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Lymphland International Lymphedema Online
September 2, 2011
Healthy Living: TruJoy promotes breast cancer education – YNN – by Web Staff -
If you were told your chance of getting cancer was 90% - what would do? How would you change your
life? Marcie Fraser shares one woman's inspirational story.
When Trudie Kelly's mom lost the battle from both ovarian cancer and breast cancer, genetically, she knew
the odds were against her.
"I carry the genetic mutation. I decided at that point and time to have a complete hysterectomy so that would
alleviate the ovarian risk," said Trudie Kelly, TruJoy Founder.
Two years after her hysterectomy, she found a cancerous tumor in her left breast. Trudie decided to have a
double mastectomy.
"I ended up had a routine MRI before the surgery and found I had it in my right side also that didn't show up
in the mammogram," said Trudie.
It's been a year after surgery and treatment, her prognosis is excellent. After experiencing cancer, Trudie
Kelly was on a mission.
"Once you have been through it, I knew what was missing, I knew the pieces that were missing for women
and that is what I wanted to address," said Trudie.
She created TruJoy.Inc, an organization to hold breast cancer educational forums, support, and a tool kit for
comfort.
"We have included a reacher, a mastectomy pillow, a stress ball to alleviate any kind of swelling that may
lead to lymphedema down the road," said Trudie.
One of TruJoy’s objectives is community education, targeting young women and teaching them about the
risk factors for breast cancer.
In an effort to raise money for the tool kits and the education forums, a motorcycle poker run is being held.
For more information, visit www.trujoy.org.
September 4, 2011 –
Gene Defect Predisposes People to Leukemia - Science Daily –
A new genetic defect that predisposes people to acute myeloid leukemia and myelodysplasia has been
discovered. The mutations were found in the GATA2 gene. Among its several regulatory roles, the gene acts
as a master control during the transition of primitive blood-forming cells into white blood cells.
The researchers started by studying four unrelated families who, over generations, have had several relatives
with acute myeloid leukemia, a type of blood cancer. Their disease onset occurred from the teens to the
early 40s. The course was rapid.
The findings will be reported Sept. 4 in Nature Genetics. The results come from an international
collaboration of scientists and the participation of families from Australia, Canada, and the United States.
In collaboration with Dr. Hamish Scott and Dr. Richard J. D'Andrea at the Centre for Cancer Biology,
University of Australia, Adelaide, the U.S. portion of the study was conducted by Dr. Marshall Horwitz,
University of Washington (UW) professor of pathology. Horwitz practices genetic medicine at UW Medical
Center and the UW Center for Human Development and Disability, both in Seattle.
The genetic mutation was first discovered in a patient from central Washington. The research participant had
been successfully treated for leukemia in 1992 through a bone marrow transplant at UW Medical Center. At
that time, Horwitz decided to seek a possible genetic reason after learning his patient had several family
members with myelodysplastic syndrome, myeloid leukemia, and intractable mycobacteria infections.
Myelodysplastic syndrome is a difficulty in producing certain kinds of blood cells. The problem originates in
the bone marrow with a decline in the number and quality of blood-forming cells. Patients often have severe
anemia and need frequent blood transfusions. The disease generally worsens due to bone marrow failure and
low blood counts. About one- third of those with the syndrome soon develop acute myeloid leukemia, in
which abnormal white cells build up in the bone marrow and interfere with normal blood production.
Horwitz's Australian colleagues had described a family with a similarly inherited blood disorder. Eighteen
years later, after rifling through many candidate genes, the researchers on both continents were relieved
finally to have hit upon the mutated gene responsible for the leukemia that affect these families. They have
gone on to identify abnormal GATA2 genes in more than 20 families and individuals.
"It's likely that this inherited error is more common than we had thought," the researchers noted. In some
families with a GATA2 mutation, the over-riding concern has been leukemia, while others suffer dangerous
infections from bacteria, viruses and fungi because of a lack of white blood cells to fight off germs.
The lab of Dr. Dennis Hickstein, formerly of the UW School of Medicine and the Puget Sound Veterans
Affairs Health System and now at the National Institute of Health, in collaboration with NIH colleague Dr.
Steven Holland, associated the mutation with mycobacteria infections. Those results were reported in
separate study appearing in the journal Blood.
Activcare Physical Therapy Announces Executive Drive Office Grand Opening On September 12 -
dBusinessNews Triangle –
Triangle - Activcare Physical Therapy, Raleigh NC’s premiere physical therapy practice, has expanded
operations to serve the community around Duke Raleigh Hospital with the opening of a new clinic on
Executive Drive.
RALEIGH, NC: Brad Hancock, MPT, of Activcare Physical Therapy, is pleased to announce the opening
of their newest clinic at 3410 Executive Drive, Suite 205 in Raleigh, adjacent to Duke Raleigh Hospital,
formerly Raleigh Community Hospital. Opening day will be celebrated at the new clinic on Monday,
September 12 with lunch from 11:30am to 2:00pm and wine and cheese at 5:00pm.
Visitors will be able to tour the new facilities as well as meet the knowledgeable and experienced therapists
at this state-of-the-art clinic. Services offered at this facility include: orthopedic therapy, sports related
injuries, neck and back pain and injuries, pain management, neurological rehabilitation, geriatrics, oncology-
related and lymphedema therapy and cardiovascular conditioning therapy, as well as balance and vestibular
dysfunctions.
“It is our mission to not only provide the highest quality physical therapy services, but to provide a friendly
and supportive atmosphere to our patients,” said Hancock. “This patient-centric approach helps ensure that
patients will reach their goals through continued treatment, and it is the key to our continued growth in the
Triangle market.”
For more information about Activcare Physical Therapy, visit www.activcarept.com or call 919-786-7434.
About Activcare Physical Therapy
Activcare Physical Therapy, with convenient locations in Raleigh and Fayetteville, NC provides physical
therapy services with a strong emphasis on orthopedic injuries, geriatrics, women’s health, neurological,
incontinence, general conditioning/cardiovascular, balance and vestibular disorders, foot and ankle
biomechanics, spine treatments including cervical decompression therapy and oncology-related and
lymphedema therapies. Our quality therapy services provide continuity of health services and positively
influence their patient outcomes. Activcare provides patients from all walks of life with world-class,
comprehensive physical and occupational therapy services that improve function, encourage independence,
and enhance quality of life. For more information, visit www.activcarept.com or call 919-786-7434.
Media Contact:
Charlie Caserta
Activcare Physical Therapy
ccaserta@activcarept.com
919-786-7434
www.activcarept.com
September 5, 2011
Swollen ankles have several possible causes - The Detroit News – Dr. Paul Donohue –
Dear Dr. Donohue: I am a diabetic male, age 96, with many aches and pains but no high blood pressure. I
have low cholesterol and am in control of my diabetes. In the past few weeks, I've noticed swelling of my
ankles and feet. I have been taking two water pills a day for it. I never use salt or eat salty foods. What can
you suggest for me?
Dear S.S.: That swelling is edema, and it has many causes. One is sitting for long periods with the legs
dangling down. With the legs in that position, gravity pulls fluid from the legs' blood vessels. Treatment for
this kind of edema consists in elevating the legs. Every hour, lie down for 10 minutes with pillows under your
legs and feet so that they are above heart level. When sitting, squeeze the leg muscles over and over. Muscle
contractions stop the oozing of fluids from the blood vessels. And take a morning and afternoon walk.
Elastic hose can keep fluid in blood vessels and out of the surrounding tissues.
Dilated leg veins — varicose veins — promote edema. A clot in a leg vein is another cause. That's usually
quite painful, and you'd be aware that something is going on if you had a clot. Liver ailments can lead to
edema. The liver makes a blood protein, albumin, that keeps fluid in circulation. With a low production of
this protein, fluid leaks out of vessels. Kidney failure is another reason why edema occurs. Medicines can
lead to it.
The booklet on edema and lymphedema explains this kind of swelling. Readers can obtain a copy by writing:
Dr. Donohue — No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no
cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address.
Write to Dr. Donohue at P.O. Box 536475, Orlando, FL 32853-6475.
Another paper appearing Sept. 4 in Nature Genetics from a London group found similar mutations of
GATA2 in leukemia patients with lymphedema and, in some cases, deafnesss. By blocking the vessels that
drain fluid from the body's tissues, lympedema causes swelling of the arms or legs.
Ongoing work in Seattle and Adelaide has identified a congenital syndrome associated with developmental
delay and a risk of myelodysplasia. This syndrome results from chromosomal loss of GATA2 and adjacent
genes.
Comparable GATA2 mutations also have been found in people with the more common, non-inherited
leukemias.
Scientists are trying to figure out why apparently similar gene mutations in GATA 2 cause such assorted
health problems. Also perplexing is how hard it has been to find genetic errors underlying blood cancers,
compared with other cancers.
"While several genes have been discovered and linked to solid, malignant tumors such as breast cancer in
families susceptible to those types of cancer, so far very few inherited mutations have been uncovered for
blood cancers," Horwitz said.
Previously, other scientists linked mutations in two other genes -- RUNX1 and CEBPA -- to injerited forms
of myelodysplastic syndrome and acute myeloid leukemia. These genes bind to DNA and control the
copying of information encoded in this molecule.
Keeping this in mind, researchers looked for mutations in similar genes in families who did not have the
RUNX1 and CEBPA mutations and who had no other explanations for their inherited blood cancer. In so
doing, the researchers identified the GATA2 mutations. They also observed that these mutations relate to
loss of function by making the gene unable to perform the molecular duties necessary to manufacture healthy
white blood cells.
According to Horwitz, the GATA2 mutations in DNA occur adjacent to an amino acid mutated in some
patients with terminal chronic myeloid leukemia. This proximity suggests a common pathway may be critical
for several types of myeloid malignancies, he said.
People at risk because of their pedigree eventually may obtain tests to detect this genetic error before
symptoms emerge. Learning that they have the gene mutation might help patients and their doctors decide on
appropriate follow-up for early diagnosis and treatment of problems that might arise.
Additional knowledge about how the GATA2 gene and its mutations operate may foster the development of
new therapeutic agents.
A clinical trial under way in the United States may point to specific treatment recommendations for persons
with a GATA2 genetic mutation.
The research for "Heritable GATA2 Mutations Associated with Familial Myelodysplastic Syndrome and
Acute Myeloid Leukemia," was supported by grants from the National Health and Medical Research
Council of Australia, a Dora Lush Postgraduate Award, Leukaemia Foundation of Australia, the Cancer
Council of South Australia, MedVet Pty Ltd., and the U.S. National Institutes of Health.
The researchers extend their gratitude to the families and individuals who participated in this project.
Horwitz has been invited to speak on the role of GATA2 in myelodysplastic syndromes at a National
Institutes of Health conference Sept. 7-8 in Bethesda, Md.
September 15, 2011
National Walk For Lymphedema And Lymphatic Diseases – Garden City News –
As Executive Director of the Lymphatic Research Foundation, Garden City resident Jacqueline Reinhard
coordinated the organization’s first walkathon last September at Belmont Lake State Park. “It was a
resounding success,” says Reinhard, “and the idea has clearly caught on with lymphatic disease patients
around the country. In the coming weeks the National Walk for Lymphedema and Lymphatic Diseases will
take place in Texas, New York, and Massachusetts!”
Founded in 1998 by Roslyn resident Wendy Chaite, LRF has become a leader in patient advocacy and a
primary force behind advancements in lymphatic science worldwide. LRF’s advocacy programs have been
effective in gaining Congressional and National Institutes of Health (NIH) support for lymphatic research at
the National Institutes of Health and at major academic research centers, elevating lymphatic diseases from
relative obscurity to a position on par with other national health priorities. The organization directly funds
cutting-edge lymphatic research by funding Postdoctoral Research Fellowship Grants, a National Lymphatic
Disease Patient Registry and Tissue Bank, a peer-review biomedical journal in lymphatics, and the first-ever
endowed academic Professorship in Lymphatic Research and Medicine (Stanford University Medical
School, 2008). Reinhard became the Foundation’s first executive director in July 2008.
The New York Walk will be at Eisenhower Park in East Meadow on September 24th. Registration begins
at 1:00 p.m. “I’m inviting all our Garden City neighbors to join this effort, said Reinhard, “ . . . and promising
a fun afternoon of live entertainment, refreshments, and the great feeling you get in supporting an important
and meaningful cause.” To learn more about the Walk, to register or donate, go to www.walklrf.org.
The Skin IQ™ Mattress Cover Does More to Lower Costs of Pressure Ulcers - Online PR News (press
release) –
With the current economic climate, hospitals and long-term care facilities are looking to find innovative ways
to cut costs. Vascular PRN™ provides compression therapy equipment to treat ulcers, deep vein
thrombosis, and lymphedema, so they uniquely know the pressures that nurses, hospital directors, and
nursing home administrators are under to save money.
Online PR News – 15-September-2011 –With the current economic climate, hospitals and long-term care
facilities are looking to find innovative ways to cut costs. It is not every day that new products make their
way into a patient’s room that cut down health care costs, workload, and the cost of medical treatment.
“We were floored when we found the Skin IQ™ Microclimate Manager,” said Vascular PRN’s president
Greg Grambor. “This KCI coverlet costs $6 a day versus low air loss mattresses that usually cost our clients
$30 a day.”
Vascular PRN™ provides compression therapy equipment to treat ulcers, deep vein thrombosis, and
lymphedema, so they uniquely know the pressures that nurses, hospital directors, and nursing home
administrators are under to save money. Every day they help specialists in long-term and critical care centers
to find the right products at the best value.
“Pressure ulcers are a major cost and cause more treatment, regulatory fines, and the potential for a lawsuit
in health care settings every day,” said Grambor. “For KCI to address this big need is huge to prevent and
manage a patient’s skin breakdown and pressure ulcers.”
The National Pressure Ulcer Advisory Panel says that, “Support surfaces are an integral part of any plan of
care for the prevention and treatment of pressure ulcers.” The Skin IQ™ waterproof mattress cover
promotes healing and addresses the variety of challenges an immobile person has. It reduces moisture from
the skin’s surface, reduces skin temperature while maintaining a patient’s comfort, and has powerful odor
control features. KCI’s case studies show that patients with stool incontinence, skin breakdown, bariatric
concerns, and associated issues can greatly benefit from using the Skin IQ™ within days or a few weeks.
“The Skin IQ™ is 30 percent better than the average healthcare facility mattress cover,” said Grambor. “It
is easy to use and fits over any pressure re-distribution mattress.”
The Skin IQ™ pulls air down through the mattress cover and cools a patient’s contact points while pulling
moisture away. This is more effective than low air loss, which blows warmed room air up through the
mattress. A Skin IQ™ mattress cover prevents new pressure ulcers and better treats existing ones, thus
helping the health care field to lower their overall costs on the non-reimbursable, "never events" of decubitus
ulcers.
To learn more, visit www.vascularprn.com or call 800-886-4331. Vascular PRN’s website at www.
vascularprn.com is the go-to site for directors of nursing, nursing home administrators, and medical
professionals to find out more about the Skin IQ™ MCM and compression therapy. The site spotlights
industry news, frequently asked questions, and director of nursing and healthcare jobs.
September 14, 2011
Pink Ribbon Program at Avon Rec Center Friday, Saturday - Vail Daily News –
AVON — The Pink Ribbon Program is an exercise program designed specifically for post-operative breast
cancer survivors. Program founder and director of the Pink Ribbon Program, Doreen Puglisi, became aware
of the need as she herself was diagnosed with breast cancer. She used the Pink Ribbon Program to regain
her range of motion, as well as strength in her affected arm.
The Avon Recreation Center will be hosting a two-day workshop on Friday and Saturday for individuals
who come in contact with breast cancer survivors through physical therapy, occupational therapy, massage
therapy, personal trainers, nurses, group exercise instructors, lymphedema treatment specialists and spa
services such as facials, manicures, etc. The goal of this interactive two-day course is to provide the
participants with a knowledge base that is essential to the successful evaluation of the breast cancer survivor,
from diagnosis to treatments, recovery, preventions of lymphedema and proper exercise guidelines and
protocols. Evidence based practice and integration of material from the areas of functional exercise, shoulder
rehabilitation and Pilates exercise will be the emphasis of the course sessions.
The Pink Ribbon Program is offered on Friday starting from 2 to 8 p.m. and Saturday from 9 a.m. to 3 p.m.
Workshop cost is $425 per person, plus $35 for course materials. Space is still available for this two day
workshop. Visit www.pinkribbonprogram.com or call 888-445-3089.
September 12, 2011
Komen QC Affiliate and Gilds's Club to hold educational symposium - Quad-Cities Online –
Susan G. Komen for the Cure-Quad Cities affiliate to hold 2nd annual educational symposium
September 12th, 2011---DAVENPORT, IA—Breast cancer survivors and their supporters are invited to
launch breast cancer awareness month in the Quad Cities on October 1st at the 2nd annual Educational
Symposium sponsored by the Komen Quad Cities Affiliate and Gilda's Club Quad Cities.
The Symposium is an effort to connect survivors to others that share a common journey and offer discussion
about topics of interest to survivors, such as lymphedema and breast reconstruction.
"We hope that breast cancer survivors take advantage of this opportunity to learn and heal," said event
organizer Sheila Soltow. .
The October 1st event runs from 8 a.m.-1:30 p.m. at the Isle of Capri in Bettendorf, and includes a lunch
and panel discussion about the pros and cons of breast reconstruction.
The cost to attend the event is $15 for survivors and $20 for others. To register for the Symposium, call
Mackenzie Batterbee at 563-421-1905. Early registration is encouraged as space is limited.
The Susan G. Komen for the Cure-Quad Cities Affiliate was formed in 1999, after the Komen Quad Cities
Race for the Cure® began in 1990. Over the past 22 years, the Affiliate has raised nearly $5 million in the
fight against breast cancer. For more information on the Affiliate or the Komen Quad Cities Race for the
Cure, please visit www.komenquadcities.org
Once-Homeless Lakeland Woman Awaits Construction of House - The Ledger – By Chase Purdy
LAKELAND | Echoing from another room in the house, Yvonne Gallimore's grandchildren squealed with
delight. After more than two months in the hospital, it's a sound to which she's still getting accustomed.
Michael Wilson | THE LEDGER
Cooped up in Lakeland Regional Medical Center for longer than she liked, Gallimore smiled from the
bedroom of her temporary home in North Lakeland. She pointed to her view of the backyard.
In June, an anonymous donor stepped forward with an offer to build Gallimore a new house. She recently
looked over the blueprints, she said, but continues to wait for Habitat for Humanity construction crews to
break ground.
"There's no place like home," she said. "There's no place like home."
For more than a decade she's suffered from a severe case of lymphedema, a condition that led to an
infection that left her hospitalized in May. Her medical issues left her weight at about 750 pounds.
On May 19, medical crews were forced to tear through a wall of her apartment so she could be transported
to the hospital. An infection in one of her legs needed immediate medical treatment, she said.
But that left her homeless, necessitating a longer stay at LRMC.
"I was miserable because I didn't have anywhere to go," she said. "It was a situation that I had no say-so
about."
Lymphedema, a condition that can be controlled but not cured, creates blockage that prevents bodily fluids
from draining well. As a result, Gallimore's legs swelled significantly, preventing her from moving freely.
With her weight, Gallimore still cannot move from room to room in her home. Claire Twomey, the chief
executive officer of Lakeland Habitat for Humanity, said the new home will be designed to offer plenty of
room for mobility.
September 9, 2011
Coping with breast cancer pain - Baltimore Sun –
This has passed on Septbember 13 sorry
September 6, 2011
Mammography: More is not necessarily better - Kansas.com – By Abigail Trafford
Mom — what are you talking about?" My friend was on a family vacation when her mother mentioned she
had to get her annual mammogram. My friend continued: "You don't need a mammogram! You're 88!"
Her mother gave her a withering look: "What? I'm so old at 88, you want me to die of breast cancer?"
So ingrained is the annual mammogram habit in this country that any challenge to it is met with a combination
of scorn and outrage.
We belong to the pink ribbon sisterhood that worked hard to strike down the stigma of breast cancer and
get better care. We walk for the cure. We lobby Congress for research funds. We demand coverage of
screening, including high-tech digital mammography. In the past 20 years, deaths from breast cancer have
gone down by about 30 percent.
But what role has screening played in this decline?
At a forum in March at the Harvard School of Public Health in Boston, physicians and policy officials
debated the question "Mammograms: Who in the world are they good for?"
Mette Kalager, a surgeon at Oslo University Hospital and a visiting scientist at the Harvard School of Public
Health, told the forum about a study she had led in Norway.
The researchers looked at the records of 40,075 women who received diagnoses of breast cancer between
1986 and 2005. Some had been screened every two years. Others had not been screened; their cancers
had been detected by physical examination. Both groups were treated by teams of specialists. Over the 20-
year period of the study, both groups saw a decline in death rates from the disease.
By comparing the groups, researchers determined that only about a third of this decline was due to
screening. Most of it was due to state-of-the art treatment and comprehensive care. Previous studies had
suggested a greater impact from screening, and the study, published in the New England Journal of
Medicine, caused a stir in the breast cancer community.
A little history is in order.
When mammography screening got under way in the United States 40 years ago, it put breast cancer on the
public agenda. Catch-it-early-when-it's-curable became a mantra of hope. Since then, treatments have
improved, and the understanding of breast cancer has changed. Perhaps more important than the timing of
detection is the biology of the cells.
"There are some very tiny cancers that are just bad biology and are destined to relapse, no matter how early
you find them," Julie Gralow, a professor of oncology at the University of Washington Medical School, told
the Harvard forum.
And some cancers don't progress even when they are found late.
"I've had patients who have had very aggressive, large cancers, which, for one reason or another, they have
ignored," continued Gralow. "And still years later, it never spreads. It doesn't come back. . . . We're
struggling to understand the biology."
Diagnosing a cancer early often leads to more-conservative treatment (such as lumpectomy instead of
mastectomy), a great advantage to patients. But the annual mammogram may not be as important as it once
was in stemming the death toll.
"The evidence seems to be that mammography screening plays less and less of a role in reducing mortality in
countries of the Western world," Kalager said.
That may be true for older women in particular. In Europe, mammography screening is recommended only
for women ages 50 to 69. Yet when Kalager and her colleagues studied breast cancer patients ages 70 to
84, they saw a reduction in mortality that "was largely the same" as in younger women who were screened.
The key for both groups was access to good care.
But Felicia Knaul, director of the Harvard Global Equity Initiative, offered a different view: "I was diagnosed
with a breast cancer 3 1/2 years ago in my first baseline mammogram at age 41," she said. "If anything saved
my life, in addition to expert care, it is that mammogram."
The room went quiet. How to resolve the experience of Knaul with the findings of a study based on more
than 40,000 women? Furthermore, as Knaul pointed out, many women, especially in developing countries,
do not have access to the state-of-the art care.
Such is the conundrum for policymakers in setting health guidelines: Personal anecdote often clashes with
wider research. But screening policies should be based on evidence from large-scale population studies: the
greatest good for the greatest number.
The United States has the most expansive mammography screening standards in the world, starting at age
40 and continuing every year. But more is not necessarily better in health care.
Wide-net screening can cause harm, leading to over-detection, over-diagnosis and unnecessary treatment,
according to Kalager and other researchers. Once a woman has a suspicious mammogram, she gets on a
medical train and can't get off until the doctor-conductor gives the all-clear signal.
Often that requires just a repeat test. But some women are treated for cancers that are not invasive or are
too slow-growing to endanger their health. They undergo surgery or drugs or radiation with side effects such
as blood clots, breathing problems, lymphedema and high blood pressure.
