is very real and very understandable. I want to do what makes the patient most comfortable."
To Christine Santiago, it is critical that women weigh carefully what their doctors say in conjunction with
their own research.
"You have to find out as much as you can about what you're going to do with this disease because it can
mean your life. And then you have to hope you make the right decision."
February 21, 2011 - Aleva Stores Adds the Zensah Product Line to its Online Stores - openPR (press
release) –
Aleva Stores recognizes the importance of compression therapy, so we’re always looking for ways to
expand our compression-related products catalog. Bringing on the Zensah line was an easy decision due to
their history of phenomenal compression technology.
Zensah compression products provide an optimal blend of graduated and pinpoint compression. The
graduated compression provides maximum compression at the bottom of the garment and gradually lessens
upward; while the pinpoint compression targets the exact source of pain.
While the Zensah catalog includes compression socks, arm sleeves, thigh sleeves, bras, and shorts, Zensah
was the first company to introduce compression leg sleeves.
February 21, 2011 - A continuing quest - Lac du Bonnet Leader - By Lory Mitton –
Once again, Lac du Bonnet's Kim Avanthay is promoting the recognition of March 6 as Lymphedema
Awareness Day.
Last year marked significant progress in her mission for recognition of the disease which is quite common
but not publicized to any great extent. Many medical professionals have never heard of lymphedema, which
the World Health Organization estimates affects more than 250 million people worldwide.
"The more people hear, the more they will be aware [of lymphedema] and can seek help if they need it,"
Avanthay explained about the importance of making the disease understood.
Forty-one municipalities across Manitoba and Manitoba's Minister of Health proclaimed March 6, 2010 as
Lymphedema Awareness Day a year ago.
"I hope to have just as much, if not more success this year," Avanthay says. So far in her correspondence
with municipalities, 13 districts have agreed to her requests and she anticipates many more will also.
Avanthay's efforts are inspired by her young son, Austin, who suffers from the disease. The Leader first
wrote about Avanthay two years ago when she graduated from the Lymph Science Advocacy Program in
California. She was there to learn more about the illness that's affected four-year-old Austin since shortly
after birth.
"Lymphedema is a chronic disease with no known cure and treatments that for some, are less than
adequate," Avanthay told the Leader.
"Much work needs to be done in this area as lymphedema requires daily care."
The disease can become a disability that prevents those affected by it from continuing in normal daily
activities including their professions.
The condition is an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in
the arms and/or legs, and occasionally in other parts of the body. Lymphedema can develop when
lymphatic vessels are missing or impaired (primary), or when lymph vessels are damaged or lymph nodes
removed (secondary).
"Those with primary lymphedema face a life of daily treatments and rising costs for treatment and support
garments," Avanthay says. "No other life-time chronic disease has the low level of awareness and support
from the provincial health care system, health care professionals and the research community."
Left untreated, lymphedema interferes with wound healing, and provides a culture medium for bacteria that
can result in lymphangitis (infection).
Since Avanthay has been promoting awareness, many people have contacted her. "One was from Selkirk
who had been living with this condition from childhood and was never diagnosed," she said.
The National Lymphedema Network, based in Oakland, CA describes the importance of March 6.
"On this day we show the world that lymphedema is no longer a rare condition by honoring the many
people living with it today, and the exceptional health care providers who, with dedication and support,
have touched their lives and hearts."
The International Lymphedema Framework (ILF) will be hosting their third ILF Conference right here in
Canada, in Toronto, in June 2011.
"This is great news for the Lymphedema community," Avanthay says. She hopes Manitoba will have some
representation at the conference.
Also picking up momentum is the Canadian Lymphedema Framework (CLF), which is working to improve
the management of lymphedema and related disorders in Canada. "They have three active working groups
focusing on education, research and partnership building. The volunteer members of the working groups
are from right across Canada," Avanthay explains.
The forming of an association for Manitoba is also in progress.
February 22, 2011 - Removing Lymph Nodes in Breast Cancer Patients Is Not Essential - TopNews
New Zealand – by Neeraj Shahane –
The new American study has revealed that it's not necessary to remove the lymph-nodes from breast
cancer patients as removing lymph nodes hasn't helped in improving survival chances of breast cancer
patients.