"I don't know how to weigh the over-detection piece," said Gralow. "We clearly have to sort that one out."
Yes, there's a lot of sorting out to do. My friend's mother, who believed in annual screening, obviously
managed her health pretty well. She never got breast cancer and lived to age 94. But my friend was also
right: Research is on her side.
More coverage
Today's story is the first in a series dealing with breast cancer. Find more in next week's Healthy Living.
If you go
2011 Komen Wichita Race for the Cure
What: More than 10,000 people are expected to participate in the local benefit for Susan G. Komen.
When: Sept. 24. Registration begins at 6:45 a.m., followed later in the morning by activities, including a
breakfast and celebration for survivors. The competitive timed 5K is at 8 a.m., and the non-competitive 5K
is at 8:15 a.m.
Where: At Douglas and Armour near Towne East Square
How much: Advance registration before Sept. 24 is $30 for the competitive and $25 for noncompetitive
races. Registrants receive a T-shirt.
To register or learn about the complete schedule and additional related special events — including Sleep-in
for the Cure and Kids for the Cure — visit www.komenmidks.org or call 316-440-7033.
Breast cancer in Kansas by the numbers
* 1,780: The approximate number of women diagnosed with breast cancer in Kansas last year.
* 370: The estimated number of women who died from breast cancer in Kansas last year.
September 20, 2011
NARH Offers Q&A Session on Hyperbaric Wound Care - iBerkshires.com –
NORTH ADAMS, Mass. — North Adams Regional Hospital will host a question-and-answer session with
the wound-care experts from the Wound Healing Center of the Berkshires on Tuesday, Oct. 4, from 6:30 to
8 p.m.
The free event takes place at the VNA & Hospice of Northern Berkshire Community Room. Pie and coffee
will be served. Registration is requested by calling 413-664-5142.
Dr. Fred Landes, center Director Kelly Morse and hyperbaric oxygen technician Gladys Conklin will take
questions on wounds resulting from radiation side effects, lymphedema, diabetes, peripheral vascular
disease, and injuryThey will also discuss new state-of-the-art techniques used to heal wounds including
hyperbaric oxygen therapy.
The Wound Healing Center opened in 2009 and has been recognized as a top-performing center among all
those operated in collaboration with National Healing Corp. The Wound Center boasts a “heal rate” of 96
percent, meaning that 96 percent of patients’ wounds are healed within nine visits.
Landes is a board-certified emergency medical physician and is the Wound Healing Center’s medical
director. He received his training from the New York Presbyterian Hospital, Cornell University, in New
York City.
Morse is a registered nurse and has worked in the health-care field for 32 years. Conklin is a licensed
practical nurse.
September 20, 2011
Breast Surgeon Addresses the Worries, the Wonders and the What-to-dos of Breast Health – TribLocal –
Join Breast Surgeon Jennifer Gambla, M.D., of Palos Community Hospital, as she discusses the latest
mammogram recommendations, measures to prevent breast cancer and the multiple steps involved in
diagnosing breast health concerns. This free event will be held on Monday, Oct. 3 from 6:30 p.m. to 7:30 p.
m. at Palos Health & Fitness Center, 15430 West Avenue in Orland Park. Call 708-226-2300 to register.
Palos Community Hospital's Comprehensive Breast Program combines the technological capabilities of
digital mammography, ultrasound and magnetic resonance imaging with a highly skilled and compassionate
staff. You benefit from the talents of radiologists who are fellowship-trained in the field of mammography.
Breast exams and procedures under all imaging modalities, as well as breast surgery, are performed at Palos
Community Hospital. Whether you need a routine exam or have a more serious breast concern, you can
trust Palos Community Hospital.
The breast care treatment team at Palos Community Hospital provides a multidisciplinary, integrated and
comprehensive approach to screening, diagnosis and treatment. Our complete continuum of services include:
Digital Mammography, Breast Ultrasound, Stereotactic & Ultrasound Guided Needle Biopsy, Excisional
Breast Biopsy, Breast MRI and MRI Guided Needle Biopsy, Ultrasound Guided Cyst Aspirations, Surgical
Treatment for Breast Cancer, Breast Reconstruction and Lymphedema Program and Support Group.
To schedule a digital mammogram or other Breast Imaging service, call (708) 827-2030.
September 20, 2011
Hospital celebrates National Rehab Week - Journal-Advocate –
Sterling Regional MedCenter Rehabilitation department is celebrating National Rehabilitation Awareness the
week of Sept. 18-24. The mission of National Rehabilitation Awareness Week is to educate people about
the benefits and impact of rehabilitation and give credit to those who help people with disabilities live up to
their fullest potential through rehabilitation.
Sterling Regional MedCenter's rehab department offers comprehensive therapy services including physical
therapy, occupational therapy, speech therapy, cardiac rehab, and the new oncology rehab program.
Patients receive individualized therapy programs that address a wide variety of patient needs. The goal of
therapy is to return patients to their highest level of function as quickly and safely as possible.
The oncology rehab program was created to assist individuals with cancer move past the challenges of their
diagnosis. Cancer treatment can be both physically and mentally challenging. Each patient's experience is
different and each patient faces unique side effects.
The oncology rehab program provides specialized treatments to cancer patients including a thorough
evaluation to access baseline values (endurance, strength, flexibility and range of motion) which lets the
rehab providers create a specialized treatment program for each patient's unique needs. Each session is
designed to address the individual's needs and provides extensive education to assist in recovery.
"The physical therapy program for cancer patients is very good. I think the support you receive helps
patients to have a positive attitude," said Henry Littler, program participant.
"It is easy to be inactive during this time due to the side effects most patients experience," notes Littler. "The
program and the therapist offer a challenge to get stronger physically as well as mentally because of the
weight loss and other effects that one experiences from treatment. I would recommend this program for
patients going through treatment!"
The program also offers lymphedema services provided by an occupational therapist certified in upper
extremity lymphedema therapy. These treatment options include manual lymph drainage, bandaging,
exercise, and skin care to assist in the effective management of this condition.
Chemotherapy, radiation, and surgical patients can all benefit from this exercise program, no matter what
stage of their diagnosis.
"We are excited to offer a program that can help people through all stages of recovery - from the initial
diagnosis to possible side effects felt years after," said Amy Baseggio, occupational therapist and certified
lymphedema therapist at Sterling Regional MedCenter. "This is a unique program that is meant to give those
with a cancer diagnosis one more way to regain their health and live their lives to the fullest. "
The therapists at SRM are dedicated to making a difference in people's lives by providing excellent patient
care in a caring and friendly environment. For more information regarding rehabilitation services at SRM,
please contact us at (970) 521-3138
September 20, 2011
Pink Ribbon Program Coming To New Orleans, LA - October 14 & 15, 2011 - PR Web –
Become a Post-Rehabilitative Breast Cancer Exercise Specialist
The Pink Ribbon Program is an exercise program designed specifically for post-operative breast cancer
survivors. Program founder and director of the Pink Ribbon Program, Doreen Puglisi M.S., became aware
of the need as she herself was diagnosed with breast cancer. She used the Pink Ribbon Program to regain
the range of motion as well as strength in her affected arm.
Xtend Barre New Orleans will be hosting a two day workshop on Friday, October 14 and Saturday,
October 15, 2011 for individuals who come in contact with breast cancer survivors through Pilates, physical
therapy, occupational therapy, massage therapy, personal trainers, nurses, group exercise instructors and
lymphedema treatment specialists. The goal of this interactive two day course is to provide the participants
with a knowledge base that is essential to the successful evaluation of the breast cancer survivor, from
diagnosis to treatment, recovery, prevention of lymphedema and proper exercise guidelines and protocols.
Evidence based practice and integration of material from the areas of functional exercise, shoulder
rehabilitation and Pilates exercise will be the emphasis of the course sessions.
The Pink Ribbon Program is offered on Friday, October 14 starting at 3:00 p.m. to 8:00 p.m. and Saturday,
October 15 starting at 8:00 a.m. to 2:00 p.m. Workshop cost is $425 per person plus $35 for course
materials. Space is still available for this two day workshop. Please visit http://www.pinkribbonprogram.com
or call 888-445-3089
September 7, 2011
Incredible New Plastic Surgery Product Helps Accelerate Healing After Popular Armlift Procedure
(Brachioplasty) - DigitalJournal.com –
An exciting new product to help speed up healing following arm lift surgery is the latest addition to Nouvelle’
s premier compression wear line. Convertible compression arm sleeves provide lightweight, yet powerful
healing compression and support for the arms. A key feature of the product is the ease with which patients
can adjust the bodice for a precise fit.
“Proper care of the arms is critical to a successful surgical result,” said Dawn Cover, president of Nouvelle.
“We’ve fine-tuned our arm care line to include products that help patients get the maximum care and best
outcomes from surgeries involving the arms,” she said.
Key uses of arm sleeves:
1. Care following arm lift surgery (brachioplasty) and liposuction.
2. Prevention of extreme, hypertrophic scarring from severe, skin-damaging burns.
3. Relief for symptoms associated with lymphedema, such as fluid retention and tissue swelling.
Also important to proper care of the arms following surgery is scar prevention. Nouvelle carries the
internationally-recognized ScarHeal product line, which features an outstanding combination of ingredients
designed to help calm inflammation and tame overactive collagen production in scars resulting from surgery,
burns, wounds, and keloids. The line features four proven products for treating scars resulting from any
trauma to the skin.
Additional Resources
Web site
The newly-designed Nouvelle Inc. Web site includes comprehensive product details, company history and
and more.
Healing Transformations
An online forum dedicated to patients, physicians and families of anyone recovering from the myriad of
emotional and physical health issues surrounding aesthetic and reconstructive surgery.
Facebook Page
Look for new products, stories from customers, and helpful recovery tips on Nouvelle’s Facebook page.
One of the first 100 people to “like” the page will be entered into a special drawing to win a free
compression or shapewear product.
About Nouvelle
Nouvelle manufactures and distributes post-surgical compression wear, body shaping garments, and scar
care products worldwide from its facility in Virginia Beach, Va. Its internationally-recognized products are
available through approved distributors and online at http://www.nouvelleinc.com.
International Distribution Opportunities
For more information about purchasing or distributing the company’s products, please contact Dawn Cover
via email or telephone: dawn(at)nouvelleinc(dot)com or 888-653-0113/757.965.3767.
September 9, 2011
Why Knees Fail in 2011: Patient, Surgeon, or Device? - Ortho SuperSite – by Steven J. Fitzgerald, MD;
Robert T. Trousdale, MD
Abstract
The outcome of total knee arthroplasty (TKA) is influenced by multiple interconnected factors, including
patient selection, implant design, and surgical technique. Total knee arthroplasty has been shown to be highly
successful, with patient satisfaction rates reported from 85% to 95% with low rates of failure, but if failure
occurs, its impact is significant. In 2003, 402,000 primary TKAs and 32,000 revision TKAs were
performed in the United States, and the number of TKAs is expected to double by 2015. Recent data on
modern implant designs and techniques have demonstrated a surprising number of early failures, although the
true number of early failures is unknown. Patient medical comorbidities should be optimized preoperatively,
while psychosocial issues and workers compensation are more nebulous yet contribute greatly to patient
perceived outcomes. Understanding current failure mechanisms of primary TKA and how to prevent
complications will be critical to help manage a potentially overwhelming TKA revision burden. This article
discusses failure rates as well as factors from the patient, surgeon, and device, that contribute to TKA failure.
Dr Fitzgerald is from Department of Orthopedic Surgery, University Hospitals Case Medical Center,
Cleveland, Ohio; and Dr Trousdale is from the Mayo Clinic, Rochester, Minnesota.
Dr Fitzgerald has no relevant financial relationships to disclose. Dr Trousdale receives royalties from DePuy,
Wright Medical Technology, and MAKO.
Presented at Current Concepts in Joint Replacement 2010 Winter Meeting; December 8–11, 2010;
Orlando, Florida.
Correspondence should be addressed to: Robert T. Trousdale, MD, Mayo Clinic, 200 First St SW,
Rochester, MN 55905 (trousdale.robert@mayo.edu).
Posted Online: September 09, 2011
The outcome of total knee arthroplasty (TKA) is affected by patient selection, implant design, and surgical
technique ( Figure). Total knee arthroplasty has been shown to be highly successful with patient satisfaction
rates reported from 85% to 95% with low failure rates, but if failure occurs, its impact is significant. 1,2 In
2003, 402,000 primary total knee and 32,000 revision TKAs were performed in the United States. The
number of total knee revisions is expected to double by 2015. 3 Understanding current failure mechanisms
of primary TKA, and how to prevent complications will be critical to help manage a potentially
overwhelming TKA revision burden. This article will discuss failure rates as well as factors from the patient,
surgeon, and device, which all contribute to the TKA failure.
Rates of Failure
Long-term studies have demonstrated excellent survivorship rates for TKA. 4–6 Rand and Bryan 7
reported failure rates of condylar total knee prostheses implanted at the Mayo Clinic over a 20-year period
and demonstrated 91% survivorship at 10 years, and 78% at 20 years. These rates improved for patients
who were women, older at the time of surgery, and had not undergone previous knee surgery. Survivorship
of patients older than 70 years at the time of surgery also increased to 94% at 10 years. Other factors that
were attributed to increased survivorship were cruciate retaining and non-modular tibial designs, although
these factors may be related to prosthesis design issues that have been improved with modern designs in
2011. We currently advise our patients that they have approximately a 1% cumulative chance per year of
their total knee failing.
Why and When do Knees Fail?
Historically, reasons for TKA failure have been attributed to infection, loosening, instability, and
patellofemoral complications. 7 Surprisingly, data detailing failure mechanisms of modern TKA is relatively
scant. Sharkey et al 2 retrospectively reviewed reasons for 212 revisions over a 3-year period from 1997 to
2000 at a tertiary referral center. Failures were subdivided into early (<2 years) and late (>2 years), with
55% falling into the early group. Overall, the most common reasons for revision were polyethylene failure,
aseptic loosening, instability, and infection. Not surprisingly, polyethylene wear and aseptic loosening were
more common in the late group comprising >70% of all late revisions combined. The most common reason
for failure in the early group was infection, comprising 25%. The early group also demonstrated a
surprisingly high rate of aseptic loosening of 16.9%, which points to surgical technique as a major
contributing factor to early revision since early loosening cannot be attributed to polyethylene wear.
Fehring et al 8 retrospectively reported reasons for revision of 440 total knees at a tertiary referral center.
They specifically looked at reasons for early failure, which they defined as revision within 5 years from the
index arthroplasty. An alarming 64% of revisions fell into this early failure group over a 10-year period.
Infection (38%) was the most common reason for early revision, followed by instability (26%), and failure of
cementless fixation (13%). Both of these studies are limited by data from tertiary referral centers, clouding
the true incidence of the mechanisms of TKA failure. They, however, demonstrate an alarming number of
early failures, and indicate room for improvement in surgical technique.
Patient Factors
Patient factors significantly contribute to the TKA failure. Medical comorbidities such as obesity, diabetes,
inflammatory arthropathy, tobacco use, lymphedema, immunosuppressive medications, and depression can
all contribute to early postoperative complications as well as long-term outcomes. 9–13 Kang et al 12
recently suggested HbA1C >8% as an independent risk factor for postoperative wound complications.
Foran et al 11 demonstrated a significantly higher revision rate in morbidly obese patients undergoing TKA
compared to non-obese patients. Other patient factors, such as patient-surgeon relationship, patient
expectations, psychosocial issues, and workers compensation add an additional layer of complexity to TKA
outcomes. 14 While not all patient factors are correctable in patients undergoing TKA; medical optimization
of diabetes, cardiopulmonary disease, smoking cessation programs, weight control, and treatment of
lymphedema should be pursued preoperatively to help mitigate the risk of complications following TKA.
Patient, Surgeon, or Device?
Failure of TKA is multifactorial with combined contributions attributable to the patient, surgeon, and device.
Medical optimization of patient comorbidities such as cardiorespiratory disease, obesity, diabetes, and
venostasis should be attempted to help mitigate the risk of perioperative complications.
Current implant design has improved greatly over the past 2 decades, but the rate of developing technology
is largely uncontrollable by both patient and surgeon. Most TKA designs today, if implanted correctly, will
have excellent long-term outcomes. Surgeons should choose an implant design that they are comfortable
with putting in well that has a proven track record. Implant design and improved materials in the future
should lead to further decreases in failure rates. However, surgeons should be cautioned against early
adoption of new technologies that have not been proven over time.
Surgeons can do the most to limit factors that lead to early failure. Judicious use of perioperative antibiotics,
good soft tissue handling techniques, and safe and efficient operative times can all help to decrease chances
of early postoperative infection. Early loosening and instability, also directly attributable to surgical technique,
can be limited with good cement technique and adherence to traditional arthroplasty balancing and alignment
principles. Continued professional education through national meetings and literature review can also keep
surgical technique up to date and help prevent the surgeon from repeating previous failures.
References
Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: Patient expectations affect
satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006; (452):35–43. doi: 10.1097/01.blo.
0000238825.63648.1e [CrossRef]
Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee
arthroplasties failing today? Clin Orthop Relat Res. 2002; (404):7–13. doi: 10.1097/00003086-
200211000-00003 [CrossRef]
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee
arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780–785. doi:
10.2106/JBJS.F.00222 [CrossRef]
Ranawat CS, Padgett DE, Ohashi Y. Total knee arthroplasty for patients younger than 55 years. Clin
Orthop Relat Res. 1989; (248):27–33.
Rand JA, Trousdale RT, Ilstrup DM, Harmsen WH. Factors affecting the durability of primary total knee
prostheses. J Bone Joint Surg Am. 2003; 85(2):259–265.
Scuderi GR, Insall JN, Windsor RE, Moran MC. Survivorship of cemented knee replacements. J Bone
Joint Surg Br. 1989; 71(5):798–803.
Rand JA, Bryan RS. Revision after total knee arthroplasty. Orthop Clin North Am. 1982; 13(1):201–212.
Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M. Early failures in total knee arthroplasty. Clin
Orthop Relat Res. 2001; (392):315–318. doi: 10.1097/00003086-200111000-00041 [CrossRef]
Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: A retrospective review of
6489 total knee replacements. Clin Orthop Relat Res. 2001; (392):15–23. doi: 10.1097/00003086-
200111000-00003 [CrossRef]
Namba RS, Paxton L, Fithian DC, Stone ML. Obesity and perioperative morbidity in total hip and total
knee arthroplasty patients. J Arthroplasty. 2005; 20(7 suppl 3):46–50. doi: 10.1016/j.arth.2005.04.023
[CrossRef]
Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS. The outcome of total knee arthroplasty in
obese patients. J Bone Joint Surg Am. 2004. 86(8):1609–1615.
Kang S, Han H, Yoon KS. Preoperative HBA1C is a good marker for predicting wound complications
after TKA in diabetics. J Bone Joint Surg Br. 2010; 92(suppl):135.
Shrader MW, Morrey BF. Insall Award paper. Primary TKA in patients with lymphedema. Clin Orthop
Relat Res. 2003; (416):22–26. doi: 10.1097/01.blo.0000092985.12414.6e [CrossRef]
Mont MA, Mayerson JA, Krackow KA, Hungerford DS. Total knee arthroplasty in patients receiving
Workers’ Compensation. J Bone Joint Surg Am. 1998; 80(9):1285–1290.
September 8, 2011
Lymphedema From Breast Cancer May Respond To Weightlifting – EmpowHer – By Jody Smith
Treatment for breast cancer can lead to an unpleasant condition called lymphedema which causes the arms
to swell. Research from the University of Pennsylvania School of Medicine indicated that weightlifting may
prevent the development of lymphedema. Previous research by the same team found that when women with
lymphedema lift weights, they can prevent the condition from becoming worse.
This Article
· VoteImproved My Health
· VoteChanged My Life
· VoteSaved My Life
The results were presented on December 8, 2010 at the San Antonio Breast Cancer Symposium. It was
published at that time in the Journal of the American Medical Association as well.
According to a Eurekalert also released on December 8, 2010, lymphedema is most likely to occur after
surgery removing multiple lymph nodes in the area of the breast that had cancer. Up to 47 percent of women
who have had this type of surgery can experience lymphedema.
Women in the study took part in a membership at a fitness center for 13 weeks where they used free
weights and machines under the watchful eyes of certified fitness professionals. They worked out twice a
week for 90 minutes at a time. For the rest of a year, the women exercised on their own, monitored monthly.
The women with lymphedema who participated in this routine had fewer setbacks and fewer symptoms than
women who did not take part in weightlifting.
It is important for a woman who has or may develop lymphedema to be in touch with her doctor, and a
certified fitness professional for safety's sake.
According to the New England Journal of Medicine's website Nejm.org, more than 2.4 million American
women are survivors of breast cancer. Depending on the type of treatment received, a woman may run a 6
percent to 70 percent chance of developing lymphedema.
Many of these survivors have been trying to restrict the use of their affected arms under the impression that
this will help. However advice along these lines is counterproductive. Instead, lymphedema responds best to
a carefully controlled increase in activity, including weightlifting.
Nejm.org concurred with the results referred to in the eurekalert, that weightlifting had an effect on hand and
arm symptoms, decreasing both severity and frequency.
Apparently exercise enhanced the flow of lymph and enhanced protein reabsorption. The effects of regular
exercise on the lungs seemed to boost lymph flow as well. It is speculated that the increase in muscle
strength may have reduced the effects of stress on the arm in daily activities.
This Article
· VoteImproved My Health
· VoteChanged My Life
· VoteSaved My Life
This research was funded by grants from the National Cancer Institute and the National Center for Research
Resources.
Sources:
Weightlifting slashes lymphedema risk after breast cancer treatment. Eurekalert.org. Web. September 5,
2011.
http://www.eurekalert.org/pub_releases/2010-12/uops-wsl120610.php
Weight Lifting in Women with Breast-Cancer-Related Lymphedema. Nejm.org. Web. September 5, 2011.
http://www.nejm.org/doi/full/10.1056/NEJMoa0810118#t=articleTop
Visit Jody's website and blog at http://www.ncubator.ca and http://ncubator.ca/blogger
Reviewed September 6, 2011
by Michele Blacksberg R.N.
September 8, 2011
New tool may help predict breast-cancer-associated lymphedema – HemOncToday –
ASCO 2011 Breast Cancer Symposium
SAN FRANCISCO — A set of statistical models have demonstrated more than 70% accuracy for
predicting the 5-year risk for developing lymphedema after lymph node removal during breast cancer
surgery.
New tool may help predict breast-cancer-associated lymphedema
ASCO 2011 Breast Cancer Symposium
SAN FRANCISCO — A set of statistical models have demonstrated more than 70% accuracy for
predicting the 5-year risk for developing lymphedema after lymph node removal during breast cancer
surgery.
Jose Bevilacqua, MD, PhD, a surgical oncologist at the Hospital Sirio Libanes in Sao Paulo, Brazil, and
colleagues studied 1,054 women with breast cancer who underwent axillary dissection in 2001 and 2002.
They used clinical factors such as age, BMI, ipsilateral arm chemotherapy infusions, level of axillary
dissection and others to develop three models and nomograms to predict the risk for developing
lymphedema.
The first model predicted lymphedema in advance of surgery and considered age, BMI and number of
chemotherapy cycles before surgery. The concordance index for this model was 0.706. The second model
used the same predictors within 6 months surgery, as well as the extent of axillary dissection and the location
of the radiotherapy field. The concordance index for this model was 0.729. The third model predicted
lymphedema 6 months or more after surgery. It considered the same predictors, as well as the development
of fluid buildup and swelling. The concordance index for this model was 0.736.