Lymph nodes are small bean-shaped glands, required to drain and regulate the flow of lymphatic fluid.
Lymph nodes also assist in eliminating bacteria and viruses from body. As part of breast cancer surgery,
removing lymph nodes was considered logical as lymph nodes are close to the breast tissue and can
transfer infection to other parts of body.
Christine Wunderlin, who runs a career counseling business, had undergone the breast cancer surgery last
year. Wunderlin was glad that other women will not have to suffer with lymphedema, the problem arising
due to removal of lymph nodes.
Lymphedema, a chronic swelling in the arm, sometimes painful, is caused by the retention of lymph fluid.
Wunderlin has to visit Dr. Richard Hodnett's Lymphatic Center regularly to have the lymphatic fluid remove
from her body. A specialist therapist massages her arm to disperse the fluid out of the body. Moreover, for
rest of her life, she must wear a compression garment on her left arm as lymphedema can be disabling.
Spotts, a graduate of Wayne State University School of Medicine explains that lumpectomy, radiation and
chemotherapy in addition with standard therapy these days, likely kill the disease in the nodes therefore
making their removal unnecessary.
February 22, 2011 - Study: Lymph node removal not always needed - Sioux Falls Argus Leader – by
Jon Walker –
Women will be spared much pain and anxiety in light of research showing less need to remove lymph
nodes from the armpit to fight breast cancer, South Dakota specialists said.
"With cancer, it used to be the more treatment the better. This study shows extra treatment doesn't affect
outcome," said Kristi Egland, an associate scientist for Sanford Research-USD.
Women benefiting most are those in early stages of breast cancer and already undergoing radiation and
chemotherapy. Removing lymph nodes is a third step in stopping the disease, but the full extent of that
approach might be nonessential and perhaps unnecessarily harmful.
"This study says having all the lymph nodes out does not increase the chance of survival," Egland said.
Leaving more nodes in place would spare women potentially painful surgery and lower the risk of
lymphedema, a swelling in the arms causing discomfort and other complications.
The center of concern is lymph nodes under the the skin, including about 30 in each armpit. The nodes,
smaller than a garden pea, are a collection point acting like a river dam in the body's self-defense system.
The nodes collect intruding viruses and bacteria migrating under the skin and alert the body's immune
system to destroy the microscopic invaders.
Cancer cells also collect at the lymph nodes, but they are oblivious to the body's defenses and instead
multiply out of control. Removing the nodes from the armpits has been a standard approach to eradicating
the problem.
"When women had one to three lymph nodes with cancer, traditionally we said we need radiation and
chemotherapy and said we have to be very, very aggressive with treatment," said Dr. Juliann Reiland, a
breast surgeon in Sioux Falls.
"The study shows going back to the operating room and removing more lymph nodes did not make these
women better. They also had chemotherapy and radiation. They didn't need all three. They only needed
two," Reiland said.
A study at 115 hospitals followed 891 women about six years, the New York Times reported. Surgeons
removed cancerous nodes in the women and in some, but not all, removed 10 additional nodes as a
precaution. Over time, the two groups showed the same survival rates. The National Cancer Institute paid
for the study, which Dr. Monica Morrow, from Memorial Sloan-Kettering Cancer Center in New York,
explained in the Journal of the American Medical Association.
Reiland is medical director at interoperative electron radiation therapy at Avera McKennan Hospital. She
has been following a protocol for several years toward less aggressive removal of nodes. Specialists inject
radioactive material that migrates to the armpit to pinpoint which nodes host cancer cells.
"For 80 percent of the women, we were overoperating. Now we know how to identify the one or two
nodes that have cancer," she said.
Betty Meyer, South Dakota vice president of Susan G. Komen for the Cure, said the study might spare
women considerable difficulty. "Anything we can do to decrease the incidence of lymphedema is going to
be really good," she said.
February 23, 2011 - Lymphedema Depot: Lymphedema Awareness Day is March 6, 2011 - Wire
Service Canada (press release) –
Do you suffer from lymphedema and don’t know where to get help?
Lymphedema is gaining notoriety as the “most-feared” complication of breast cancer surgery. You may
have heard of lymphedema but what do you know about it? On the other hand, you may know a lot about
lymphedema, but do you share what you know?