“The statistical models and the corresponding nomograms use readily available clinical factors and allow for
quick and easy estimation of individual risks of developing lymphedema after axillary lymph node surgery in
women with breast cancer,” Bevilacqua said. “For the sake of comparison, these modeling tools are as
accurate for predicting a woman’s risk of developing lymphedema as mammography is for the detection of
breast cancer.”
September 7, 2011
2011 Breast Cancer Symposium Research Reveals Trends in Survival, Treatment - -Newswise
Newswise — ALEXANDRIA, Va. – New studies on breast cancer screening, treatment, and survival were
released today in advance of the 2011 Breast Cancer Symposium. The symposium is being held September
8-10, 2011, at the San Francisco Marriott Marquis in San Francisco.
Four major studies were highlighted in today’s presscast:
- Two Studies Report Similar Recurrence, Survival Rates for Breast Conservation and Mastectomy among
Younger Women with Breast Cancer: A pair of studies indicates comparable outcomes – in local recurrence
and survival rates – for lumpectomy (breast conservation surgery) or mastectomy (entire breast removal)
among women with breast cancer age 40 and younger.
a) Study Finds Recurrence Rates are Similar in Younger Women Who Have Either Breast Conservation
Surgery or Mastectomy: A retrospective study of medical records of more than 600 women aged 40 and
younger who were diagnosed with up to stage III breast cancer, analyzed according to the type of surgery
(lumpectomy versus mastectomy) the women had, found no statistically significant difference in local cancer
recurrence risk.
b) Large Analysis Shows Breast Conservation and Mastectomy Result in Similar Survival Among Younger
Women With Early Stage Breast Cancer: Using the National Cancer Institute’s SEER (Surveillance,
Epidemiology, and End Results) database, investigators compared overall survival and breast cancer-
specific survival among nearly 15,000 women age 40 and younger, finding no significant differences between
the two groups.
- New Statistical Tool May Predict Risk of Common Debilitating Side Effect – Lymphedema – Associated
with Breast Cancer Surgery: Researchers have created a set of statistical models that are more than 70
percent accurate for predicting the five-year risk of developing lymphedema (debilitating swelling) after
lymph node removal during breast cancer surgery.
- Large Michigan Study Suggests Continued Importance of Self-Exams, Annual Mammography in Breast
Cancer Detection, Even in Younger Women: An analysis of breast cancer diagnosis data from nearly 6,000
women in Michigan suggests that mammography and self-breast exams remain important tools for detecting
breast cancer, even among women aged 40 to 49 for whom routine mammography has been questioned by
the U.S. Preventive Services Task Force (USPSTF).
“Improvements in detection, as well as insights into surgical treatment options and their outcomes, have
increasingly led to longer, improved lives for women with breast cancer,” said Andrew Seidman, MD,
American Society of Clinical Oncology Cancer Communications Committee member. “The studies
presented today reflect the impact of these advances in treatment approaches on patient outcomes and
treatment decision-making.”
In 2011, an estimated 230,480 new cases of invasive breast cancer are expected to occur in women in the
United States, and another 2,140 cases are expected in U.S. men. An additional 57,650 cases of in situ
(non-invasive) breast cancer are expected to occur in U.S. women as well, totaling more than 290,000 new
cases.* This year’s Breast Cancer Symposium will include more than 300 abstracts and focus on a range of
breast cancer topics that range from prevention and screening to treatment and survivor care.
*Source: Cancer Facts & Figures 2011. Atlanta, GA; American Cancer Society: 2011.
The full release is available at the following link:
http://www.asco.org/ASCOv2/Department Content/Communications/Downloads/BCS11 Research Release
Final.pdf
About the 2011 Breast Cancer Symposium
The fifth annual Breast Cancer Symposium is co-sponsored American Society of Breast Disease, the
American Society of Breast Surgeons, the American Society of Clinical Oncology, the American Society for
Radiation Oncology, the National Consortium of Breast Centers and the Society of Surgical Oncology.
Susan G. Komen for the Cure®, the world's largest grassroots network of breast cancer survivors and
advocates, is the primary supporter of the Symposium.
Information for Media: www.asco.org/BCSpresskit
Relevant Links on ASCO’s CancerProgress.Net Website:
http://cancerprogress.net/breast
Relevant Links on ASCO’s Cancer.Net:
• Guide to Breast Cancer
• Cancer Screening
• Mammography – What to Expect
• Expert Perspective from ASCO on Mammography Screening for Breast Cancer
• Understanding Cancer Surgery
• Talking With the Doctor About Breast Surgery Options
• After Treatment for Breast Cancer: Preventing Lymphedema
• Coping With Fear of Recurrence
ATTRIBUTION TO THE 2011 BREAST CANCER SYMPOSIUM IS REQUESTED IN ALL NEWS
COVERAGE
September 7, 2011
New Nomograms Predict Lymphedema After Axillary Lymph Node Dissection - Internal Medicine News
Digital Network – By: SUSAN LONDON
A new set of nomograms based on easily assessed risk factors accurately predicts a woman’s likelihood of
developing lymphedema after axillary lymph node dissection for breast cancer, researchers are reporting at a
breast cancer symposium sponsored by the American Society of Clinical Oncology.
The nomograms, which enable risk assessment throughout the course of treatment using data available at the
time, had accuracy exceeding 70%, according to results presented in a press briefing before the meeting.
"The accuracy is the same as mammography to detect breast cancer. ... So that’s a very good statistical
tool," said lead author Dr. Jose Bevilacqua, a surgical oncologist at the Hospital Sirio-Libanês in São Paulo,
Brazil.
Being able to identify high-risk patients has several potential applications, he added. They could be
monitored more closely and offered interventions that might prevent or reduce the severity of lymphedema,
such as use of compression sleeves. "The earlier you detect [it], the better is the outcome," Dr. Bevilacqua
said.
Additionally, high-risk patients with a positive sentinel lymph node could be counseled about the risk of
further surgery. Thus, "you have physicians who make closer follow-up and [have] a better discussion with
the patients."
Finally, the nomograms could be applied in clinical research. "These tools might help [ongoing] or new
studies to select high-risk patients in order to avoid exposing the low-risk patients to unproven therapies," he
explained.
Dr. Andrew Seidman, moderator of the press briefing and a medical oncologist at the Memorial Sloan-
Kettering Cancer Center in New York, commended the investigators for a study that "has real practical
implications for patients."
"It allows us to identify patients who then can be appropriately triaged for early intervention and perhaps for
clinical trials aimed at preventing what many consider inevitable, and that is the development of lymphedema."
The effectiveness of early interventions is controversial, according to Dr. Seidman, who did not report any
relevant conflicts of interest. "There are believers and there are nonbelievers," he commented. "What I think
this nomogram does is [allow] us in a scientific way to segregate out patients in terms of their risk, and by
doing that, we can have more uniform cohorts for which early intervention can be studied more rigorously."
The researchers prospectively followed 1,054 women with unilateral breast cancer who underwent breast-
conserving surgery or mastectomy with an axillary lymph node dissection in 2001-2002. Median follow-up
was 41 months.
"As far as we know, we have established the largest prospective cohort specifically established to study the
incidence and factors associated with lymphedema after axillary node dissection for breast cancer,"
commented Dr. Bevilacqua.
Using Data to Predict Lymphedema
The women had serial arm volume measurements starting before surgery. To facilitate this process, the
researchers created a tool that is now available free online (www.armvolume.com).
They then developed and internally validated three multivariate nomograms (or statistical models) for
predicting lymphedema using data available at various time points.
The first model, to be used preoperatively, incorporated age, body mass index, and number of cycles of
neoadjuvant chemotherapy infusions in the ipsilateral arm.
The second model, to be used within the first 6 months after surgery, incorporated all the factors from the
first plus the extent of axillary dissection, the location of radiation therapy field, and the number of cycles of
adjuvant chemotherapy infusions in the ipsilateral arm.
The third model, to be used 6 months or later after surgery, incorporated all the factors from the second,
plus the development of postoperative seroma and development of early edema.
Study results showed that within 5 years of axillary lymph node dissection, 30.3% of the women developed
lymphedema (defined as a difference in volume of at least 200 mL between arms at 6 months or later after
surgery).
All of the risk factors used in the models were significantly associated with the development of lymphedema,
Dr. Bevilacqua reported.
"One of the novelties of our study is the [finding] that ipsilateral neoadjuvant chemotherapy infusion is as
morbid as adjuvant chemotherapy infusion to increase the risk of lymphedema," he pointed out. "This is
somewhat intuitive, but it has never been described, and the great majority of clinical oncologists are not
aware of this fact."
For predicting the 5-year risk of lymphedema, the first, second, and third models had accuracy of 70.6%,
72.9%, and 73.6%, respectively. The investigators have converted the models into free, user-friendly
calculators that are available online (www.lymphedemarisk.com) during the ASCO Breast Cancer
Symposium (Sept. 8-10), but will be taken off line until the manuscript is published, after which they are to
become available again.
Dr. Bevilacqua reported that he had no relevant conflicts of interest.
September 8, 2011
New Research: Acupuncture treats Breast Cancer Lymphedema – HealthCMI –
Recent Memorial Sloan-Kettering Cancer Center research demonstrates that acupuncture significantly
reduces lymphoedema related arm swelling in women after breast cancer surgery. Lymphoedema is a when
there is fluid retention and tissue swelling in the body due to disorders of the lymphatic system. The
lymphatic system controls the return of interstitial fluid to the bloodstream. After breast cancer surgery, the
lymphatic system can be damaged by lymph node surgery or radiation therapy. Symptoms may appear
quickly or take several months or years to become apparent. Swelling of the arms and sides of the body is
most common after lymphatic system damage due to breast cancer procedures.
The researchers at Sloan-Kettering in New York note that existing conventional treatments for
lymphoedema are only “marginally beneficial, rarely reducing arm swelling in any meaningful way.” The new
study concludes that acupuncture is safe and that some of the women in the study showed a 30 percent or
better reduction of lymphoedema related arm swelling.
Acupuncture Results
In this study, lymphoedema was diagnosed when the affected arm was greater than 2cm in circumference
than the unaffected arm. Participants received acupuncture at a rate of 2 times per week for a total of four
weeks. Results were tabulated after a six month follow-up. No serious events were reported and the study
concludes that “acupuncture appears safe and may reduce lymphoedema associated with breast cancer
surgery.”
Acupunct Med. doi:10.1136/aim.2011.004069. A safety and efficacy pilot study of acupuncture for the
treatment of chronic lymphedema. Barrie R Cassileth, Kimberly J Van Zee, Yi Chan, Marci I Coleton,
Clifford A Hudis, Sara Cohen, James Lozada, Andrew J Vickers.
Author Affiliations:
Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York.
Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York.
Integrative Medicine
September 8, 2011
New Research: Acupuncture treats Breast Cancer Lymphedema – HealthCMI –
Recent Memorial Sloan-Kettering Cancer Center research demonstrates that acupuncture significantly
reduces lymphoedema related arm swelling in women after breast cancer surgery. Lymphoedema is a when
there is fluid retention and tissue swelling in the body due to disorders of the lymphatic system. The
lymphatic system controls the return of interstitial fluid to the bloodstream. After breast cancer surgery, the
lymphatic system can be damaged by lymph node surgery or radiation therapy. Symptoms may appear
quickly or take several months or years to become apparent. Swelling of the arms and sides of the body is
most common after lymphatic system damage due to breast cancer procedures.
The researchers at Sloan-Kettering in New York note that existing conventional treatments for
lymphoedema are only “marginally beneficial, rarely reducing arm swelling in any meaningful way.” The new
study concludes that acupuncture is safe and that some of the women in the study showed a 30 percent or
better reduction of lymphoedema related arm swelling.
Acupuncture Results
In this study, lymphoedema was diagnosed when the affected arm was greater than 2cm in circumference
than the unaffected arm. Participants received acupuncture at a rate of 2 times per week for a total of four
weeks. Results were tabulated after a six month follow-up. No serious events were reported and the study
concludes that “acupuncture appears safe and may reduce lymphoedema associated with breast cancer
surgery.”
Acupunct Med. doi:10.1136/aim.2011.004069. A safety and efficacy pilot study of acupuncture for the
treatment of chronic lymphedema. Barrie R Cassileth, Kimberly J Van Zee, Yi Chan, Marci I Coleton,
Clifford A Hudis, Sara Cohen, James Lozada, Andrew J Vickers.
Author Affiliations:
Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York.
Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York.
Integrative Medicine Service and Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering
Cancer Center, New York.
September 7, 2011
Software Predicts Lymphedema Risk After Axillary Dissection – Medscape –
Sorry have to be a member of something to access this article.
September 8, 2011
MBCS: Tool Predicts Arm Swelling in Breast Cancer - MedPage Today – By Crystal Phend
SAN FRANCISCO -- Five-year risk of lymphedema can be predicted with at least 70% accuracy using a
free online statistical tool, researchers found.
Concordance of predicted risk with actual outcomes was 70.6% when calculated preoperatively, 72.9%
when calculated within the first six months after surgery, and 73.6% when calculated further along in the
postop course, Jose Bevilacqua, MD, PhD, of Hospital Sirio Libanes in Sao Paulo, Brazil, and colleagues
reported.
Although some high-risk patients might be missed by the tool, this level of accuracy is similar to what has
been seen with mammography, according to Bevilacqua.
He reported the results at a press telebriefing in advance of presentation at the Multidisciplinary Breast
Cancer Symposium here.
This kind of risk prediction is an important step forward that could have real practical implications for
patients, commented telebriefing moderator Andrew D. Seidman, MD, of Memorial Sloan-Kettering
Cancer Center in New York City.
"It allows us to identify patients who can then be appropriately triaged for early intervention and perhaps for
clinical trials aimed at preventing what many consider inevitable [lymphedema]," he told reporters.
Bevilacqua suggested a strategy of close follow-up for patients identified as high risk by the lymphedema
prediction tool.
Currently, "patients are often referred when lymphedema is already very significant, where it begins to
interfere with function," Seidman noted at the briefing.
There's debate about whether any prevention strategies are actually effective, but, Seidman said, catching
the complication at an early stage can delay progression to the later debilitating stages.
Those early stage patients can be referred for physical therapy, and given compression sleeves and standard
instructions on prevention, such as avoidance of heat and heavy lifting with the affected arm, Bevilacqua
added.
His study used a prospective cohort of 1,054 women followed for lymphedema after axillary lymph node
dissection as part of surgery for breast cancer done at the Brazilian National Cancer Institute from Aug.
2001 to Nov. 2002.
The five-year cumulative incidence of lymphedema was 30.3%.
Significant independent predictors in the statistical models included:
For preoperative prediction, age, body mass index (BMI), and number of cycles of neoadjuvant
chemotherapy
For prediction within six months of surgery, age, BMI, number of cycles of neoadjuvant or adjuvant
chemotherapy, level of axillary lymph node dissection, and extent of radiotherapy field
For prediction beyond six months after surgery, all the earlier factors as well as development of seroma and
evidence of early edema
The researchers cautioned that their nomograms have yet to be validated on an independent cohort of
patients.
The online tool, found at lymphedemarisk.com, is hosted by the Cleveland Clinic, which collaborated on the
project. The Web site will be available temporarily during the conference (from September 8 through 10)
and permanently accessible after planned publication of the study.
The researchers reported having no conflicts of interest to disclose.
Seidman reported having served as consultant or advisor to Enzon and Wyeth and having received
honoraria from Celgene, Genentech, and Genomic Health.
Primary source: Multidisciplinary Breast Cancer Symposium
Source reference:
Bevilacqua JLB "Nomograms for predicting the risk of arm lymphedema after axillary dissection in breast
cancer" MBCS 2011; Abstract 8.
September 7, 2011
Hampton community events - Daily Press –
L.E.A.P- Lymphedma, Education, Advocacy, Program Support Group Meeting. 6 p.m. Sept. 15, Sentara
Hampton Careplex first floor conference room C. All are welcome to attend. L.E.A.P. is for patients, family
members, and/or friends suffering from lymphedema. Also, come hear about how you can make a difference
and learn more about the Lymphedema Treatment Act. Contact Tiffany at leap.director@gmail.com for
more information or visit http://www.wix.com/leapdirector/lymphedema.
This one has passed but sounds like it might be a regular meeting on Thursdays
September 7, 2011
Software Predicts Lymphedema Risk After Axillary Dissection – Medscape –
You have to be a member to access this article sorry
September 24, 2011
Telemedicine Service Launched at Shirgaon through Spanco's Maha E Seva Kendra - Business Wire India -
The telemedicine service for Filarias (Lymphedema) disease was launched in Maha e-Seva Kendra at
Shirgoan, under the National e-Governance Plan. Government of Maharashtra has implemented a National
e-Governance Plan (NeGP) to provide government services to the rural population at their doorstep at an
affordable cost .The telemedicine project is a part of the Common Services Centers scheme, and has been
implemented by Spanco through the CSC centre at Shirgoan.
The Telemedicine service was inaugurated, by the hands of Honorable Dr.Shashi Bhushan Gogia Director
SAATHI (NGO). Mr.Ravindra Jogal member of Zillah Parishad and Mr.Mangesh Dhopate Shirgaon
Sarpanch were also apart of the telemedicine launch event.
The Shirgoan Maha E Seva Kendra will facilitate Lymphedema Patient to get a check up done with a
nominal consultancy fee ranging between Rs.30-50/-in their village. For this activity Spanco Limited has
provided the facility to install the necessary equipments costing Rs.1.5 lacs in the Maha E Seva Kendra
center. Beside this Spanco has also made 10 special medical kits available each costing Rs.2000/- for
Lymphedema patients through this Center.
Spanco has taken this initiative in Sindhudurg as villagers are affected by this disease and along with local
social activist & health department Spanco intends to eradicate this disease from Sindhudurg district. During
the launch camp, 2 patients were methodically examined by Dr.Gogia as apart of the launch program.
“Detailed information about the disease is available in Spanco’s Maha e Seva Kendra and those people who
are suffering in the district are advised to take the benefit of this Telemedicine service by visiting the centre
“said Mr.Dhananjay Vartak- Head citizen Service Group, Spanco Limited.
For this Inauguration Honorable Dr.Mrs. Arunarekha Gogia, Dr.Ashish Keche Shiragon Primary Medical
officer, Ms.Sugandha Satam Zila Bank Vice President, Ms.Archana Kalra Spanco’s General Manager, Mr.
Sagar Tope Asst. General Manager Spanco, Mr.Sandeep Uttekar Area Manager Spanco and Mrs. Harsha
Ajit Chahan representative of Maha E Seva Kendra, Shirgaon were present at this function.
About Spanco
Spanco is in the business of creating Technology Infrastructure to help drive governance efficiency across
key sectors.Spanco is SEI CMM Level 3 and ISO 9001:2008 certified. We have more than 12,000
employees working across 4 continents.
Spanco caters to large complex Technology Infrastructure projects across Government, Power, Transport
and Telecom Service Provider’s space. We also have a formidable presence in the BPO space catering to
India, US/Europe, Middle East and African markets
September 23
Pink Ribbon Produce Launching at Price Chopper to Support Susan G Komen for the Cure – WBGH
From Price Chopper:
Pink Ribbon Produce, a unique retail program committed to raising breast cancer awareness, will return to
Price Chopper stores for its fourth year from October 2 through October 29. The educational fundraising
program partners the grocery retailer with produce suppliers in an effort to raise money for local Susan G.
Komen for the Cure® Affiliates.
“Price Chopper is proud to participate in the Pink Ribbon Produce program again this year as part of our
multifaceted year-round initiative to raise funds for breast cancer research and support services,” said Mona
Golub, vice president of public relations, consumer and marketing services for Price Chopper
Supermarkets. “During October, our customers can show their support for Susan G. Komen for the Cure
by buying healthy fruits and vegetables from the branded partners that are participating in the program.”
Barbara Connolly, who once worked at Price Chopper, is a courageous mother of five who was diagnosed
with breast cancer at just 29 years old. Connolly was passionate in her personal fight against breast cancer.
She drew inspiration from support groups led by Komen for the Cure and benefitted from grants to receive
treatment and supplies for Lymphedema, which developed after her breast cancer treatment. Connolly now
gives back to Komen by volunteering for the Northeast Pennsylvania (NEPA) Affiliate of Susan G. Komen
for the Cure. Connolly was awarded the Spirit of Hope Award by NEPA in 2011 and has inspired many by
her participation in “Pink in the Park,” a Northeast Pennsylvania Affiliate walking program. In addition to
walking, Connolly participated in Team Survivor and with just six weeks of training, ran a 5k during the
Susan G. Komen Race for the Cure®. She took third place in the survivor division in September 2010.
Through various fundraising activities, including Pink Ribbon Produce and the Race for the Cure series,
Komen has invested more than $1.9 billion in research and lifesaving community programs.
By bringing together Price Chopper, Komen and produce suppliers, Pink Ribbon Produce provides
shoppers with an easy way to give back to their communities and support efforts to find cures for breast
cancer. The money raised goes to local Komen Affiliates. Stores will direct shoppers to the participating
produce suppliers with a Pink Ribbon Produce program icon on posters and point-of-sale signs at the
product.
Produce partners supporting this year’s Pink Ribbon campaign include:
· Calavo
· Custom Pak
· Del Monte Fresh Produce
· Dole
· Earthbound Farm
· Fowler Packing
· Mastronardi
· POM Wonderful
· Santa Sweets
September 23, 2011
A Walk and a Wedding for Westbury's Nancy Safran - Westbury Times –
Westbury resident Nancy Safran never suspected retirement would be so frenzied.
Recently retired from Nassau BOCES after a 34-year teaching career – the past 24 years of which have
been “extremely rewarding” as a speech teacher for the hearing impaired – Nancy is now focusing on a
speech of a quite different kind.
On Oct. 1, Nancy and her husband, Howard, will proudly deliver some very special words at the wedding
of their daughter, Marnie.
“Helping Marnie to plan her wedding has been a joy,” said Nancy recently. “I miss teaching and the kids
and my colleagues so much, but this year – with the wedding and with Lymphatic Research Foundation’s
(LRF) New York Walk right on top of one another, I’m almost too busy to feel that September back-to-
school pull on the heartstrings.”
In addition to preparing for the wedding and volunteering with LRF, Nancy is finding that retirement gives
her time to pursue long-held interests and reconnect with friends.
She is taking golf lessons, has joined a book club and a canasta club, and tries to find time for frequent
walks on the Jones Beach Boardwalk. Over the summer she has been working extra volunteer hours with
the Glen Cove-based Lymphatic Research Foundation (LRF) to help garner support for their National Walk
for Lymphedema and Lymphatic Diseases at Eisenhower Park on Saturday, Sept. 24.
“As a family we have journeyed with lymphedema since Marnie was a little girl. We have faced serious
health issues, a frustrating lack of knowledge about lymphatic diseases, and a medical system that offers few
treatment options and little hope for reversing the sometimes devastating effects of lymphedema and other
lymphatic disorders,” Nancy explained. “Now I do what I can to inform and support other families facing a
similar situation; and I help LRF because I know that more scientific and medical research offers the best
hope for finding better treatments and cures.”
Born with congenital lymphedema, Marnie Safran, a 1999 graduate of W. Tresper Clarke High School and
now an early childhood special educator with the NYL Gramercy Pre-School in Manhattan, will be married
to Scott Lesser at Temple Chaverim in Plainview on Oct. 1
“Everything is finally all set,” said Marnie. “It’s going to be a great wedding. I’m still working on getting the
right shoes, but I know I’ve got the right life partner – and that’s what’s important,” Marnie added.
In honor of their wedding, Marnie and Scott are making a generous donation to support the work of the
Lymphatic Research Foundation. Founded in 1998 by Roslyn resident Wendy Chaite, LRF has become a
leader in patient advocacy and a primary force behind advancements in lymphatic science worldwide.
LRF’s advocacy programs have been effective in gaining Congressional and National Institutes of Health
(NIH) support for lymphatic research at the National Institutes of Health and at major academic research
centers, elevating lymphatic diseases from relative obscurity to a position on a par with other national health
priorities. The organization directly funds cutting edge lymphatic research by funding Postdoctoral Research
Fellowship Grants, a National Lymphatic Disease Patient Registry and Tissue Bank, a peer-review
biomedical journal in lymphatics, and the first-ever endowed academic Professorship in Lymphatic Research
and Medicine (Stanford University Medical School, 2008).
“I’m glad to be walking for LRF and walking for Marnie the week before the wedding,” said Nancy. “That’
s going to be a great day, too, with all of our friends coming out to support us.”
Visit www.walklrf.org for details and to support Team Safran.
September 22, 2011
Tennis Rally for the Cure, October 2, at the Mountain Home Tennis Center - Baxter Bulletin –
The Third Annual Tennis "Rally for the Cure" will be held Sunday, October 2, at the Mountain Home Tennis
Center. The Tennis Rally is open to women and men who want to help win the fight against breast cancer.
Rally for the Cure is the largest grassroots world-wide network of breast cancer survivors and activists
hosting a Rally that include tennis, golf, running and dining events created to support the promise of Susan G.
Komen for the Cure and spread the message that early detection saves lives. More than 1.3 million people
have participated in Rally for the Cure events across the nation since its inception in 1996. The program was
started by the sister of Susan G. Komen, who died at only 36 of breast cancer.
The Mountain Home Tennis Center Rally will begin at 11:00 a.m. at the Tennis Center. A complimentary
luncheon will be served for all participants and donors, followed by more tennis in the afternoon.. The cost
for the day is $25.00 a person ($20.00 for full-time college students) with checks made out to Rally for the
Cure and all proceeds going to the Foundation.
Each participant will receive a goody bag with Komen breast health information, an exclusive Rally bandana,
a pink ribbon pin, a Rally towel, a Rally Charm, Cards for the Cure from Hallmark and a one-year
subscription to a selection of Condi Nast magazines, including SELF, Bon Appetit, Architectural Digest and
other choices. Participants are encouraged to wear pink, the signature color of Rally for the Cure.
"We are proud and happy to again open the Mountain Home Tennis Center for the Cure event which is a
fun way to give our members and people from the area a chance to come together to support an important
cause while playing a sport they love", states Mark Klingelhoets, owner of the Tennis Center.
On October 2, Lisa McBrayer, Flippin, and Debbie Voss, ellvillle, will represent women like them in our
community who have battled breast cancer and survived. Lisa has been a local Ambassador for this cause
and instrumental in organizing the October Tennis Rallys the past two years, along with Maria Acree, Cindy
Holeyfield, Roberta Heldenbrand and Charlotte and Al Wynne. Lisa is grateful to the Komen foundation,
which provided her with a free wig and also a free massage every week while she was undergoing radiation
therapy at Carti.
Up to 75% of the net income from each Rally or Race stays in that local community " The Komen Grant
touches us personally in Mountain Home because of this", states Karyn Klingelhoets, one of the Rally
organizers. "Here is some of what comes home to us from the Komen Grant":
CARTI radiation treatment regardless of income, ability to pay or distance from a CARTI facility.
Treatments typically last 4-6 weeks.
Baxter Regional Medical Center provides schools with a "TELL YOUR MOM, SAVE A LIFE" outreach
program aimed at education and prevention at all ages.
BRMC Mobile Mammography Unit which travels to provide easy access to remote areas and workplaces
to provide reduced cost mammography.
Lymphedema Outreach VI to provide compression garments to survivors after surgery.
The mission of Rally for the Cure has been to emphasize the vital importance of early detection in the
successful treatment of breast cancer and to someday eradicate this life-threatening disease. According to
Komen for the Cure, each year breast cancer is the leading cause of death for women ages 35-54 and
accounts for more then 75% of all cancer deaths in women 55 years of age and older. Since 1996, Komen
has received over $46 million from Rally events nationwide to support their mission.
Rally for the Cure is based in Wilton, Connecticut. They can be reached at 800.327.6811 or at their
website: www.rallyforthecure.com.
To register for the October 2 Rally in Mountain Home, call the Tennis Center at 425-5009 or stop in at the
Tennis Center at 111 CR 27.
Take Hwy 5 No. to Roller Funeral Home. Turn right just past the cemetery onto Canne Baker (Hwy 27).
The Center is located on the immediate right. Donations should be made out to Rally for the Cure and sent
to the Tennis Center, or call to have a Rally organizer pick up your contribution.
September 22, 2011
Doctors' Choice earns accreditation - Daytona Beach News-Journal – by Peggy Ellis
SOUTH DAYTONA -- Doctors' Choice, a home health service, has earned accreditation by the
Accreditation Commission for Health Care Inc. (ACHC) for the services of skilled nursing, home health
aide, therapy and social work.
Doctors' Choice Home Health provides skilled nursing, therapy, medical social work and home health aide
services to clients in Volusia and Flagler counties. The company also offers psychiatric and wound certified
nurses, lymphedema treatment, intravenous therapy administration, cardiac care, balance and low vision
programs, diabetic education and pulmonary rehabilitation.
ACHC, a private, not-for-profit corporation, was developed by home care and community-based providers
to help companies improve business operations and quality of patient care. Accreditation is a voluntary
activity where healthcare organizations submit to peer review for their internal policies, processes and patient
care delivery against national standards.
September 22, 2011
Laurantis Pharma Release: New Treatment for Lymphedema Could Mean Breakthrough for Breast Cancer
Patients - PipelineReview.com
Laurantis Pharma announced that LymfactinTM, adenoviral VEGF-C growth factor therapy, was successful
in rebuilding lymphatic vessels in pre-clinical animal models
STOCKHOLM, Sweden | September 21, 2011 | Laurantis Pharma, a privately held biotechnology
company based in Finland, today announced that LymfactinTM, adenoviral VEGF-C growth factor therapy,
was successful in rebuilding lymphatic vessels in pre-clinical animal models. The use of VEGF-C growth
therapy to regenerate lymphatic vessels over time may be used to assist lymph node transfer surgery as a
technique to treat secondary lymphedema.
The results were presented at the 23rd International Congress of Lymphology in Malmö, Sweden by Kari
Alitalo, MD, PhD, Academy Professor, Molecular Cancer Biology Program
Biomedicum Helsinki, University of Helsinki, and Anne Saaristo, MD, PhD, Consultant Plastic Surgeon,
Turku University Central Hospital, Turku, Finland. The researchers were able to demonstrate VEGF-C’s
ability to induce the spontaneous growth of lymphatic vessels during the first two weeks of treatment, which
then stabilized and matured over the course of the next six months.
The ability of VEGF-C to regulate the growth of lymphatic vessels presents an advantage for the use of
lymph node transfer as a way of treating lymphedema. Currently lymph node transfer is being tested as a
way to rebuild the lymphatic vascular anatomy but no treatment currently helps to assist the spontaneous
growth of lymphatic vessels.
“Breast cancer patients have an urgent need for better treatments for lymphedma,” said Dr. Saaristo. “With
Lymfactin, we see the potential to increase the impact of the operation and reduce the amount of lymphoid
tissue that needs to be removed from other parts of the body. Ideally Lymfactin will result in more durable
lymph node transplants, reducing the need for painful pressure bandages.”
Lymphedema
Lymphedema, localized swelling due to fluid accumulation, is caused by the disruption in the flow of
lymphatic fluid, usually associated with the removal of lymph nodes as treatment for breast cancer. About 20
to 30 percent of patients who have had lymph nodes removed as a part of treatment for breast cancer will
develop chronic lymphedema. Currently, there is no cure for the condition, and treatments are limited in their
ability to reduce swelling and reduce the risk of infection.
About Laurantis Pharma
Laurantis Pharma is a clinical-stage specialty pharmaceutical development company with a broad portfolio
of first-in-class products based on two proprietary technologies. The Company’s lead products target the
treatment of a variety of inflammatory diseases and conditions including atopic dermatitis, dry eye syndrome,
interstitial cystitis, and lymphatic disorders, as well as the treatment of bladder cancer.
The Company’s pipeline includes proprietary and patent-protected formulations and applications of cis-uroc
anic acid (cis-UCA), a locally acting anti-inflammatory and anti-proliferative agent. Laurantis Pharma is also
developing Lymfactin™, a vascular endothelial growth factor C (VEGF-C) in an adenoviral vector, for the
treatment of secondary lymphedema. Laurantis Pharma is located in Turku, Finland. More information can
be found at www.laurantis.com
SOURCE: Laurantis Pharma
September 22, 2011
in, Fatigue, Cognitive Deficits in Breast Cancer Survivors – Medscape –
Sorry you have to be a member of something to get this article
September 25, 2011
Dighton family seeks to raise awareness, a cure for lymphatic diseases - Taunton Daily Gazette – By Joan
Psotto –
Dighton —
With the exception of lymphoma – a cancer of the lymphatic system – most people have never heard of
lymphatic disease. That changed four years ago for one Dighton couple when their daughter, Giana, was
born with a lymphatic malformation of the head and neck.
Initially diagnosed at birth with a bronchial cyst, a fairly common congenital anomaly, little Giana was sent
home at one week of age. But with a mother's instinct, Wendy Richard knew something more serious was
interfering with Giana's breathing. When she was two weeks old Giana was admitted to Children's Hospital
Boston where specialists diagnosed the lymphatic malformation.
“It was a nightmare,” says Wendy now. “My son was 21 months old and my infant daughter had a life-
threatening condition that was preventing her from breathing normally.”
Giana underwent schlerotherapy (injections to break down the cystic mass); and at one month old was sent
home with a tracheotomy to open her airway. “At first they told us the trach would be removed by her
second birthday; but she's 4 now, and now we're hoping that it will come out next summer,” said her mother.
Wendy recalls the first few difficult months at home: “It was terrifying ... not only did Giana have special
medical needs and infection risks because of the tracheotomy and breathing difficulties, (but) she could not
make any sound. You had to be looking at her to know she was crying. Someone had to be with her all the
time, even when she slept.”
The family had home nursing assistance for Giana's first three years.
The family struggled — and continues to struggle — with the difficulties of having a child with a rare disease.
“Giana's first year was a very difficult time, a terrible strain on our family — emotionally and financially,”
recalls Wendy. “I wasn't able to go back to work. There was so much to learn about and so much to worry
about. And no one could tell us what kind of future our little girl would have. We felt like pioneers, but we
also felt guilty thinking that — as parents — it was somehow our fault. That was the hardest thing. There is
just no way to know why this happened to Giana and still happens to other children. At this point there isn't
enough known about lymphatic diseases and malformations to know what causes them or what will cure
them.”
Giana's father Chris agrees, but says that their daughter's condition has also been a blessing to the family.
“Giana's struggle with this lymphatic malformation has helped our family grow closer together and closer to
God,” he said. “We just keep believing that God will help us to work it all out.”
Now 4 years old, Giana runs and plays with other children, but doesn't understand why she cannot romp in
the waves at the beach or play in the pool with her brother and cousins. She began pre-K this September,
and her brother Zachary is in kindergarten.
Her parents and grandmother, Taunton resident Karen Castro, have become advocates for lymphatic
disease awareness. They have reached out to the Lymphatic Research Foundation, a non-profit organization
supporting biomedical research of the lymphatic system and advocacy for lymphatic disease patients.
“It's amazing to me that no one has heard of this,” says Castro, Wendy’s mom. “They ask why Giana has
the tracheotomy ... and no one's ever heard of lymphatic malformations or even knows what the lymphatic
system is. Aside from worrying about Giana, that's the most frustrating thing ... no one has even heard of
what she has!”
The family will be walking with Giana to raise awareness of lymphatic diseases and to raise funding for
lymphatic research at the Oct. 2 National Walk for Lymphedema and Lymphatic Diseases in Melrose.
“Giana's Dream Team will be out there walking for our girl,” says Castro.
To learn more about the Walk, and to support the Richard family's efforts, visit www.walklrf.org or www.
lymphaticresearch.org.
Joan Psotto is affiliated with the Lymphatic Research Foundation.
Copyright 2011 The Taunton Gazette. Some rights reserved
September 25, 2011
Telemedicine Service Launched at Shirgaon through Spanco's Maha E ... - IT News Online
This is a duplicate article see above September 24, 2011
September 25, 2011
Andrew set for gruelling fundraiser - NW Evening Mail –
A SEVERELY disabled man will complete a gruelling solo wheelchair push to raise money for other people
affected by his condition.
Double amputee Andrew Stevens, who has spina bifida and hydrocephalous, will push himself on a six-mile
route around Barrow on October 15.
The 40-year-old, who lost both legs to lymphedema in 2005, will set off from The Forum, in Duke Street,
and travel around Holbeck, Roose and town centre streets.
His friend Bryn Tyson, 17, will be accompanying him to provide moral support.
Mr Stevens completed a five-mile push last year in memory of a friend who died 20 years ago. This year he
was determined to do it to raise money and awareness for people with spina bifida.
It took him around three hours to complete the task last year, and Mr Stevens has a similar target for when
he does it this time round.
Mr Stevens, of Ewan Close, Barrow, is now drumming up support for the challenge, which will raise money
for the Association for Spina Bifida and Hydrocephalus.
He said: “Last time, I did it in memory of a friend, but as spina bifida affects people around the world, I
wanted to do something for that.
“ASBAH has helped so many people in my situation with help and advice, I think it’s important to give
something back so they can continue helping people.
“I got a real sense of achievement from it last time, but this time it has been a real struggle getting people to
sponsor me. Everybody has got financial problems or worries.
“I have been in a wheelchair all my life. I was born with spina bifida and because there was a hole in my
spine, my mother was told they could either operate to close it, which would paralyse me, or I would not
survive.
“I’ve been training for a few months for it. I try and get out and do a couple of miles in my chair whenever I
can motivate myself, because you need a lot of strength in your arms. I just keep pushing until I’m tired.”
To sponsor Mr Stevens, visit www.justgiving.com/Andrew-Stevens0.
September 26, 2011
Traveling? Veterans share the lowdown on flying after cancer treatment - MLive.com – by Sue Schroder
Karen Hogan puts it well: You decide how much risk you let into your life.
Hogan, a breast cancer survivor who has been cancer-free for three years, is no stranger to risk, but there’s
one she won’t take: air travel.
She had 18 lymph nodes removed following breast cancer surgery, and two more nodes five months later.
As a result of that and radiation, she says air travel, with its changes in air pressure, would increase her risk
of developing lymphedema.
For her, that would be a painful and debilitating swelling of her right arm and hand, which could be, she says,
even disfiguring.
“I don’t know what percentage of risk that could be, but I have met too many women with lymphedema,
and when I ask them if they have traveled via an airplane, they have all said yes. So, I am very scared to
potentially trigger this lifetime side effect for me.
“I treat my arm like having a special needs child with me,” said Hogan, who calls it a small price to pay for
being alive. She took part in a one-year clinical trial designed to prevent lymphedema through the Lemmen-
Holton Cancer Pavilion, Spectrum Health and Mary Free Bed Rehabilitation Hospital.
“Maybe I know too much now. But I follow the instructions/tips to a T — carrying my purse on my
nonaffected side, not carrying anything (that weighs more than) a gallon of milk, no manicures on my right
side — wearing my (compression) sleeve when I exercise, etc.”
She’s given up air travel, but she’s still on the go on her terms: She drives, or in the case of a cross-country
business trip, takes a train.
“I guess I would love to know — now, three years later — if those restrictions on travel have changed? And
am I being too overkill on this or not?”
The risk has not gone away.
“Lymphedema can flair up on airplanes, so the National Lymphedema Network has some precautions,” said
Deb Bisel, oncology nurse and manager of Cancer Program Compliance for Spectrum Health Cancer
Services.
“There are many considerations (about traveling and cancer),” Bisel wrote in an email. “We have a fair
amount of people who winter in warmer climates, and have part of their treatment here and part elsewhere.
Due to our electronic environment, it is becoming easier for physicians to communicate and set up treatment
plans.
“If (a patient is) under active treatment, there should be some pre-planning to know where the hospitals and
local resources are for your destination.
“I’ve personally contacted an oncology nurse in the area where a patient is traveling, if I have concerns that
they could get in trouble while away. The patient then has a local contact number to seek help or advice for
an unplanned side effect, for example.”
Advice which takes on extra significance for those of us who have experienced blood clots: On long flights,
wear compression hose. I just traded up to full foot-to-knee compression socks by Zensa.
Sue Schroder, former features editor for The Grand Rapids Press, was diagnosed with non-Hodgkin’s
lymphoma in late 2009. Email her at livenow.ss@gmail.com.
September 25, 2011
Cancer survivor joins CIBC Run for the Cure - Calgary Herald –
CALGARY — Active, healthy and a hard-working career woman in her late 40s, Diane Martin had always
avoided mammograms, figuring she was too young to worry about breast cancer.
In May 2000, her doctor finally convinced her to go for a routine ultrasound as part of her annual physical,
which revealed swollen lymph nodes under her arm, near her left breast.
A biopsy soon after confirmed stage 3 breast cancer, and Martin’s breath was taken away.
“I remember my doctor came into the room and sat down, pulling her chair very close to me,” she said.
“I knew something was up. But you can never prepare yourself.
“When she said the two words ‘breast cancer,’ I lost my breath. I didn’t hear much of anything else she said
after that.”
About two months before her diagnosis, Martin had lost her own father to lung cancer. He died just two
weeks after checking into the hospital, worried about pneumonia-like symptoms.
“I thought I would end up the same. I thought, that’s it, I have two weeks left to live. What am I going to
do?”
But the next few weeks brought on what Martin likes to call her “warrior face” and she took her battle head
on, realizing she had too much to live for.
“I thought, ‘I want to live, I want to meet more people. And I want people to meet me, because I’m a pretty
special person,’” she said.
A lumpectomy, followed by six weeks of chemotherapy and one month of radiation left her exhausted,
shaken and plagued by constant nausea.
But a life once devoted to career, collecting money and material wealth, changed completely for Martin.
She still remembers one night during her recovery “I was sitting outside one summer night. It was 4 a.m. and
I couldn’t sleep. I looked around at the trees and the flowers and I thought, ‘have these always been here?
Because I’d never really noticed them before.’”
She quickly became involved in volunteer work, the CIBC Run for the Cure, and helping other women
battling breast cancer.
But her difficult road wasn’t over.
A year later, a small cut on her left hand led to massive, painful swelling all along her left arm.
Because lymph nodes had been damaged during her surgery, lymphatic fluid was building up as it reacted to
infection in her hand.
It wasn’t cancer, but a case of lymphedema few doctors were able to help her with.
After hundreds of phone calls, Martin was able to finally find a lymphedema therapist that was able to
massage the fluid out of her arm and into the rest of her body.
Although the ailment is typical in breast cancer survivors, help is hard to find. So Martin and her therapist
created the Alberta Lymphedema Association to provide support for sufferers and better education and
awareness within the medical community.
Over the next several years, Martin continued her volunteer work and also helped her sister battle kidney
cancer.
But, by 2007, Martin found another lump near her left breast as she lathered up in the shower.
It was only days before her annual check up.
A mammogram, followed up by another biopsy confirmed, again, stage 3 cancer.
And while Martin, “warrior-face” on was ready to fight once more, it was her husband Doug, that found the
news really hard to take.
“I could tell it was really hurting him this time.”
Her second bout of chemotherapy was much more difficult than the first, forcing her to lay in bed for up to
eight hours at a time, connected to an IV, being fed an even harsher concoction this time.“The pain was like
my bones were being squeezed together, three or four days at a time,” she said. “It was terrible. Every time
I came back for the next round, I knew how bad it was going to be.”
After her final round in late 2007, Martin found yet another lump in the same area and was sent straight to
surgery.
But this time doctors confirmed it was benign.
The good news and her clean bill of health since has Martin now working as co-run director for the CIBC
Run for the Cure for the Prairies and NWT region.
Up to 5,300 runners are already registered for this year’s run, eager to beat last year’s fundraising total of
$1.7 million.
Martin looks forward will be run alongside other survivors like her, ready to lend a helping hand, and a
supportive ear.
“When you go you have to just stop and look around. It’s a sea of pink,” she said. “And everyone is there
to support each other.
“It’s a wonderful feeling.”
September 24, 2011
Lymfactin™ Found To Significantly Increase Growth Of Lymphatic Vessels In Animal Study –
Laurantis Pharma, a privately held biotechnology company based in Finland, announced that LymfactinTM,
adenoviral VEGF-C growth factor therapy, was successful in rebuilding lymphatic vessels in pre-clinical
animal models. The use of VEGF-C growth therapy to regenerate lymphatic vessels over time may be used
to assist lymph node transfer surgery as a technique to treat secondary lymphedema.
The results were presented at the 23rd International Congress of Lymphology in Malmö, Sweden by Kari
Alitalo, MD, PhD, Academy Professor, Molecular Cancer Biology Program Biomedicum Helsinki,
University of Helsinki, and Anne Saaristo, MD, PhD, Consultant Plastic Surgeon, Turku University Central
Hospital, Turku, Finland. The researchers were able to demonstrate VEGF-C's ability to induce the
spontaneous growth of lymphatic vessels during the first two weeks of treatment, which then stabilized and
matured over the course of the next six months.
The ability of VEGF-C to regulate the growth of lymphatic vessels presents an advantage for the use of
lymph node transfer as a way of treating lymphedema. Currently lymph node transfer is being tested as a
way to rebuild the lymphatic vascular anatomy but no treatment currently helps to assist the spontaneous
growth of lymphatic vessels.
"Breast cancer patients have an urgent need for better treatments for lymphedma," said Dr. Saaristo. "With
Lymfactin, we see the potential to increase the impact of the operation and reduce the amount of lymphoid
tissue that needs to be removed from other parts of the body. Ideally Lymfactin will result in more durable
lymph node transplants, reducing the need for painful pressure bandages."
Lymphedema
Lymphedema, localized swelling due to fluid accumulation, is caused by the disruption in the flow of
lymphatic fluid, usually associated with the removal of lymph nodes as treatment for breast cancer. About 20
to 30 percent of patients who have had lymph nodes removed as a part of treatment for breast cancer will
develop chronic lymphedema. Currently, there is no cure for the condition, and treatments are limited in their
ability to reduce swelling and reduce the risk of infection
September 26, 2011
Lymphedema Depot Fundraising for Lymphedema Association of Ontario - Wire Service Canada –
It’s that time of year again! It's time for Team Niagara to put on their walking shoes to support the
Lymphedema Association of Ontario in their annual fundraising 5K walk/run.
On October 16, 2011, Lymphedema Depot and Team Niagara will be participating in a local fundraising
event. This local event in St. Catharines, Ontario, is a satellite event to the annual Scotiabank Toronto
Waterfront 5k Run/Walk.
Lymphedema Depot will be raising funds for The Lymphedema Association of Ontario (LAO) as we take a
5K walk (you can run if you like) along the scenic Welland Canal in St. Catharines, Ontario.
The work of the LAO supports the lymphedema community in Ontario and beyond.
According to John Mulligan, a registered massage therapist and certified lymphedema therapist, and Clinical
Specialist with Lymphedema Depot, "The LAO gives a voice to lymphedema patients and connects them
with therapists, goods and services and, most importantly, connects them with one another. The LAO has
been putting on conferences and publishing a newsletter for 15 years now, and they need our support to
continue.The LAO gives a voice to lymphedema patients and connects them with therapists, goods and
services and, most importantly, connects them with one another. The LAO has been putting on conferences
and publishing a newsletter for 15 years now, and they need our support to continue."