Do you know someone with a chronically swollen arm or leg that you have never asked them about?
Do you suffer from lymphedema and find yourself reluctant to talk about it with others?
Do you suffer from lymphedema and don’t know where to get help?
On Lymphedema Awareness Day we challenge you to learn something about lymphedema and to tell
someone else what you learned. You might start by searching Facebook for “Lymphedema Awareness
Day Canada” and seeing what you find.
Some municipalities have been urged to officially proclaim March 6th as Lymphedema Awareness Day to
help bring about increased awareness of this lifelong condition.
February 23, 2011 - Study shows some breast cancer patients can safely keep lymph nodes - Tampabay.
com – By Irene Maher –
A medical study published this month promised good news for thousands of women whose breast cancer
surgery might lead to a painful condition known as lymphedema.
This drastic and persistent arm swelling is a frequent consequence not of breast surgery itself, but of
removing nearby lymph nodes.
But it turns out that the women in the study who kept their nodes, even if cancer was present, fared just as
well as those who had them removed.
Still, will doctors and patients knowingly leave behind anything cancerous, even just a lymph node or two?
It will be a tough sell, admits Dr. Peter Blumencranz, director of Morton Plant Hospital's Comprehensive
Breast Care Center and a co-author of the study, published in the Journal of the American Medical
Association. Leaving behind lymph nodes known to have cancer goes against physician training and most
current medical guidelines.
"We had trouble recruiting patients for the study because surgeons were uncomfortable with the idea of not
taking the nodes," he said. Researchers hoped to enroll 1,900 patients, but only about half that number
signed up.
"What we were asking them to do was radical," he said.
• • •
For decades, doctors removed all lymph nodes from all breast cancer patients. Later, researchers found
that only women with positive sentinel nodes (the first nodes where breast cancer typically spreads) had to
have all their nodes removed. Then in 1999, a group of physicians, including Blumencranz, launched a
study to find out if breast cancer patients with positive sentinel lymph nodes could be spared complete
node removal.
The thought was that radiation and chemotherapy would eradicate stray cancer cells in the lymph nodes.
"The good news is, after six years of followup, those women who kept their nodes did as well as those
who had their other nodes removed," Blumencranz said.
Dr. Christine Laronga, program leader of the Don and Erika Wallace Comprehensive Breast Program at
the H. Lee Moffitt Cancer Center in Tampa, helped recruit patients and remembers the early days of the
study. "When doctors first heard about this study, everybody thought, are you crazy?" she said.
But as results started trickling in and there was virtually no difference in outcomes, Laronga and other
practitioners started offering select patients the option.
When the study made national headlines, "all the women we saw wanted to be considered for not having
their lymph nodes out," she said.
Only certain patients are considered eligible for the node-sparing approach: those who have early-stage
breast cancer and are treated with lumpectomy, chemotherapy and whole breast radiation.
Dr. Suzanne Lynn, a breast surgeon at St. Joseph's Women's Hospital in Tampa, is bracing for
disappointed patients. "They come in so hopeful; you hate to burst their bubble, but this doesn't apply to
everyone," she says. Patients who opt for a mastectomy or for partial breast radiation were not included in
the study, and may still be counseled to have their lymph nodes removed.
• • •
Despite the research findings and the lowered risk of lymphedema, some patients still opt for node
removal. Blumencranz said many women dropped out of the study when they found out their nodes were
positive. "They were just uncomfortable with leaving any cancer behind," he said.
Cheri Wetzel, 62, of Sun City Center, understands those women. She was diagnosed with breast cancer in
2008 and had a lumpectomy. Three sentinel nodes were positive for cancer. A patient of Laronga, Wetzel
wanted the nodes out then and says she would make the same decision today — even though she has
suffered from lymphedema (see box).
"Leaving lymph nodes behind, where you know there are cancer cells, no," Wetzel said. "I feel more
comfortable that it's been removed."
Will this study change medical treatment guidelines?
Experts say yes, but it may take time to win over skeptical physicians and patients.
"Some will be very happy to know they can keep their nodes," Lynn said. "Others will still have the fear of
leaving cancer behind. At least now we can let them know what the facts are."