"Not only does the LAO support lymphedema patients and therapists but their work crosses over into
helping patients with lipedema, venous insufficiency and other related conditions. Not only do they support
lymphedema patients and therapists but their work crosses over into helping patients with lipedema, venous
insufficiency and other related conditions."
Mulligan states, "If you are in the Niagara region and you would like to come out on October 16 and join
Team Lymphedema Niagara in this awareness and fundraising event for the Lymphedema Association of
Ontario, the Team would love to hear from you!"
Contact team captain, John Mulligan
at John@LymphedemaTherapist.com or (905) 687-1828.
If you can’t make it, please consider making a donation online in support of the LAO using the link provided
here:
http://my.e2rm.com/TeamPage.aspx?teamID=259759&langPref=en-CA.
You can learn more about the Lymphedema Association of Ontario here:
http://www.torontowaterfrontmarathon.com/en/charity/lao.htm.
"I can’t overstate the importance of the Lymphedema Association of Ontario and the work they do, and
have done for the past 15 years," Mulligan continued. "Through their persistent efforts they have made the
general public and the medical profession more aware of lymphedema."
"No donation is too small and every dollar helps this wonderful non-profit organization to accomplish their
important objectives. Any donation cheque must be made out to the Lymphedema Association of Ontario,
or simply LAO."
All pledges will receive an official tax receipt.
September 27, 2011
Cancer Patient Carrying Out Voluntary Work to Help Other Patients - French Tribune –
Most of the women do not go for mammograms and end up with cancer diagnosed at advanced stages, this
is what happened with Diane Martin who did not underwent mammograms thinking that it was too early to
get the check-up done.
But finally in 2000, she underwent ultrasound where swollen lymph nodes under her arm besides her breast
were discovered, which was later identified as stage-three breast cancer.
Her doctor had many a times asked her to go for the check-up but she delayed the issue which resulted in
breast cancer at advanced stage. If she would not have been thinking much, she would have got her cancer
detected timely. Similar is the case with lot of women who due to some reasons do not consider it as
necessary and end up in screwing up their lives.
After undergoing treatment, she is now working as volunteer at the Canadian Breast Cancer Foundation
CIBC Run for Cure and has been providing help to women in need.
Even after the surgery, lymphatic fluid was building up in her arm, so she finally found a lymphedema
therapist who helped her take the fluid out.
Now, she and her therapists have joined hands with Alberta Lymphedema Association that make the
women aware about the early diagnosis and help them in related problems.
inful surgery to remove the lymph nodes is not necessary for some women – Ocala – By Molly Larmie -
For more than 100 years, standard treatment for breast cancer has included a painful surgery: the removal of
lymph nodes under the armpit. But a new study finds that for 20 percent of invasive breast cancer patients
— around 40,000 women in the U.S. each year — radiation and chemotherapy treat the cancer just as
effectively as removing the nodes.
The study, conducted by the American College of Surgeons Oncology Group, throws the traditional view of
breast cancer treatment "out the window," said Dr. Uma Swamy, a radiation oncologist at North Florida
Regional Medical Center.
Once breast cancer reaches the lymph nodes, it has the potential to spread to other vital organs. If cancer is
detected in the armpit, wary surgeons typically remove about 10 nodes.
"The thought with cancer has usually been ‘Cut, cut, cut — take as much out as possible,'" Swamy said.
Painful complications can accompany node removal surgery, including infection, limitation of motion and
lymphedema, a chronic swelling in the arm. These side effects have long been considered necessary evils in
the successful treatment of breast cancer.
But the study, published in The Journal of the American Medical Association, finds there is no difference in
overall survival rate between women who had 10 or more lymph nodes removed and those who had only
one or two removed for testing.
The findings turn over a new leaf in the much-evolved history of breast cancer treatment.
Forty years ago, the standard of treatment for breast cancer was the Halsted radical mastectomy, in which
surgeons removed the whole breast and surrounding muscles. Lymph nodes in the armpit were removed in a
procedure called axillary lymph node dissection, or ALND.
Over time, as research shed new light on the disease, rates of mastectomy declined. Most breast cancer
patients today undergo a lumpectomy, in which doctors remove large tumors in the breast and treat
microscopic disease with radiation and chemotherapy.
A technique called sentinel lymph node dissection, or SLND, is commonly used to detect cancer in the
lymph nodes. Using SLND, physicians inject dye into the breast and observe the path the dye takes to the
lymph nodes. If cancer has spread from the breast to the lymph nodes, this is the route it would have taken.
The illuminated or "sentinel" lymph nodes are removed and tested for cancer. If the nodes test negative, the
patient will not require further surgery in the armpit. If a positive result comes back, surgeons usually remove
eight to 10 additional nodes.
After armpit surgery, some women experience numbness, limited range of motion or lymphedema, a painful
swelling in the arm that occurs when scar tissue blocks the flow of fluid. Radiation increases the risk for
lymphedema, which has no cure.
The lead author of the study, Dr. Armando Giuliano, and his team worried that physicians were ordering
painful surgeries for patients with no proof that removing the lymph nodes actually increases the chance of
survival.
With funding from The National Cancer Institute, the researchers enrolled 891 patients at 115 medical
centers into the study. All patients had early invasive breast cancer with tumors less than 2 inches across and
no more than two cancerous sentinel lymph nodes.
After undergoing lumpectomies and whole-breast radiation, the women were randomly assigned to either
undergo ALND, with 10 or more lymph nodes taken out, or no further surgery.
The reduced risk of complications could help sway their decision. With radiation and SLND alone, patients
have a less than 5 percent risk of lymphedema, Swamy said.
"As a patient, you must be careful and talk to your physicians to make sure the study applies to you,"
Swamy said. "And it is the physician's responsibility to make sure patients understand as much as they need
to make an informed decision."
Marshall Browning & SIH Reach Affiliation Agreement - Du Quoin Evening Call –
Du Quoin, Ill. —
Marshall Browning Hospital (MBH) in Du Quoin and Southern Illinois Healthcare (SIH) in Carbondale
today announced a formal affiliation between the two facilities.
Under the affiliation, patients of Marshall Browning Hospital will continue to receive high-quality care from
the providers they know and trust at the hospital they have long relied upon. MBH will remain as a separate
entity with its own Board of Directors, identity and endowment.
"Marshall Browning Hospital is pleased to partner with a highly regarded organization such as SIH to
enhance services for the residents of Perry County through outreach, development and clinical integration,"
says William Huff, CEO, Marshall Browning Hospital. Huff emphasized that “this is not a merger or
acquisition and that Marshall Browning Hospital would retain its own identity. The affiliation will provide a
rich spectrum of educational, administrative, and clinical opportunities in the healthcare professions, meet
community needs for high quality, cost-effective healthcare and develop new regional linkages among
healthcare providers.”
A significant benefit of the affiliation is for patients with complex medical needs who require tertiary care or
specialty services unavailable at MBH. The affiliation will offer better coordination of care and services
through such means as an expanded pool of consulting subspecialists. In addition, SIH will work closely with
the hospital to identify opportunities to enhance the services available at MBH.
"The Marshall Browning Hospital Board took extensive steps to consider the affiliation prior to formal
adoption and feels confident that the alignment is proper and in the best interest of the hospital and the
patients it serves," stated Harold Rice, President of the Marshall Browning Hospital Board. William Huff,
CEO, added that a key benefit of the affiliation is allowing the hospital to remain a local facility with "local
citizens serving on the Board to work to provide services for the citizens in its service area."
The affiliation builds on and expands the various collaborations that already exist between SIH and MBH
such as its partnership with SIH and Prairie Cardiovascular through its Prairie STATHeart program.
STATHeart identifies, treats, and transfers acute heart attack patients to a cardiac cath lab within 90 minutes
of arriving in Marshall Browning Hospital’s emergency room. The STATHeart program melds cooperation
and collaboration between the community hospital emergency department, EMS ground and air transport,
Memorial Hospital of Carbondale and cardiologists of Prairie Cardiovascular.
In addition, SIH physicians have long consulted at MBH, seeing patients in such specialties as cardiology,
oncology/hematology, and pulmonology.
“The affiliation is not meant to be disruptive of pre-existing clinical relationships or referral patterns. Rather
we want to work closely with the hospital to identify gaps in care and determine how SIH can help fill in
those gaps as well as reinforce or add services that will be helpful to Perry County” said SIH President and
CEO Rex Budde.
Marshall Browning Hospital is a not-for-profit Critical Access Hospital providing a broad range of services
to citizens of Perry County and the surrounding communities. Founded in 1919, the 25-bed hospital
maintains a deep tradition of providing high-quality care to a service area of over 20,000.
The hospital also includes Marshall Browning Therapy Center, located on the hospital campus. Services
offered at the center include Physical Therapy, Occupational Therapy, Speech Therapy, Athletic Training,
ImPACT Concussion Testing, Aquatic Therapy, Lymphedema Therapy, Vestibular Therapy, Hand
Therapy, Pediatrics and Hippotherapy. Marshall Browning Therapy Center also has become the only facility
in southern Illinois to have certified instructors to offer the highly acclaimed Sportsmetrics™ Training
Program, effective in reducing the risk of knee injuries in female athletes.
The campus also includes a 22-unit Independent Living Center and Marshall Browning Medical Clinic that
includes the practices of Dr. Gladstone Tucker, Dr. Terrence Hall, Dr. Beth Bigham, and Family Nurse
Practitioner, Felicia Kimbrough. Marshall Browning Hospital is fully accredited by The Joint Commission.
The hospital has in excess of 43,000 patient visits which include inpatient, outpatient and ER visits per year.
Southern Illinois Healthcare includes Memorial Hospital of Carbondale, Herrin Hospital, St. Joseph
Memorial Hospital, the SIH Cancer Institute and Miners Memorial Health Center.
Copyright 2011 Du Quoin Evening Call. Some rights reserved
September 28, 2011,
Life After Breast Cancer Can Be Difficult: Dr. Pearman - MyFox Chicago -
Chicago - More women than ever before are surviving breast cancer, but some still struggle to feel normal
and healthy after beating their disease. Dr. Timothy Pearman, a clinical psychologist and director of the
supportive oncology program at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer
Center, joined us.
Pearman said after battling breast cancer, woman may struggle with fatigue, cognitive problems (sometimes
known as chemobrain), nutrition, depression and side effects that may present themselves years after
treatment. Quality of life for breast cancer survivors, in particular, is often affected by lymphedema,
premature menopause and concerns about their risk of recurrence and libido.
A lot of these issues, which may be either disease related or treatment related, tend to revolve around
emotional support. Anywhere from 30 to 50 percent of patients will be clinically depressed or experience
clinical anxiety at some point during their treatment, Pearman said.
To make the transition to life after breast cancer easier, woman can take care of their mental and physical
health, Pearman said. Specialists like social workers, cancer rehabilitation therapists, nutritionists and health
educators can be a big help in helping women striving to live healthy lives after cancer.
The free Lynn Sage Breast Cancer Town Hall Meeting on Sunday, Oct. 2 is open to the public from 1 p.m.
until 4 p.m. in the Arthur Rubloff Building’s Thorne Auditorium, 375 East Chicago Avenue, on
Northwestern University’s Chicago Campus. Exhibits and registration start at noon.
Recovery Club: Pro-Level Training Tools for Weekend Warriors - Wired News – By Joe Lindsey -
I lean back in a chaise lounge while what look like the world’s largest blood pressure cuffs slowly inflate
around my legs. But this is no medical test: This is the future of active recovery for amateur athletes.
Professional athletes have for years had access to better training tools and techniques than us workaday
amateurs. They benefit from more sophisticated approaches because the price, complexity, or simple rarity
of many of these modalities puts them out of reach of the rest of us.
Josh Shadle hopes to change all that. A longtime massage therapist, Shadle earlier this year opened
AllSports Recovery Club, which he believes is the first open-to-the-public recovery center in the world.
And while his clientele includes pro athletes, he’s targeting amateurs, giving them access to the same tools as
elite competitors.
“I’ve been doing massage for five years,” he says, “and the next step, to me, was a walk-in recovery center
where people could go and use these tools themselves, without anyone having to do it for them.”
AllSports is focused on FDA-approved products that you can use without medical supervision. The suite of
tools runs a broad range, from cold lasers to a custom temperature-controlled ice bath that circulates
saltwater at a constant 50 degrees. One ingenious hack is a $25 Ryobi six-inch orbital buffer, perfect for
self-massage.
But the star of the show is clearly the NormaTec MVP boots, a compression therapy that Shadle likens to
an extremely effective massage. You can buy static compression clothing, but the research on its
effectiveness is mixed.
The NormaTec system, by contrast, uses dynamic sequential gradient compression, which is a fancy way of
saying it pressurizes five separate chambers in sequence; you can control intensity and duration to match
your needs.
Clinical research in sports recovery hasn’t caught up to use yet, but the system — invented for hospital
patients — has been shown effective in medical settings at counteracting lymphedema, the painful and
dangerous pooling of lymphatic fluid in tissues.
Dynamic compression’s action mechanism for sports recovery is unclear. It may help speed toxins and
promote circulation; it may enhance muscles’ thixotropic properties — their ability to become more flexible
when used.
Mesa State University’s Bill Sands, a physiologist who formerly ran the United States Olympic Training
Center’s recovery facility, says compression — particularly dynamic compression like the NormaTec
system — is one of the few recovery modalities he’s studied that show clinical promise for producing an
actual performance benefit.
Anecdotally, results are more emphatic. Mirinda Carfrae, the reigning Ironman World Triathlon Champion,
and an AllSports client, says that ice baths AND NormaTec boots are her top choices for post-workout
recovery.
So what’s to stop you from getting this stuff yourself? Well, a pair of boots is $5,000, for one. An ice bath
from iCool, one of the cheapest available, will set you back another $4,990 or more. Cold lasers are cheap
by comparison, starting around $300 for a basic model.
Shadle’s club offers unlimited walk-in access to all that for $60 a month, plus discounted à la carte services
like chiropractic, massage and Graston technique. “I’ve been to the USOC’s recovery room,” says
NormaTec vice-president Gilad Jacobs, “and what Josh has going is every bit as good as that.”
For a retail model, Shadle is less focused on the gym or yoga studio model and more on an icon from the
tech industry: Apple. “I envision it like the Genius Bar,” Shadle says. “You come in and tell us what
problems you’re having and we set you up with the tools and a recovery protocol to help. It’s free advice,
so that we can help educate people to get the kind of help they need to be healthy and improve their
performance.”
That’s great, I think, but I still have two questions.
First, do amateur athletes really need all that? After all, we don’t work out as hard as pros.
Sure, replies Shadle. “In fact, we think amateur athletes have more to gain here. Pros are already focused on
recovery and are looking at single-percent performance gains. But amateurs often don’t have time for
recovery workouts; when they work out they go hard every time. So muscles get tight from all that
metabolic waste, and it builds up and people never really recover. With amateurs, the room for improvement
is so much bigger.”
Second, right now the only location is in Boulder, Colorado, a town known for being packed wall-to-wall
with endurance athletes at 4 percent body fat. Will it play, as they say, in Peoria?
Shadle hopes so. He realizes not every city could support an AllSports, but that’s part of why the price is
set where it is. “This is the same price as a one-hour massage,” he points out, “but you can come here every
day if you like.”
And because everything is in one place, AllSports might be all you need. Carfrae has a set of NormaTec
boots at home, but comes in anyway, she says, because of what else AllSports offers. “I can go in for a
massage, do some Graston, or jump in the ice bath and use the boots,” she says of the range. “It’s a one-
stop shop.”
Carfrae defends her title on Oct. 8. You can bet Shadle will be watching closely.
September 28, 2011
Nomograms can predict 5-year lymphedema risk - Oncology Nurse Advisor –
Estimating the risk of lymphedema after axillary dissection for breast cancer is difficult, but a group of
researchers has used a large data set to develop graphical statistical tools known as nomograms to help
predict 5-year probability.
Jose L. Bevilacqua, MD, PhD, a surgical oncologist at Hospital Sírio-Libanês in São Paulo, Brazil, and
colleagues collected clinicopathologic features from a prospective cohort study of 1,054 women with
unilateral breast cancer. All subjects had undergone axillary dissection, between August 2001 and
November 2002, as part of their surgical treatment
The investigators determined the cumulative incidence of lymphedema and predicted the risk of developing
the condition based on the available data at each of three timepoints: preoperatively, within 6 months
postoperatively, and 6 months or more postoperatively. They defined lymphedema as a volume difference of
at least 200 mL between arms at 6 months or more after surgery.
As reported at the American Society of Clinical Oncology 2011 Breast Cancer Symposium, held
September 8-10, 2011, in San Francisco, California, Bevilacqua and associates found the 5-year cumulative
incidence of lymphedema to be 30.3% (www.asco.org/ASCOv2/Meetings/Abstracts?
&vmview=abst_detail_view&confID=111&abstractID=86647). Independent risk factors for the condition
were age, body mass index (BMI), ipsilateral arm chemotherapy infusions, level of axillary dissection,
location of radiotherapy field, development of postoperative seroma, infection, and early edema.
The predicted 5-year risks calculated by the nomograms were more than 70% accurate for all three
timepoints assessed—70.6% for the preoperative model, 72.9% for the within-6-months-postoperatively
model, and 73.6% for the 6-months-or-more-postoperatively model.
The investigators concluded that the proposed nomograms can help clinicians and patients predict the 5-year
probability of lymphedema after axillary dissection for breast cancer, knowledge that could identify patients
who may benefit from early intervention.
September 29, 2011
QH Medical Supply Joins G'Town Chamber – Memphis Daily News – By JOHN LINTNER
QH Medical Supply hasn’t moved to a new location, but the company will celebrate its membership into the
Germantown Chamber of Commerce with a ribbon-cutting ceremony Tuesday, Oct. 4.
That event will be followed by an open house at QH Medical Supply’s headquarters, 2965 N. Germantown
Road in Bartlett.
QH Medical is a durable medical equipment company specializing in mastectomy products and pain
management. It also carries a host of other items such as lymphedema sleeves, compression hose, adult
diapers and wheelchair cushions.
All employees are certified to fit mastectomy products such as bras and forms.
The company, which works directly with patients, providing them with much-needed supplies that are
ordered by a physician, also has a retail location.
“I have 25 years’ experience doing medical billing and medical software,” said Patricia Barnett, co-owner of
QH Medical Supply. “So, I’m a certified vendor – not QH – but I’m a certified vendor with Medicare as far
as medical software. (Co-owner) Jan (Freudenberg) and I both have been in the (durable medical
equipment) business with another company. We have extensive backgrounds in DME as well as medical
billing.”
The medical supply company now offers Freedom Alert, which is a two-way emergency pendant
communicator that allows wearers to call 911, family members or remotely answer incoming calls. It carries
no monthly maintenance fee.
QH is Medicare-accredited and carries most insurance. It is also a member of the Bartlett Chamber of
Commerce.
September 30, 2011
NJ med firm, office manager admit fraud charges - Houston Chronicle –
TRENTON, N.J. (AP) — State authorities say a southern New Jersey medical firm and its office manager
have admitted defrauding Medicaid and Medicare of $3 million.
Attorney General Paula Dow announced the guilty pleas Friday, one day after The Center for Lymphatic
Disorders, based in Egg Harbor Township, and 54-year-old Farah Iranipour Houtan appeared in state
Superior Court in Atlantic County. Houtan admitted that between 2004 and 2007, she billed the health care
programs for treatment that wasn't provided.
In a related matter, 45-year-old Khashayar Salartash of Linwood, a surgeon and company owner, agreed
Thursday to repay the $3 million as part of a separate consent agreement with the state.
The company treated patients with lymphedema, a disorder that causes fluid accumulation and swelling of
the arms and legs.
St. John's Cancer Center of Ventura County Offers Several Free Classes and Support Groups Each Month
- Ventura County Star -
St. John’s Cancer Center of Ventura County offers various free classes and support groups to help those
affected by cancer. For more information or to register for a class, please call (805) 988-2641.
The following classes are offered at St. John’s Cancer Center of Ventura County, located at 1700 North
Rose Avenue, Suite 145 in Oxnard, unless otherwise indicated:
Colorectal Cancer Support Group: second and fourth Thursdays of each month from 6 to 7:30 p.m. Co-
sponsored by the American Cancer Society. Facilitated by MaryAnna Palmer, MS, MFT from The
Wellness Community.
The Color of Love Group: first and third Thursdays of each month from 7 to 8:30 p.m. This group is
designed to allow cancer patients and their families to express themselves through art. Facilitated by local
artist Kathleen Hagen, who has over eight years of experience in leading this group.
Exercise is Wise—an After Breast Cancer Surgery Exercise Class: Wednesdays from 4 to 5 p.m. Classes
are held at St. John’s Outpatient Therapy Center, 961 N. Rice Avenue, #3, Oxnard.
Free Wigs, Hats and Scarves
Individual Bilingual Counseling for Patients and Caregivers: By appointment only. Call (805) 988-2641.
Kids with Relatives with Cancer Support Group: Tuesdays from 6:30 to 8 p.m. Facilitated by Diane Martell,
LMFT. Co-sponsored by The Wellness Community.
Latina Breast Cancer Support Group: first and third Thursdays of each month from 12 to 1 p.m. Facilitated
by Rosie Hernandez, MSW.
Latina Women’s Support Group: second and fourth Mondays of each month from 10 to 11:3-0 a.m. for
Latina women with any kind of cancer. Facilitated by Diane Martell, LMFT. Co-sponsored by The
Wellness Community.
Latino Cancer Support Group: fourth Thursday of each month from 6:30 to 8 p.m. for patients and family
members. Facilitated by Mario Cepeda, MA. Co-sponsored by The Wellness Community.
Latino Men’s Support Group: first and third Mondays of each month from 10 to 11:30 a.m. Facilitated by
Diane Martell, LMFT. Cosponsored by The Wellness Community.
Lymphedema Education and Screening Clinic: third Friday of each month from 2 to 3 p.m. Individual risk
assessments and valuable information for the prevention of chronic lymphedema will be provided by
Cassandra Norton, PT.
Nutrition Counseling: Thursdays from 9 a.m. to 3 p.m. Individual one-hour sessions with Susan J. Speer,
MS, RD, FADA, CSO a certified nutritionist specializing in diets for cancer patients that can help you eat
better and feel better. She can explain problems related to your individual condition and develop a dietary
plan to meet your special needs.
Prostate Cancer Support Group: third Tuesday of each month from 10 to 11:30 a.m. Facilitated by Helmut
K. Hoenigsberg, a volunteer with the American Cancer Society. Co-sponsored by the American Cancer
Society.
Relaxation Therapy in the Reiki Tradition: see the Cancer Center calendar for days and times. Practitioners
strategically place their hands on various positions of the body so Reiki Energy can begin to flow. Patients
often report they have less pain and nausea and are able to sleep better and think more clearly.
Reinhabiting You Yoga Classes: Gentle Yoga for Your Journey with Cancer—Thursdays from 1:45 to 3 p.
m.; Feeling Better and Stronger with Yoga—Thursdays from 3 to 4:30 p.m. Taught by Audrey Waltzer,
owner and director of the Camarillo Yoga Center.
Women with Cancer Support Group: Tuesdays from 1 to 2:30 p.m. Facilitated by Joyce Boucher, LCSW,
MFT. Co-sponsored by The Wellness Community.
October 1, 2011
Occupational Therapist - Minot Daily News –
MEDICAL HELP WANTED
OCCUPATIONAL THERAPIST
Full-time position. Mon.- Fri. day shift with some weekend coverage required. Job duties include but not
limited to: Orthopaedics, Vestibular, Incontinence, Fibromyalgia, Lymphedema, Pool Therapy, Skilled,
Home Health and Care Center. Occupational Therapy License required. Sign-on bonus and paid CEU's.
HOSPITAL PHARMACIST
Full-time position. Mon.- Fri. 9:00 a.m. - 5:30 p.m. but will require flexibility. Job will primarily be in the
hospital pharmacy at both Wright Medical Center and Belmond Medical Center and will float as needed in
the retail pharmacy at Wright Medical Center. Position will be required to be on a call rotation and work
every fourth Saturday morning. Hospital pharmacy experience preferred.
Positions offer outstanding wages & fringe benefits. Please stop by and pick up an application, apply on-line
at www.wrightmed.com or contact the Human Resouces Department at 515-602 9801 to receive an
application by mail. All positions are subject to criminal/department adult abuse background checks, pre-
employment physical and drug testing.
WRIGHT MEDICAL CENTER
1316 S. MAIN STREET
CLARION, IA 50525
Wright Medical CENTER
Breast cancer 'not a death sentence' - Taunton Daily Gazette – By Deborah Allard –
FALL RIVER —
In the waiting room of Charlton Memorial Hospital’s Southcoast Center for Cancer Care, Juanita
Thompson sang softly to a tune that she alone could hear from her iPod.
Thompson, a breast cancer survivor, had a mastectomy about a year ago and several rounds of
chemotherapy. Despite losing her hair and a breast, the spiritual woman has found a renewed sense of joy.
“I’ve come out of this with a brand new mind, body and spirit,” Thompson said. “It’s really not a death
sentence. It’s made me think about life and make every minute of it count.”
Thompson, like most who suffer from breast cancer, has gone on to live a long and healthy life — a far cry
from what women endured not so many years ago when little was known about breast cancer.
Today, there are some 50 forms of chemotherapy, hormonal agents and targeted therapies that work
together to kill breast cancer cells, not to mention surgical options, radiation therapy and clinical trials,
according to materials from Saint Anne’s Hospital’s Regional Cancer Care center.
Susan O’Brien, an oncology nurse practitioner at Saint Anne’s Hospital, said breast cancer has become
more chronic than fatal.
“Once a woman is diagnosed, it’s a journey that she undertakes,” O’Brien said. “It’s so wonderful that these
women with breast cancer are living so long.”
O’Brien said breast cancer survival rates have been incredibly improved even since she started at Saint
Anne’s Hospital 25 years ago. Because of advances made in drugs and in education, more women are
diagnosed with curable Stage I and II cancers, rather than at more advanced stages.
The five-year survival rates for Stage I and II breast cancer now ranges from 74 to 88 percent, according to
the American Cancer Society. The survival rates for stage III and IV breast cancer are as high as 67 percent.
Until the 1960s — and later, in some cases — survival rates were very low, and the disease often resulted in
death. People thought breast cancer was embarrassing, and it was a hushed topic that often resulted in a
late, if any, diagnosis.
Dr. William Stewart Halsted is credited with being one of the fathers of modern American surgery at Johns
Hopkins University Hospital in the late 1800s. He developed the radical mastectomy, which consisted of
removing the entire breast, the underlying chest wall muscles and all lymph nodes in the armpit, according to
the National Surgical Adjuvant Breast and Bowel Project.
The deforming operation resulted in a concave appearance, O’Brien explained. Women who underwent the
procedure often sought to wear a heavy prosthetic breast afterward.
This procedure was the standard breast cancer surgery for decades, until brothers Drs. Bernard and Edwin
Fisher challenged the radical mastectomy in the 1960s.
Today, doctors know that mastectomy has the same end result as lumpectomy plus radiation for most
women. Those undergoing mastectomy do not lose as much tissue as in decades past.
Until 25 years ago, women also underwent 14 cycles of chemotherapy lasting for 14 months, as opposed to
today’s roughly four months of chemotherapy.
“I never thought I would die,” said Margaret McCaffrey, who had breast cancer in 1995. Now retired, she
is a greeter at the Hudner Oncology Center at Saint Anne’s Hospital.
Because most women live with breast cancer, there is a whole new population of women in follow-up care
for years after their surgery or treatments. For them, living with breast cancer is the new normal.
For Thompson, follow-up care has included doctor’s visits every three months and monthly blood work.
Breast cancer can also result in complications. Thompson experienced lymphedema in her arm, a swelling of
the tissue, due to the surgery.
O’Brien said there are many “immediate and long-term effects.”
Besides lymphedema, patients can suffer from cognitive difficulties, low energy and depression. They may
also suffer effects to the heart and lungs, or go into early menopause, which can lead to osteoporosis.
Follow-up care generally consists of following any side effects, and includes hormone therapy for some.
Support groups, yoga, meditation and spiritual retreats are also part of what is offered at local hospitals.
Thompson attends a monthly support group where she is free to talk about her experience with breast
cancer and other topics.
“I love it,” Thompson said. “Talking about it helps other women through it. We lift each other up.”
Thompson plans to have reconstructive surgery in the near future, and is also planning on getting gastric
bypass surgery to lose weight. Now 51, she has begun computer programming classes at Bristol Community
College, something the mother of five has wanted to do for decades.
“I want to live,” Thompson said. “I want to enjoy the rest of my life. I feel wonderful.”
Healthy Living: TruJoy promotes breast cancer education – YNN – by Web Staff -
If you were told your chance of getting cancer was 90% - what would do? How would you change your
life? Marcie Fraser shares one woman's inspirational story.
When Trudie Kelly's mom lost the battle from both ovarian cancer and breast cancer, genetically, she knew
the odds were against her.
"I carry the genetic mutation. I decided at that point and time to have a complete hysterectomy so that would
alleviate the ovarian risk," said Trudie Kelly, TruJoy Founder.
Two years after her hysterectomy, she found a cancerous tumor in her left breast. Trudie decided to have a
double mastectomy.
"I ended up had a routine MRI before the surgery and found I had it in my right side also that didn't show up
in the mammogram," said Trudie.
It's been a year after surgery and treatment, her prognosis is excellent. After experiencing cancer, Trudie
Kelly was on a mission.
"Once you have been through it, I knew what was missing, I knew the pieces that were missing for women
and that is what I wanted to address," said Trudie.
She created TruJoy.Inc, an organization to hold breast cancer educational forums, support, and a tool kit for
comfort.
"We have included a reacher, a mastectomy pillow, a stress ball to alleviate any kind of swelling that may
lead to lymphedema down the road," said Trudie.
One of TruJoy’s objectives is community education, targeting young women and teaching them about the
risk factors for breast cancer.
In an effort to raise money for the tool kits and the education forums, a motorcycle poker run is being held.
For more information, visit www.trujoy.org.
September 4, 2011 –
Gene Defect Predisposes People to Leukemia - Science Daily –
A new genetic defect that predisposes people to acute myeloid leukemia and myelodysplasia has been
discovered. The mutations were found in the GATA2 gene. Among its several regulatory roles, the gene acts
as a master control during the transition of primitive blood-forming cells into white blood cells.
The researchers started by studying four unrelated families who, over generations, have had several relatives
with acute myeloid leukemia, a type of blood cancer. Their disease onset occurred from the teens to the
early 40s. The course was rapid.
The findings will be reported Sept. 4 in Nature Genetics. The results come from an international
collaboration of scientists and the participation of families from Australia, Canada, and the United States.
In collaboration with Dr. Hamish Scott and Dr. Richard J. D'Andrea at the Centre for Cancer Biology,
University of Australia, Adelaide, the U.S. portion of the study was conducted by Dr. Marshall Horwitz,
University of Washington (UW) professor of pathology. Horwitz practices genetic medicine at UW Medical
Center and the UW Center for Human Development and Disability, both in Seattle.
The genetic mutation was first discovered in a patient from central Washington. The research participant had
been successfully treated for leukemia in 1992 through a bone marrow transplant at UW Medical Center. At
that time, Horwitz decided to seek a possible genetic reason after learning his patient had several family
members with myelodysplastic syndrome, myeloid leukemia, and intractable mycobacteria infections.
Myelodysplastic syndrome is a difficulty in producing certain kinds of blood cells. The problem originates in
the bone marrow with a decline in the number and quality of blood-forming cells. Patients often have severe
anemia and need frequent blood transfusions. The disease generally worsens due to bone marrow failure and
low blood counts. About one- third of those with the syndrome soon develop acute myeloid leukemia, in
which abnormal white cells build up in the bone marrow and interfere with normal blood production.
Horwitz's Australian colleagues had described a family with a similarly inherited blood disorder. Eighteen
years later, after rifling through many candidate genes, the researchers on both continents were relieved
finally to have hit upon the mutated gene responsible for the leukemia that affect these families. They have
gone on to identify abnormal GATA2 genes in more than 20 families and individuals.
"It's likely that this inherited error is more common than we had thought," the researchers noted. In some
families with a GATA2 mutation, the over-riding concern has been leukemia, while others suffer dangerous
infections from bacteria, viruses and fungi because of a lack of white blood cells to fight off germs.
The lab of Dr. Dennis Hickstein, formerly of the UW School of Medicine and the Puget Sound Veterans
Affairs Health System and now at the National Institute of Health, in collaboration with NIH colleague Dr.
Steven Holland, associated the mutation with mycobacteria infections. Those results were reported in
separate study appearing in the journal Blood.
Activcare Physical Therapy Announces Executive Drive Office Grand Opening On September 12 -
dBusinessNews Triangle –
Triangle - Activcare Physical Therapy, Raleigh NC’s premiere physical therapy practice, has expanded
operations to serve the community around Duke Raleigh Hospital with the opening of a new clinic on
Executive Drive.
RALEIGH, NC: Brad Hancock, MPT, of Activcare Physical Therapy, is pleased to announce the opening
of their newest clinic at 3410 Executive Drive, Suite 205 in Raleigh, adjacent to Duke Raleigh Hospital,
formerly Raleigh Community Hospital. Opening day will be celebrated at the new clinic on Monday,
September 12 with lunch from 11:30am to 2:00pm and wine and cheese at 5:00pm.
Visitors will be able to tour the new facilities as well as meet the knowledgeable and experienced therapists
at this state-of-the-art clinic. Services offered at this facility include: orthopedic therapy, sports related
injuries, neck and back pain and injuries, pain management, neurological rehabilitation, geriatrics, oncology-
related and lymphedema therapy and cardiovascular conditioning therapy, as well as balance and vestibular
dysfunctions.
“It is our mission to not only provide the highest quality physical therapy services, but to provide a friendly
and supportive atmosphere to our patients,” said Hancock. “This patient-centric approach helps ensure that
patients will reach their goals through continued treatment, and it is the key to our continued growth in the
Triangle market.”
For more information about Activcare Physical Therapy, visit www.activcarept.com or call 919-786-7434.
About Activcare Physical Therapy
Activcare Physical Therapy, with convenient locations in Raleigh and Fayetteville, NC provides physical
therapy services with a strong emphasis on orthopedic injuries, geriatrics, women’s health, neurological,
incontinence, general conditioning/cardiovascular, balance and vestibular disorders, foot and ankle
biomechanics, spine treatments including cervical decompression therapy and oncology-related and
lymphedema therapies. Our quality therapy services provide continuity of health services and positively
influence their patient outcomes. Activcare provides patients from all walks of life with world-class,
comprehensive physical and occupational therapy services that improve function, encourage independence,
and enhance quality of life. For more information, visit www.activcarept.com or call 919-786-7434.
Media Contact:
Charlie Caserta
Activcare Physical Therapy
ccaserta@activcarept.com
919-786-7434
www.activcarept.com
September 5, 2011
Swollen ankles have several possible causes - The Detroit News – Dr. Paul Donohue –
Dear Dr. Donohue: I am a diabetic male, age 96, with many aches and pains but no high blood pressure. I
have low cholesterol and am in control of my diabetes. In the past few weeks, I've noticed swelling of my
ankles and feet. I have been taking two water pills a day for it. I never use salt or eat salty foods. What can
you suggest for me?
Dear S.S.: That swelling is edema, and it has many causes. One is sitting for long periods with the legs
dangling down. With the legs in that position, gravity pulls fluid from the legs' blood vessels. Treatment for
this kind of edema consists in elevating the legs. Every hour, lie down for 10 minutes with pillows under your
legs and feet so that they are above heart level. When sitting, squeeze the leg muscles over and over. Muscle
contractions stop the oozing of fluids from the blood vessels. And take a morning and afternoon walk.
Elastic hose can keep fluid in blood vessels and out of the surrounding tissues.
Dilated leg veins — varicose veins — promote edema. A clot in a leg vein is another cause. That's usually
quite painful, and you'd be aware that something is going on if you had a clot. Liver ailments can lead to
edema. The liver makes a blood protein, albumin, that keeps fluid in circulation. With a low production of
this protein, fluid leaks out of vessels. Kidney failure is another reason why edema occurs. Medicines can
lead to it.
The booklet on edema and lymphedema explains this kind of swelling. Readers can obtain a copy by writing:
Dr. Donohue — No. 106, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no
cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address.
Write to Dr. Donohue at P.O. Box 536475, Orlando, FL 32853-6475.
Another paper appearing Sept. 4 in Nature Genetics from a London group found similar mutations of
GATA2 in leukemia patients with lymphedema and, in some cases, deafnesss. By blocking the vessels that
drain fluid from the body's tissues, lympedema causes swelling of the arms or legs.
Ongoing work in Seattle and Adelaide has identified a congenital syndrome associated with developmental
delay and a risk of myelodysplasia. This syndrome results from chromosomal loss of GATA2 and adjacent
genes.
Comparable GATA2 mutations also have been found in people with the more common, non-inherited
leukemias.
Scientists are trying to figure out why apparently similar gene mutations in GATA 2 cause such assorted
health problems. Also perplexing is how hard it has been to find genetic errors underlying blood cancers,
compared with other cancers.
"While several genes have been discovered and linked to solid, malignant tumors such as breast cancer in
families susceptible to those types of cancer, so far very few inherited mutations have been uncovered for
blood cancers," Horwitz said.
Previously, other scientists linked mutations in two other genes -- RUNX1 and CEBPA -- to injerited forms
of myelodysplastic syndrome and acute myeloid leukemia. These genes bind to DNA and control the
copying of information encoded in this molecule.
Keeping this in mind, researchers looked for mutations in similar genes in families who did not have the
RUNX1 and CEBPA mutations and who had no other explanations for their inherited blood cancer. In so
doing, the researchers identified the GATA2 mutations. They also observed that these mutations relate to
loss of function by making the gene unable to perform the molecular duties necessary to manufacture healthy
white blood cells.
According to Horwitz, the GATA2 mutations in DNA occur adjacent to an amino acid mutated in some
patients with terminal chronic myeloid leukemia. This proximity suggests a common pathway may be critical
for several types of myeloid malignancies, he said.
People at risk because of their pedigree eventually may obtain tests to detect this genetic error before
symptoms emerge. Learning that they have the gene mutation might help patients and their doctors decide on
appropriate follow-up for early diagnosis and treatment of problems that might arise.
Additional knowledge about how the GATA2 gene and its mutations operate may foster the development of
new therapeutic agents.
A clinical trial under way in the United States may point to specific treatment recommendations for persons
with a GATA2 genetic mutation.
The research for "Heritable GATA2 Mutations Associated with Familial Myelodysplastic Syndrome and
Acute Myeloid Leukemia," was supported by grants from the National Health and Medical Research
Council of Australia, a Dora Lush Postgraduate Award, Leukaemia Foundation of Australia, the Cancer
Council of South Australia, MedVet Pty Ltd., and the U.S. National Institutes of Health.
The researchers extend their gratitude to the families and individuals who participated in this project.
Horwitz has been invited to speak on the role of GATA2 in myelodysplastic syndromes at a National
Institutes of Health conference Sept. 7-8 in Bethesda, Md.
September 15, 2011
National Walk For Lymphedema And Lymphatic Diseases – Garden City News –
As Executive Director of the Lymphatic Research Foundation, Garden City resident Jacqueline Reinhard
coordinated the organization’s first walkathon last September at Belmont Lake State Park. “It was a
resounding success,” says Reinhard, “and the idea has clearly caught on with lymphatic disease patients
around the country. In the coming weeks the National Walk for Lymphedema and Lymphatic Diseases will
take place in Texas, New York, and Massachusetts!”
Founded in 1998 by Roslyn resident Wendy Chaite, LRF has become a leader in patient advocacy and a
primary force behind advancements in lymphatic science worldwide. LRF’s advocacy programs have been
effective in gaining Congressional and National Institutes of Health (NIH) support for lymphatic research at
the National Institutes of Health and at major academic research centers, elevating lymphatic diseases from
relative obscurity to a position on par with other national health priorities. The organization directly funds
cutting-edge lymphatic research by funding Postdoctoral Research Fellowship Grants, a National Lymphatic
Disease Patient Registry and Tissue Bank, a peer-review biomedical journal in lymphatics, and the first-ever
endowed academic Professorship in Lymphatic Research and Medicine (Stanford University Medical
School, 2008). Reinhard became the Foundation’s first executive director in July 2008.
The New York Walk will be at Eisenhower Park in East Meadow on September 24th. Registration begins
at 1:00 p.m. “I’m inviting all our Garden City neighbors to join this effort, said Reinhard, “ . . . and promising
a fun afternoon of live entertainment, refreshments, and the great feeling you get in supporting an important
and meaningful cause.” To learn more about the Walk, to register or donate, go to www.walklrf.org.
The Skin IQ™ Mattress Cover Does More to Lower Costs of Pressure Ulcers - Online PR News (press
release) –
With the current economic climate, hospitals and long-term care facilities are looking to find innovative ways
to cut costs. Vascular PRN™ provides compression therapy equipment to treat ulcers, deep vein
thrombosis, and lymphedema, so they uniquely know the pressures that nurses, hospital directors, and
nursing home administrators are under to save money.
Online PR News – 15-September-2011 –With the current economic climate, hospitals and long-term care
facilities are looking to find innovative ways to cut costs. It is not every day that new products make their
way into a patient’s room that cut down health care costs, workload, and the cost of medical treatment.
“We were floored when we found the Skin IQ™ Microclimate Manager,” said Vascular PRN’s president
Greg Grambor. “This KCI coverlet costs $6 a day versus low air loss mattresses that usually cost our clients
$30 a day.”
Vascular PRN™ provides compression therapy equipment to treat ulcers, deep vein thrombosis, and
lymphedema, so they uniquely know the pressures that nurses, hospital directors, and nursing home
administrators are under to save money. Every day they help specialists in long-term and critical care centers
to find the right products at the best value.
“Pressure ulcers are a major cost and cause more treatment, regulatory fines, and the potential for a lawsuit
in health care settings every day,” said Grambor. “For KCI to address this big need is huge to prevent and
manage a patient’s skin breakdown and pressure ulcers.”
The National Pressure Ulcer Advisory Panel says that, “Support surfaces are an integral part of any plan of
care for the prevention and treatment of pressure ulcers.” The Skin IQ™ waterproof mattress cover
promotes healing and addresses the variety of challenges an immobile person has. It reduces moisture from
the skin’s surface, reduces skin temperature while maintaining a patient’s comfort, and has powerful odor
control features. KCI’s case studies show that patients with stool incontinence, skin breakdown, bariatric
concerns, and associated issues can greatly benefit from using the Skin IQ™ within days or a few weeks.
“The Skin IQ™ is 30 percent better than the average healthcare facility mattress cover,” said Grambor. “It
is easy to use and fits over any pressure re-distribution mattress.”
The Skin IQ™ pulls air down through the mattress cover and cools a patient’s contact points while pulling
moisture away. This is more effective than low air loss, which blows warmed room air up through the
mattress. A Skin IQ™ mattress cover prevents new pressure ulcers and better treats existing ones, thus
helping the health care field to lower their overall costs on the non-reimbursable, "never events" of decubitus
ulcers.
To learn more, visit www.vascularprn.com or call 800-886-4331. Vascular PRN’s website at www.
vascularprn.com is the go-to site for directors of nursing, nursing home administrators, and medical
professionals to find out more about the Skin IQ™ MCM and compression therapy. The site spotlights
industry news, frequently asked questions, and director of nursing and healthcare jobs.
September 14, 2011
Pink Ribbon Program at Avon Rec Center Friday, Saturday - Vail Daily News –
AVON — The Pink Ribbon Program is an exercise program designed specifically for post-operative breast
cancer survivors. Program founder and director of the Pink Ribbon Program, Doreen Puglisi, became aware
of the need as she herself was diagnosed with breast cancer. She used the Pink Ribbon Program to regain
her range of motion, as well as strength in her affected arm.
The Avon Recreation Center will be hosting a two-day workshop on Friday and Saturday for individuals
who come in contact with breast cancer survivors through physical therapy, occupational therapy, massage
therapy, personal trainers, nurses, group exercise instructors, lymphedema treatment specialists and spa
services such as facials, manicures, etc. The goal of this interactive two-day course is to provide the
participants with a knowledge base that is essential to the successful evaluation of the breast cancer survivor,
from diagnosis to treatments, recovery, preventions of lymphedema and proper exercise guidelines and
protocols. Evidence based practice and integration of material from the areas of functional exercise, shoulder
rehabilitation and Pilates exercise will be the emphasis of the course sessions.
The Pink Ribbon Program is offered on Friday starting from 2 to 8 p.m. and Saturday from 9 a.m. to 3 p.m.
Workshop cost is $425 per person, plus $35 for course materials. Space is still available for this two day
workshop. Visit www.pinkribbonprogram.com or call 888-445-3089.
September 12, 2011
Komen QC Affiliate and Gilds's Club to hold educational symposium - Quad-Cities Online –
Susan G. Komen for the Cure-Quad Cities affiliate to hold 2nd annual educational symposium
September 12th, 2011---DAVENPORT, IA—Breast cancer survivors and their supporters are invited to
launch breast cancer awareness month in the Quad Cities on October 1st at the 2nd annual Educational
Symposium sponsored by the Komen Quad Cities Affiliate and Gilda's Club Quad Cities.
The Symposium is an effort to connect survivors to others that share a common journey and offer discussion
about topics of interest to survivors, such as lymphedema and breast reconstruction.
"We hope that breast cancer survivors take advantage of this opportunity to learn and heal," said event
organizer Sheila Soltow. .
The October 1st event runs from 8 a.m.-1:30 p.m. at the Isle of Capri in Bettendorf, and includes a lunch
and panel discussion about the pros and cons of breast reconstruction.
The cost to attend the event is $15 for survivors and $20 for others. To register for the Symposium, call
Mackenzie Batterbee at 563-421-1905. Early registration is encouraged as space is limited.
The Susan G. Komen for the Cure-Quad Cities Affiliate was formed in 1999, after the Komen Quad Cities
Race for the Cure® began in 1990. Over the past 22 years, the Affiliate has raised nearly $5 million in the
fight against breast cancer. For more information on the Affiliate or the Komen Quad Cities Race for the
Cure, please visit www.komenquadcities.org
Once-Homeless Lakeland Woman Awaits Construction of House - The Ledger – By Chase Purdy
LAKELAND | Echoing from another room in the house, Yvonne Gallimore's grandchildren squealed with
delight. After more than two months in the hospital, it's a sound to which she's still getting accustomed.
Michael Wilson | THE LEDGER
Cooped up in Lakeland Regional Medical Center for longer than she liked, Gallimore smiled from the
bedroom of her temporary home in North Lakeland. She pointed to her view of the backyard.
In June, an anonymous donor stepped forward with an offer to build Gallimore a new house. She recently
looked over the blueprints, she said, but continues to wait for Habitat for Humanity construction crews to
break ground.
"There's no place like home," she said. "There's no place like home."
For more than a decade she's suffered from a severe case of lymphedema, a condition that led to an
infection that left her hospitalized in May. Her medical issues left her weight at about 750 pounds.
On May 19, medical crews were forced to tear through a wall of her apartment so she could be transported
to the hospital. An infection in one of her legs needed immediate medical treatment, she said.
But that left her homeless, necessitating a longer stay at LRMC.
"I was miserable because I didn't have anywhere to go," she said. "It was a situation that I had no say-so
about."
Lymphedema, a condition that can be controlled but not cured, creates blockage that prevents bodily fluids
from draining well. As a result, Gallimore's legs swelled significantly, preventing her from moving freely.
With her weight, Gallimore still cannot move from room to room in her home. Claire Twomey, the chief
executive officer of Lakeland Habitat for Humanity, said the new home will be designed to offer plenty of
room for mobility.
September 9, 2011
Coping with breast cancer pain - Baltimore Sun –
This has passed on Septbember 13 sorry
September 6, 2011
Mammography: More is not necessarily better - Kansas.com – By Abigail Trafford
Mom — what are you talking about?" My friend was on a family vacation when her mother mentioned she
had to get her annual mammogram. My friend continued: "You don't need a mammogram! You're 88!"
Her mother gave her a withering look: "What? I'm so old at 88, you want me to die of breast cancer?"
So ingrained is the annual mammogram habit in this country that any challenge to it is met with a combination
of scorn and outrage.
We belong to the pink ribbon sisterhood that worked hard to strike down the stigma of breast cancer and
get better care. We walk for the cure. We lobby Congress for research funds. We demand coverage of
screening, including high-tech digital mammography. In the past 20 years, deaths from breast cancer have
gone down by about 30 percent.
But what role has screening played in this decline?
At a forum in March at the Harvard School of Public Health in Boston, physicians and policy officials
debated the question "Mammograms: Who in the world are they good for?"
Mette Kalager, a surgeon at Oslo University Hospital and a visiting scientist at the Harvard School of Public
Health, told the forum about a study she had led in Norway.
The researchers looked at the records of 40,075 women who received diagnoses of breast cancer between
1986 and 2005. Some had been screened every two years. Others had not been screened; their cancers
had been detected by physical examination. Both groups were treated by teams of specialists. Over the 20-
year period of the study, both groups saw a decline in death rates from the disease.
By comparing the groups, researchers determined that only about a third of this decline was due to
screening. Most of it was due to state-of-the art treatment and comprehensive care. Previous studies had
suggested a greater impact from screening, and the study, published in the New England Journal of
Medicine, caused a stir in the breast cancer community.
A little history is in order.
When mammography screening got under way in the United States 40 years ago, it put breast cancer on the
public agenda. Catch-it-early-when-it's-curable became a mantra of hope. Since then, treatments have
improved, and the understanding of breast cancer has changed. Perhaps more important than the timing of
detection is the biology of the cells.
"There are some very tiny cancers that are just bad biology and are destined to relapse, no matter how early
you find them," Julie Gralow, a professor of oncology at the University of Washington Medical School, told
the Harvard forum.
And some cancers don't progress even when they are found late.
"I've had patients who have had very aggressive, large cancers, which, for one reason or another, they have
ignored," continued Gralow. "And still years later, it never spreads. It doesn't come back. . . . We're
struggling to understand the biology."
Diagnosing a cancer early often leads to more-conservative treatment (such as lumpectomy instead of
mastectomy), a great advantage to patients. But the annual mammogram may not be as important as it once
was in stemming the death toll.
"The evidence seems to be that mammography screening plays less and less of a role in reducing mortality in
countries of the Western world," Kalager said.
That may be true for older women in particular. In Europe, mammography screening is recommended only
for women ages 50 to 69. Yet when Kalager and her colleagues studied breast cancer patients ages 70 to
84, they saw a reduction in mortality that "was largely the same" as in younger women who were screened.
The key for both groups was access to good care.
But Felicia Knaul, director of the Harvard Global Equity Initiative, offered a different view: "I was diagnosed
with a breast cancer 3 1/2 years ago in my first baseline mammogram at age 41," she said. "If anything saved
my life, in addition to expert care, it is that mammogram."
The room went quiet. How to resolve the experience of Knaul with the findings of a study based on more
than 40,000 women? Furthermore, as Knaul pointed out, many women, especially in developing countries,
do not have access to the state-of-the art care.
Such is the conundrum for policymakers in setting health guidelines: Personal anecdote often clashes with
wider research. But screening policies should be based on evidence from large-scale population studies: the
greatest good for the greatest number.
The United States has the most expansive mammography screening standards in the world, starting at age
40 and continuing every year. But more is not necessarily better in health care.
Wide-net screening can cause harm, leading to over-detection, over-diagnosis and unnecessary treatment,
according to Kalager and other researchers. Once a woman has a suspicious mammogram, she gets on a
medical train and can't get off until the doctor-conductor gives the all-clear signal.
Often that requires just a repeat test. But some women are treated for cancers that are not invasive or are
too slow-growing to endanger their health. They undergo surgery or drugs or radiation with side effects such
as blood clots, breathing problems, lymphedema and high blood pressure.
"I don't know how to weigh the over-detection piece," said Gralow. "We clearly have to sort that one out."
Yes, there's a lot of sorting out to do. My friend's mother, who believed in annual screening, obviously
managed her health pretty well. She never got breast cancer and lived to age 94. But my friend was also
right: Research is on her side.
More coverage
Today's story is the first in a series dealing with breast cancer. Find more in next week's Healthy Living.
If you go
2011 Komen Wichita Race for the Cure
What: More than 10,000 people are expected to participate in the local benefit for Susan G. Komen.
When: Sept. 24. Registration begins at 6:45 a.m., followed later in the morning by activities, including a
breakfast and celebration for survivors. The competitive timed 5K is at 8 a.m., and the non-competitive 5K
is at 8:15 a.m.
Where: At Douglas and Armour near Towne East Square
How much: Advance registration before Sept. 24 is $30 for the competitive and $25 for noncompetitive
races. Registrants receive a T-shirt.
To register or learn about the complete schedule and additional related special events — including Sleep-in
for the Cure and Kids for the Cure — visit www.komenmidks.org or call 316-440-7033.
Breast cancer in Kansas by the numbers
* 1,780: The approximate number of women diagnosed with breast cancer in Kansas last year.
* 370: The estimated number of women who died from breast cancer in Kansas last year.
September 20, 2011
NARH Offers Q&A Session on Hyperbaric Wound Care - iBerkshires.com –
NORTH ADAMS, Mass. — North Adams Regional Hospital will host a question-and-answer session with
the wound-care experts from the Wound Healing Center of the Berkshires on Tuesday, Oct. 4, from 6:30 to
8 p.m.
The free event takes place at the VNA & Hospice of Northern Berkshire Community Room. Pie and coffee
will be served. Registration is requested by calling 413-664-5142.
Dr. Fred Landes, center Director Kelly Morse and hyperbaric oxygen technician Gladys Conklin will take
questions on wounds resulting from radiation side effects, lymphedema, diabetes, peripheral vascular
disease, and injuryThey will also discuss new state-of-the-art techniques used to heal wounds including
hyperbaric oxygen therapy.
The Wound Healing Center opened in 2009 and has been recognized as a top-performing center among all
those operated in collaboration with National Healing Corp. The Wound Center boasts a “heal rate” of 96
percent, meaning that 96 percent of patients’ wounds are healed within nine visits.
Landes is a board-certified emergency medical physician and is the Wound Healing Center’s medical
director. He received his training from the New York Presbyterian Hospital, Cornell University, in New
York City.
Morse is a registered nurse and has worked in the health-care field for 32 years. Conklin is a licensed
practical nurse.
September 20, 2011
Breast Surgeon Addresses the Worries, the Wonders and the What-to-dos of Breast Health – TribLocal –
Join Breast Surgeon Jennifer Gambla, M.D., of Palos Community Hospital, as she discusses the latest
mammogram recommendations, measures to prevent breast cancer and the multiple steps involved in
diagnosing breast health concerns. This free event will be held on Monday, Oct. 3 from 6:30 p.m. to 7:30 p.
m. at Palos Health & Fitness Center, 15430 West Avenue in Orland Park. Call 708-226-2300 to register.
Palos Community Hospital's Comprehensive Breast Program combines the technological capabilities of
digital mammography, ultrasound and magnetic resonance imaging with a highly skilled and compassionate
staff. You benefit from the talents of radiologists who are fellowship-trained in the field of mammography.
Breast exams and procedures under all imaging modalities, as well as breast surgery, are performed at Palos
Community Hospital. Whether you need a routine exam or have a more serious breast concern, you can
trust Palos Community Hospital.
The breast care treatment team at Palos Community Hospital provides a multidisciplinary, integrated and
comprehensive approach to screening, diagnosis and treatment. Our complete continuum of services include:
Digital Mammography, Breast Ultrasound, Stereotactic & Ultrasound Guided Needle Biopsy, Excisional
Breast Biopsy, Breast MRI and MRI Guided Needle Biopsy, Ultrasound Guided Cyst Aspirations, Surgical
Treatment for Breast Cancer, Breast Reconstruction and Lymphedema Program and Support Group.
To schedule a digital mammogram or other Breast Imaging service, call (708) 827-2030.
September 20, 2011
Hospital celebrates National Rehab Week - Journal-Advocate –
Sterling Regional MedCenter Rehabilitation department is celebrating National Rehabilitation Awareness the
week of Sept. 18-24. The mission of National Rehabilitation Awareness Week is to educate people about
the benefits and impact of rehabilitation and give credit to those who help people with disabilities live up to
their fullest potential through rehabilitation.
Sterling Regional MedCenter's rehab department offers comprehensive therapy services including physical
therapy, occupational therapy, speech therapy, cardiac rehab, and the new oncology rehab program.
Patients receive individualized therapy programs that address a wide variety of patient needs. The goal of
therapy is to return patients to their highest level of function as quickly and safely as possible.
The oncology rehab program was created to assist individuals with cancer move past the challenges of their
diagnosis. Cancer treatment can be both physically and mentally challenging. Each patient's experience is
different and each patient faces unique side effects.
The oncology rehab program provides specialized treatments to cancer patients including a thorough
evaluation to access baseline values (endurance, strength, flexibility and range of motion) which lets the
rehab providers create a specialized treatment program for each patient's unique needs. Each session is
designed to address the individual's needs and provides extensive education to assist in recovery.
"The physical therapy program for cancer patients is very good. I think the support you receive helps
patients to have a positive attitude," said Henry Littler, program participant.
"It is easy to be inactive during this time due to the side effects most patients experience," notes Littler. "The
program and the therapist offer a challenge to get stronger physically as well as mentally because of the
weight loss and other effects that one experiences from treatment. I would recommend this program for
patients going through treatment!"
The program also offers lymphedema services provided by an occupational therapist certified in upper
extremity lymphedema therapy. These treatment options include manual lymph drainage, bandaging,
exercise, and skin care to assist in the effective management of this condition.
Chemotherapy, radiation, and surgical patients can all benefit from this exercise program, no matter what
stage of their diagnosis.
"We are excited to offer a program that can help people through all stages of recovery - from the initial
diagnosis to possible side effects felt years after," said Amy Baseggio, occupational therapist and certified
lymphedema therapist at Sterling Regional MedCenter. "This is a unique program that is meant to give those
with a cancer diagnosis one more way to regain their health and live their lives to the fullest. "
The therapists at SRM are dedicated to making a difference in people's lives by providing excellent patient
care in a caring and friendly environment. For more information regarding rehabilitation services at SRM,
please contact us at (970) 521-3138
September 20, 2011
Pink Ribbon Program Coming To New Orleans, LA - October 14 & 15, 2011 - PR Web –
Become a Post-Rehabilitative Breast Cancer Exercise Specialist
The Pink Ribbon Program is an exercise program designed specifically for post-operative breast cancer
survivors. Program founder and director of the Pink Ribbon Program, Doreen Puglisi M.S., became aware
of the need as she herself was diagnosed with breast cancer. She used the Pink Ribbon Program to regain
the range of motion as well as strength in her affected arm.
Xtend Barre New Orleans will be hosting a two day workshop on Friday, October 14 and Saturday,
October 15, 2011 for individuals who come in contact with breast cancer survivors through Pilates, physical
therapy, occupational therapy, massage therapy, personal trainers, nurses, group exercise instructors and
lymphedema treatment specialists. The goal of this interactive two day course is to provide the participants
with a knowledge base that is essential to the successful evaluation of the breast cancer survivor, from
diagnosis to treatment, recovery, prevention of lymphedema and proper exercise guidelines and protocols.
Evidence based practice and integration of material from the areas of functional exercise, shoulder
rehabilitation and Pilates exercise will be the emphasis of the course sessions.
The Pink Ribbon Program is offered on Friday, October 14 starting at 3:00 p.m. to 8:00 p.m. and Saturday,
October 15 starting at 8:00 a.m. to 2:00 p.m. Workshop cost is $425 per person plus $35 for course
materials. Space is still available for this two day workshop. Please visit http://www.pinkribbonprogram.com
or call 888-445-3089
September 7, 2011
Incredible New Plastic Surgery Product Helps Accelerate Healing After Popular Armlift Procedure
(Brachioplasty) - DigitalJournal.com –
An exciting new product to help speed up healing following arm lift surgery is the latest addition to Nouvelle’
s premier compression wear line. Convertible compression arm sleeves provide lightweight, yet powerful
healing compression and support for the arms. A key feature of the product is the ease with which patients
can adjust the bodice for a precise fit.
“Proper care of the arms is critical to a successful surgical result,” said Dawn Cover, president of Nouvelle.
“We’ve fine-tuned our arm care line to include products that help patients get the maximum care and best
outcomes from surgeries involving the arms,” she said.
Key uses of arm sleeves:
1. Care following arm lift surgery (brachioplasty) and liposuction.
2. Prevention of extreme, hypertrophic scarring from severe, skin-damaging burns.
3. Relief for symptoms associated with lymphedema, such as fluid retention and tissue swelling.
Also important to proper care of the arms following surgery is scar prevention. Nouvelle carries the
internationally-recognized ScarHeal product line, which features an outstanding combination of ingredients
designed to help calm inflammation and tame overactive collagen production in scars resulting from surgery,
burns, wounds, and keloids. The line features four proven products for treating scars resulting from any
trauma to the skin.
Additional Resources
Web site
The newly-designed Nouvelle Inc. Web site includes comprehensive product details, company history and
and more.
Healing Transformations
An online forum dedicated to patients, physicians and families of anyone recovering from the myriad of
emotional and physical health issues surrounding aesthetic and reconstructive surgery.
Facebook Page
Look for new products, stories from customers, and helpful recovery tips on Nouvelle’s Facebook page.
One of the first 100 people to “like” the page will be entered into a special drawing to win a free
compression or shapewear product.
About Nouvelle
Nouvelle manufactures and distributes post-surgical compression wear, body shaping garments, and scar
care products worldwide from its facility in Virginia Beach, Va. Its internationally-recognized products are
available through approved distributors and online at http://www.nouvelleinc.com.
International Distribution Opportunities
For more information about purchasing or distributing the company’s products, please contact Dawn Cover
via email or telephone: dawn(at)nouvelleinc(dot)com or 888-653-0113/757.965.3767.
September 9, 2011
Why Knees Fail in 2011: Patient, Surgeon, or Device? - Ortho SuperSite – by Steven J. Fitzgerald, MD;
Robert T. Trousdale, MD
Abstract
The outcome of total knee arthroplasty (TKA) is influenced by multiple interconnected factors, including
patient selection, implant design, and surgical technique. Total knee arthroplasty has been shown to be highly
successful, with patient satisfaction rates reported from 85% to 95% with low rates of failure, but if failure
occurs, its impact is significant. In 2003, 402,000 primary TKAs and 32,000 revision TKAs were
performed in the United States, and the number of TKAs is expected to double by 2015. Recent data on
modern implant designs and techniques have demonstrated a surprising number of early failures, although the
true number of early failures is unknown. Patient medical comorbidities should be optimized preoperatively,
while psychosocial issues and workers compensation are more nebulous yet contribute greatly to patient
perceived outcomes. Understanding current failure mechanisms of primary TKA and how to prevent
complications will be critical to help manage a potentially overwhelming TKA revision burden. This article
discusses failure rates as well as factors from the patient, surgeon, and device, that contribute to TKA failure.
Dr Fitzgerald is from Department of Orthopedic Surgery, University Hospitals Case Medical Center,
Cleveland, Ohio; and Dr Trousdale is from the Mayo Clinic, Rochester, Minnesota.
Dr Fitzgerald has no relevant financial relationships to disclose. Dr Trousdale receives royalties from DePuy,
Wright Medical Technology, and MAKO.
Presented at Current Concepts in Joint Replacement 2010 Winter Meeting; December 8–11, 2010;
Orlando, Florida.
Correspondence should be addressed to: Robert T. Trousdale, MD, Mayo Clinic, 200 First St SW,
Rochester, MN 55905 (trousdale.robert@mayo.edu).
Posted Online: September 09, 2011
The outcome of total knee arthroplasty (TKA) is affected by patient selection, implant design, and surgical
technique ( Figure). Total knee arthroplasty has been shown to be highly successful with patient satisfaction
rates reported from 85% to 95% with low failure rates, but if failure occurs, its impact is significant. 1,2 In
2003, 402,000 primary total knee and 32,000 revision TKAs were performed in the United States. The
number of total knee revisions is expected to double by 2015. 3 Understanding current failure mechanisms
of primary TKA, and how to prevent complications will be critical to help manage a potentially
overwhelming TKA revision burden. This article will discuss failure rates as well as factors from the patient,
surgeon, and device, which all contribute to the TKA failure.
Rates of Failure
Long-term studies have demonstrated excellent survivorship rates for TKA. 4–6 Rand and Bryan 7
reported failure rates of condylar total knee prostheses implanted at the Mayo Clinic over a 20-year period
and demonstrated 91% survivorship at 10 years, and 78% at 20 years. These rates improved for patients
who were women, older at the time of surgery, and had not undergone previous knee surgery. Survivorship
of patients older than 70 years at the time of surgery also increased to 94% at 10 years. Other factors that
were attributed to increased survivorship were cruciate retaining and non-modular tibial designs, although
these factors may be related to prosthesis design issues that have been improved with modern designs in
2011. We currently advise our patients that they have approximately a 1% cumulative chance per year of
their total knee failing.
Why and When do Knees Fail?
Historically, reasons for TKA failure have been attributed to infection, loosening, instability, and
patellofemoral complications. 7 Surprisingly, data detailing failure mechanisms of modern TKA is relatively
scant. Sharkey et al 2 retrospectively reviewed reasons for 212 revisions over a 3-year period from 1997 to
2000 at a tertiary referral center. Failures were subdivided into early (<2 years) and late (>2 years), with
55% falling into the early group. Overall, the most common reasons for revision were polyethylene failure,
aseptic loosening, instability, and infection. Not surprisingly, polyethylene wear and aseptic loosening were
more common in the late group comprising >70% of all late revisions combined. The most common reason
for failure in the early group was infection, comprising 25%. The early group also demonstrated a
surprisingly high rate of aseptic loosening of 16.9%, which points to surgical technique as a major
contributing factor to early revision since early loosening cannot be attributed to polyethylene wear.
Fehring et al 8 retrospectively reported reasons for revision of 440 total knees at a tertiary referral center.
They specifically looked at reasons for early failure, which they defined as revision within 5 years from the
index arthroplasty. An alarming 64% of revisions fell into this early failure group over a 10-year period.
Infection (38%) was the most common reason for early revision, followed by instability (26%), and failure of
cementless fixation (13%). Both of these studies are limited by data from tertiary referral centers, clouding
the true incidence of the mechanisms of TKA failure. They, however, demonstrate an alarming number of
early failures, and indicate room for improvement in surgical technique.
Patient Factors
Patient factors significantly contribute to the TKA failure. Medical comorbidities such as obesity, diabetes,
inflammatory arthropathy, tobacco use, lymphedema, immunosuppressive medications, and depression can
all contribute to early postoperative complications as well as long-term outcomes. 9–13 Kang et al 12
recently suggested HbA1C >8% as an independent risk factor for postoperative wound complications.
Foran et al 11 demonstrated a significantly higher revision rate in morbidly obese patients undergoing TKA
compared to non-obese patients. Other patient factors, such as patient-surgeon relationship, patient
expectations, psychosocial issues, and workers compensation add an additional layer of complexity to TKA
outcomes. 14 While not all patient factors are correctable in patients undergoing TKA; medical optimization
of diabetes, cardiopulmonary disease, smoking cessation programs, weight control, and treatment of
lymphedema should be pursued preoperatively to help mitigate the risk of complications following TKA.
Patient, Surgeon, or Device?
Failure of TKA is multifactorial with combined contributions attributable to the patient, surgeon, and device.
Medical optimization of patient comorbidities such as cardiorespiratory disease, obesity, diabetes, and
venostasis should be attempted to help mitigate the risk of perioperative complications.
Current implant design has improved greatly over the past 2 decades, but the rate of developing technology
is largely uncontrollable by both patient and surgeon. Most TKA designs today, if implanted correctly, will
have excellent long-term outcomes. Surgeons should choose an implant design that they are comfortable
with putting in well that has a proven track record. Implant design and improved materials in the future
should lead to further decreases in failure rates. However, surgeons should be cautioned against early
adoption of new technologies that have not been proven over time.
Surgeons can do the most to limit factors that lead to early failure. Judicious use of perioperative antibiotics,
good soft tissue handling techniques, and safe and efficient operative times can all help to decrease chances
of early postoperative infection. Early loosening and instability, also directly attributable to surgical technique,
can be limited with good cement technique and adherence to traditional arthroplasty balancing and alignment
principles. Continued professional education through national meetings and literature review can also keep
surgical technique up to date and help prevent the surgeon from repeating previous failures.
References
Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award: Patient expectations affect
satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006; (452):35–43. doi: 10.1097/01.blo.
0000238825.63648.1e [CrossRef]
Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Insall Award paper. Why are total knee
arthroplasties failing today? Clin Orthop Relat Res. 2002; (404):7–13. doi: 10.1097/00003086-
200211000-00003 [CrossRef]
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee
arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007; 89(4):780–785. doi:
10.2106/JBJS.F.00222 [CrossRef]
Ranawat CS, Padgett DE, Ohashi Y. Total knee arthroplasty for patients younger than 55 years. Clin
Orthop Relat Res. 1989; (248):27–33.
Rand JA, Trousdale RT, Ilstrup DM, Harmsen WH. Factors affecting the durability of primary total knee
prostheses. J Bone Joint Surg Am. 2003; 85(2):259–265.
Scuderi GR, Insall JN, Windsor RE, Moran MC. Survivorship of cemented knee replacements. J Bone
Joint Surg Br. 1989; 71(5):798–803.
Rand JA, Bryan RS. Revision after total knee arthroplasty. Orthop Clin North Am. 1982; 13(1):201–212.
Fehring TK, Odum S, Griffin WL, Mason JB, Nadaud M. Early failures in total knee arthroplasty. Clin
Orthop Relat Res. 2001; (392):315–318. doi: 10.1097/00003086-200111000-00041 [CrossRef]
Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement: A retrospective review of
6489 total knee replacements. Clin Orthop Relat Res. 2001; (392):15–23. doi: 10.1097/00003086-
200111000-00003 [CrossRef]
Namba RS, Paxton L, Fithian DC, Stone ML. Obesity and perioperative morbidity in total hip and total
knee arthroplasty patients. J Arthroplasty. 2005; 20(7 suppl 3):46–50. doi: 10.1016/j.arth.2005.04.023
[CrossRef]
Foran JR, Mont MA, Etienne G, Jones LC, Hungerford DS. The outcome of total knee arthroplasty in
obese patients. J Bone Joint Surg Am. 2004. 86(8):1609–1615.
Kang S, Han H, Yoon KS. Preoperative HBA1C is a good marker for predicting wound complications
after TKA in diabetics. J Bone Joint Surg Br. 2010; 92(suppl):135.
Shrader MW, Morrey BF. Insall Award paper. Primary TKA in patients with lymphedema. Clin Orthop
Relat Res. 2003; (416):22–26. doi: 10.1097/01.blo.0000092985.12414.6e [CrossRef]
Mont MA, Mayerson JA, Krackow KA, Hungerford DS. Total knee arthroplasty in patients receiving
Workers’ Compensation. J Bone Joint Surg Am. 1998; 80(9):1285–1290.
September 8, 2011
Lymphedema From Breast Cancer May Respond To Weightlifting – EmpowHer – By Jody Smith
Treatment for breast cancer can lead to an unpleasant condition called lymphedema which causes the arms
to swell. Research from the University of Pennsylvania School of Medicine indicated that weightlifting may
prevent the development of lymphedema. Previous research by the same team found that when women with
lymphedema lift weights, they can prevent the condition from becoming worse.
This Article
· VoteImproved My Health
· VoteChanged My Life
· VoteSaved My Life
The results were presented on December 8, 2010 at the San Antonio Breast Cancer Symposium. It was
published at that time in the Journal of the American Medical Association as well.
According to a Eurekalert also released on December 8, 2010, lymphedema is most likely to occur after
surgery removing multiple lymph nodes in the area of the breast that had cancer. Up to 47 percent of women
who have had this type of surgery can experience lymphedema.
Women in the study took part in a membership at a fitness center for 13 weeks where they used free
weights and machines under the watchful eyes of certified fitness professionals. They worked out twice a
week for 90 minutes at a time. For the rest of a year, the women exercised on their own, monitored monthly.
The women with lymphedema who participated in this routine had fewer setbacks and fewer symptoms than
women who did not take part in weightlifting.
It is important for a woman who has or may develop lymphedema to be in touch with her doctor, and a
certified fitness professional for safety's sake.
According to the New England Journal of Medicine's website Nejm.org, more than 2.4 million American
women are survivors of breast cancer. Depending on the type of treatment received, a woman may run a 6
percent to 70 percent chance of developing lymphedema.
Many of these survivors have been trying to restrict the use of their affected arms under the impression that
this will help. However advice along these lines is counterproductive. Instead, lymphedema responds best to
a carefully controlled increase in activity, including weightlifting.
Nejm.org concurred with the results referred to in the eurekalert, that weightlifting had an effect on hand and
arm symptoms, decreasing both severity and frequency.
Apparently exercise enhanced the flow of lymph and enhanced protein reabsorption. The effects of regular
exercise on the lungs seemed to boost lymph flow as well. It is speculated that the increase in muscle
strength may have reduced the effects of stress on the arm in daily activities.
This Article
· VoteImproved My Health
· VoteChanged My Life
· VoteSaved My Life
This research was funded by grants from the National Cancer Institute and the National Center for Research
Resources.
Sources:
Weightlifting slashes lymphedema risk after breast cancer treatment. Eurekalert.org. Web. September 5,
2011.
http://www.eurekalert.org/pub_releases/2010-12/uops-wsl120610.php
Weight Lifting in Women with Breast-Cancer-Related Lymphedema. Nejm.org. Web. September 5, 2011.
http://www.nejm.org/doi/full/10.1056/NEJMoa0810118#t=articleTop
Visit Jody's website and blog at http://www.ncubator.ca and http://ncubator.ca/blogger
Reviewed September 6, 2011
by Michele Blacksberg R.N.
September 8, 2011
New tool may help predict breast-cancer-associated lymphedema – HemOncToday –
ASCO 2011 Breast Cancer Symposium
SAN FRANCISCO — A set of statistical models have demonstrated more than 70% accuracy for
predicting the 5-year risk for developing lymphedema after lymph node removal during breast cancer
surgery.
New tool may help predict breast-cancer-associated lymphedema
ASCO 2011 Breast Cancer Symposium
SAN FRANCISCO — A set of statistical models have demonstrated more than 70% accuracy for
predicting the 5-year risk for developing lymphedema after lymph node removal during breast cancer
surgery.
Jose Bevilacqua, MD, PhD, a surgical oncologist at the Hospital Sirio Libanes in Sao Paulo, Brazil, and
colleagues studied 1,054 women with breast cancer who underwent axillary dissection in 2001 and 2002.
They used clinical factors such as age, BMI, ipsilateral arm chemotherapy infusions, level of axillary
dissection and others to develop three models and nomograms to predict the risk for developing
lymphedema.
The first model predicted lymphedema in advance of surgery and considered age, BMI and number of
chemotherapy cycles before surgery. The concordance index for this model was 0.706. The second model
used the same predictors within 6 months surgery, as well as the extent of axillary dissection and the location
of the radiotherapy field. The concordance index for this model was 0.729. The third model predicted
lymphedema 6 months or more after surgery. It considered the same predictors, as well as the development
of fluid buildup and swelling. The concordance index for this model was 0.736.
“The statistical models and the corresponding nomograms use readily available clinical factors and allow for
quick and easy estimation of individual risks of developing lymphedema after axillary lymph node surgery in
women with breast cancer,” Bevilacqua said. “For the sake of comparison, these modeling tools are as
accurate for predicting a woman’s risk of developing lymphedema as mammography is for the detection of
breast cancer.”
September 7, 2011
2011 Breast Cancer Symposium Research Reveals Trends in Survival, Treatment - -Newswise
Newswise — ALEXANDRIA, Va. – New studies on breast cancer screening, treatment, and survival were
released today in advance of the 2011 Breast Cancer Symposium. The symposium is being held September
8-10, 2011, at the San Francisco Marriott Marquis in San Francisco.
Four major studies were highlighted in today’s presscast:
- Two Studies Report Similar Recurrence, Survival Rates for Breast Conservation and Mastectomy among
Younger Women with Breast Cancer: A pair of studies indicates comparable outcomes – in local recurrence
and survival rates – for lumpectomy (breast conservation surgery) or mastectomy (entire breast removal)
among women with breast cancer age 40 and younger.
a) Study Finds Recurrence Rates are Similar in Younger Women Who Have Either Breast Conservation
Surgery or Mastectomy: A retrospective study of medical records of more than 600 women aged 40 and
younger who were diagnosed with up to stage III breast cancer, analyzed according to the type of surgery
(lumpectomy versus mastectomy) the women had, found no statistically significant difference in local cancer
recurrence risk.
b) Large Analysis Shows Breast Conservation and Mastectomy Result in Similar Survival Among Younger
Women With Early Stage Breast Cancer: Using the National Cancer Institute’s SEER (Surveillance,
Epidemiology, and End Results) database, investigators compared overall survival and breast cancer-
specific survival among nearly 15,000 women age 40 and younger, finding no significant differences between
the two groups.
- New Statistical Tool May Predict Risk of Common Debilitating Side Effect – Lymphedema – Associated
with Breast Cancer Surgery: Researchers have created a set of statistical models that are more than 70
percent accurate for predicting the five-year risk of developing lymphedema (debilitating swelling) after
lymph node removal during breast cancer surgery.
- Large Michigan Study Suggests Continued Importance of Self-Exams, Annual Mammography in Breast
Cancer Detection, Even in Younger Women: An analysis of breast cancer diagnosis data from nearly 6,000
women in Michigan suggests that mammography and self-breast exams remain important tools for detecting
breast cancer, even among women aged 40 to 49 for whom routine mammography has been questioned by
the U.S. Preventive Services Task Force (USPSTF).
“Improvements in detection, as well as insights into surgical treatment options and their outcomes, have
increasingly led to longer, improved lives for women with breast cancer,” said Andrew Seidman, MD,
American Society of Clinical Oncology Cancer Communications Committee member. “The studies
presented today reflect the impact of these advances in treatment approaches on patient outcomes and
treatment decision-making.”
In 2011, an estimated 230,480 new cases of invasive breast cancer are expected to occur in women in the
United States, and another 2,140 cases are expected in U.S. men. An additional 57,650 cases of in situ
(non-invasive) breast cancer are expected to occur in U.S. women as well, totaling more than 290,000 new
cases.* This year’s Breast Cancer Symposium will include more than 300 abstracts and focus on a range of
breast cancer topics that range from prevention and screening to treatment and survivor care.
*Source: Cancer Facts & Figures 2011. Atlanta, GA; American Cancer Society: 2011.
The full release is available at the following link:
http://www.asco.org/ASCOv2/Department Content/Communications/Downloads/BCS11 Research Release
Final.pdf
About the 2011 Breast Cancer Symposium
The fifth annual Breast Cancer Symposium is co-sponsored American Society of Breast Disease, the
American Society of Breast Surgeons, the American Society of Clinical Oncology, the American Society for
Radiation Oncology, the National Consortium of Breast Centers and the Society of Surgical Oncology.
Susan G. Komen for the Cure®, the world's largest grassroots network of breast cancer survivors and
advocates, is the primary supporter of the Symposium.
Information for Media: www.asco.org/BCSpresskit
Relevant Links on ASCO’s CancerProgress.Net Website:
http://cancerprogress.net/breast
Relevant Links on ASCO’s Cancer.Net:
• Guide to Breast Cancer
• Cancer Screening
• Mammography – What to Expect
• Expert Perspective from ASCO on Mammography Screening for Breast Cancer
• Understanding Cancer Surgery
• Talking With the Doctor About Breast Surgery Options
• After Treatment for Breast Cancer: Preventing Lymphedema
• Coping With Fear of Recurrence
ATTRIBUTION TO THE 2011 BREAST CANCER SYMPOSIUM IS REQUESTED IN ALL NEWS
COVERAGE
September 7, 2011
New Nomograms Predict Lymphedema After Axillary Lymph Node Dissection - Internal Medicine News
Digital Network – By: SUSAN LONDON
A new set of nomograms based on easily assessed risk factors accurately predicts a woman’s likelihood of
developing lymphedema after axillary lymph node dissection for breast cancer, researchers are reporting at a
breast cancer symposium sponsored by the American Society of Clinical Oncology.
The nomograms, which enable risk assessment throughout the course of treatment using data available at the
time, had accuracy exceeding 70%, according to results presented in a press briefing before the meeting.
"The accuracy is the same as mammography to detect breast cancer. ... So that’s a very good statistical
tool," said lead author Dr. Jose Bevilacqua, a surgical oncologist at the Hospital Sirio-Libanês in São Paulo,
Brazil.
Being able to identify high-risk patients has several potential applications, he added. They could be
monitored more closely and offered interventions that might prevent or reduce the severity of lymphedema,
such as use of compression sleeves. "The earlier you detect [it], the better is the outcome," Dr. Bevilacqua
said.
Additionally, high-risk patients with a positive sentinel lymph node could be counseled about the risk of
further surgery. Thus, "you have physicians who make closer follow-up and [have] a better discussion with
the patients."
Finally, the nomograms could be applied in clinical research. "These tools might help [ongoing] or new
studies to select high-risk patients in order to avoid exposing the low-risk patients to unproven therapies," he
explained.
Dr. Andrew Seidman, moderator of the press briefing and a medical oncologist at the Memorial Sloan-
Kettering Cancer Center in New York, commended the investigators for a study that "has real practical
implications for patients."
"It allows us to identify patients who then can be appropriately triaged for early intervention and perhaps for
clinical trials aimed at preventing what many consider inevitable, and that is the development of lymphedema."
The effectiveness of early interventions is controversial, according to Dr. Seidman, who did not report any
relevant conflicts of interest. "There are believers and there are nonbelievers," he commented. "What I think
this nomogram does is [allow] us in a scientific way to segregate out patients in terms of their risk, and by
doing that, we can have more uniform cohorts for which early intervention can be studied more rigorously."
The researchers prospectively followed 1,054 women with unilateral breast cancer who underwent breast-
conserving surgery or mastectomy with an axillary lymph node dissection in 2001-2002. Median follow-up
was 41 months.
"As far as we know, we have established the largest prospective cohort specifically established to study the
incidence and factors associated with lymphedema after axillary node dissection for breast cancer,"
commented Dr. Bevilacqua.
Using Data to Predict Lymphedema
The women had serial arm volume measurements starting before surgery. To facilitate this process, the
researchers created a tool that is now available free online (www.armvolume.com).
They then developed and internally validated three multivariate nomograms (or statistical models) for
predicting lymphedema using data available at various time points.
The first model, to be used preoperatively, incorporated age, body mass index, and number of cycles of
neoadjuvant chemotherapy infusions in the ipsilateral arm.
The second model, to be used within the first 6 months after surgery, incorporated all the factors from the
first plus the extent of axillary dissection, the location of radiation therapy field, and the number of cycles of
adjuvant chemotherapy infusions in the ipsilateral arm.
The third model, to be used 6 months or later after surgery, incorporated all the factors from the second,
plus the development of postoperative seroma and development of early edema.
Study results showed that within 5 years of axillary lymph node dissection, 30.3% of the women developed
lymphedema (defined as a difference in volume of at least 200 mL between arms at 6 months or later after
surgery).
All of the risk factors used in the models were significantly associated with the development of lymphedema,
Dr. Bevilacqua reported.
"One of the novelties of our study is the [finding] that ipsilateral neoadjuvant chemotherapy infusion is as
morbid as adjuvant chemotherapy infusion to increase the risk of lymphedema," he pointed out. "This is
somewhat intuitive, but it has never been described, and the great majority of clinical oncologists are not
aware of this fact."
For predicting the 5-year risk of lymphedema, the first, second, and third models had accuracy of 70.6%,
72.9%, and 73.6%, respectively. The investigators have converted the models into free, user-friendly
calculators that are available online (www.lymphedemarisk.com) during the ASCO Breast Cancer
Symposium (Sept. 8-10), but will be taken off line until the manuscript is published, after which they are to
become available again.
Dr. Bevilacqua reported that he had no relevant conflicts of interest.
September 8, 2011
New Research: Acupuncture treats Breast Cancer Lymphedema – HealthCMI –
Recent Memorial Sloan-Kettering Cancer Center research demonstrates that acupuncture significantly
reduces lymphoedema related arm swelling in women after breast cancer surgery. Lymphoedema is a when
there is fluid retention and tissue swelling in the body due to disorders of the lymphatic system. The
lymphatic system controls the return of interstitial fluid to the bloodstream. After breast cancer surgery, the
lymphatic system can be damaged by lymph node surgery or radiation therapy. Symptoms may appear
quickly or take several months or years to become apparent. Swelling of the arms and sides of the body is
most common after lymphatic system damage due to breast cancer procedures.
The researchers at Sloan-Kettering in New York note that existing conventional treatments for
lymphoedema are only “marginally beneficial, rarely reducing arm swelling in any meaningful way.” The new
study concludes that acupuncture is safe and that some of the women in the study showed a 30 percent or
better reduction of lymphoedema related arm swelling.
Acupuncture Results
In this study, lymphoedema was diagnosed when the affected arm was greater than 2cm in circumference
than the unaffected arm. Participants received acupuncture at a rate of 2 times per week for a total of four
weeks. Results were tabulated after a six month follow-up. No serious events were reported and the study
concludes that “acupuncture appears safe and may reduce lymphoedema associated with breast cancer
surgery.”
Acupunct Med. doi:10.1136/aim.2011.004069. A safety and efficacy pilot study of acupuncture for the
treatment of chronic lymphedema. Barrie R Cassileth, Kimberly J Van Zee, Yi Chan, Marci I Coleton,
Clifford A Hudis, Sara Cohen, James Lozada, Andrew J Vickers.
Author Affiliations:
Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York.
Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York.
Integrative Medicine
September 8, 2011
New Research: Acupuncture treats Breast Cancer Lymphedema – HealthCMI –
Recent Memorial Sloan-Kettering Cancer Center research demonstrates that acupuncture significantly
reduces lymphoedema related arm swelling in women after breast cancer surgery. Lymphoedema is a when
there is fluid retention and tissue swelling in the body due to disorders of the lymphatic system. The
lymphatic system controls the return of interstitial fluid to the bloodstream. After breast cancer surgery, the
lymphatic system can be damaged by lymph node surgery or radiation therapy. Symptoms may appear
quickly or take several months or years to become apparent. Swelling of the arms and sides of the body is
most common after lymphatic system damage due to breast cancer procedures.
The researchers at Sloan-Kettering in New York note that existing conventional treatments for
lymphoedema are only “marginally beneficial, rarely reducing arm swelling in any meaningful way.” The new
study concludes that acupuncture is safe and that some of the women in the study showed a 30 percent or
better reduction of lymphoedema related arm swelling.
Acupuncture Results
In this study, lymphoedema was diagnosed when the affected arm was greater than 2cm in circumference
than the unaffected arm. Participants received acupuncture at a rate of 2 times per week for a total of four
weeks. Results were tabulated after a six month follow-up. No serious events were reported and the study
concludes that “acupuncture appears safe and may reduce lymphoedema associated with breast cancer
surgery.”
Acupunct Med. doi:10.1136/aim.2011.004069. A safety and efficacy pilot study of acupuncture for the
treatment of chronic lymphedema. Barrie R Cassileth, Kimberly J Van Zee, Yi Chan, Marci I Coleton,
Clifford A Hudis, Sara Cohen, James Lozada, Andrew J Vickers.
Author Affiliations:
Integrative Medicine Service, Memorial Sloan-Kettering Cancer Center, New York.
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York.
Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center, New York.
Integrative Medicine Service and Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering
Cancer Center, New York.
September 7, 2011
Software Predicts Lymphedema Risk After Axillary Dissection – Medscape –
Sorry have to be a member of something to access this article.
September 8, 2011
MBCS: Tool Predicts Arm Swelling in Breast Cancer - MedPage Today – By Crystal Phend
SAN FRANCISCO -- Five-year risk of lymphedema can be predicted with at least 70% accuracy using a
free online statistical tool, researchers found.
Concordance of predicted risk with actual outcomes was 70.6% when calculated preoperatively, 72.9%
when calculated within the first six months after surgery, and 73.6% when calculated further along in the
postop course, Jose Bevilacqua, MD, PhD, of Hospital Sirio Libanes in Sao Paulo, Brazil, and colleagues
reported.
Although some high-risk patients might be missed by the tool, this level of accuracy is similar to what has
been seen with mammography, according to Bevilacqua.
He reported the results at a press telebriefing in advance of presentation at the Multidisciplinary Breast
Cancer Symposium here.
This kind of risk prediction is an important step forward that could have real practical implications for
patients, commented telebriefing moderator Andrew D. Seidman, MD, of Memorial Sloan-Kettering
Cancer Center in New York City.
"It allows us to identify patients who can then be appropriately triaged for early intervention and perhaps for
clinical trials aimed at preventing what many consider inevitable [lymphedema]," he told reporters.
Bevilacqua suggested a strategy of close follow-up for patients identified as high risk by the lymphedema
prediction tool.
Currently, "patients are often referred when lymphedema is already very significant, where it begins to
interfere with function," Seidman noted at the briefing.
There's debate about whether any prevention strategies are actually effective, but, Seidman said, catching
the complication at an early stage can delay progression to the later debilitating stages.
Those early stage patients can be referred for physical therapy, and given compression sleeves and standard
instructions on prevention, such as avoidance of heat and heavy lifting with the affected arm, Bevilacqua
added.
His study used a prospective cohort of 1,054 women followed for lymphedema after axillary lymph node
dissection as part of surgery for breast cancer done at the Brazilian National Cancer Institute from Aug.
2001 to Nov. 2002.
The five-year cumulative incidence of lymphedema was 30.3%.
Significant independent predictors in the statistical models included:
For preoperative prediction, age, body mass index (BMI), and number of cycles of neoadjuvant
chemotherapy
For prediction within six months of surgery, age, BMI, number of cycles of neoadjuvant or adjuvant
chemotherapy, level of axillary lymph node dissection, and extent of radiotherapy field
For prediction beyond six months after surgery, all the earlier factors as well as development of seroma and
evidence of early edema
The researchers cautioned that their nomograms have yet to be validated on an independent cohort of
patients.
The online tool, found at lymphedemarisk.com, is hosted by the Cleveland Clinic, which collaborated on the
project. The Web site will be available temporarily during the conference (from September 8 through 10)
and permanently accessible after planned publication of the study.
The researchers reported having no conflicts of interest to disclose.
Seidman reported having served as consultant or advisor to Enzon and Wyeth and having received
honoraria from Celgene, Genentech, and Genomic Health.
Primary source: Multidisciplinary Breast Cancer Symposium
Source reference:
Bevilacqua JLB "Nomograms for predicting the risk of arm lymphedema after axillary dissection in breast
cancer" MBCS 2011; Abstract 8.
September 7, 2011
Hampton community events - Daily Press –
L.E.A.P- Lymphedma, Education, Advocacy, Program Support Group Meeting. 6 p.m. Sept. 15, Sentara
Hampton Careplex first floor conference room C. All are welcome to attend. L.E.A.P. is for patients, family
members, and/or friends suffering from lymphedema. Also, come hear about how you can make a difference
and learn more about the Lymphedema Treatment Act. Contact Tiffany at leap.director@gmail.com for
more information or visit http://www.wix.com/leapdirector/lymphedema.
This one has passed but sounds like it might be a regular meeting on Thursdays
September 7, 2011
Software Predicts Lymphedema Risk After Axillary Dissection – Medscape –
You have to be a member to access this article sorry
September 24, 2011
Telemedicine Service Launched at Shirgaon through Spanco's Maha E Seva Kendra - Business Wire India -
The telemedicine service for Filarias (Lymphedema) disease was launched in Maha e-Seva Kendra at
Shirgoan, under the National e-Governance Plan. Government of Maharashtra has implemented a National
e-Governance Plan (NeGP) to provide government services to the rural population at their doorstep at an
affordable cost .The telemedicine project is a part of the Common Services Centers scheme, and has been
implemented by Spanco through the CSC centre at Shirgoan.
The Telemedicine service was inaugurated, by the hands of Honorable Dr.Shashi Bhushan Gogia Director
SAATHI (NGO). Mr.Ravindra Jogal member of Zillah Parishad and Mr.Mangesh Dhopate Shirgaon
Sarpanch were also apart of the telemedicine launch event.
The Shirgoan Maha E Seva Kendra will facilitate Lymphedema Patient to get a check up done with a
nominal consultancy fee ranging between Rs.30-50/-in their village. For this activity Spanco Limited has
provided the facility to install the necessary equipments costing Rs.1.5 lacs in the Maha E Seva Kendra
center. Beside this Spanco has also made 10 special medical kits available each costing Rs.2000/- for
Lymphedema patients through this Center.
Spanco has taken this initiative in Sindhudurg as villagers are affected by this disease and along with local
social activist & health department Spanco intends to eradicate this disease from Sindhudurg district. During
the launch camp, 2 patients were methodically examined by Dr.Gogia as apart of the launch program.
“Detailed information about the disease is available in Spanco’s Maha e Seva Kendra and those people who
are suffering in the district are advised to take the benefit of this Telemedicine service by visiting the centre
“said Mr.Dhananjay Vartak- Head citizen Service Group, Spanco Limited.
For this Inauguration Honorable Dr.Mrs. Arunarekha Gogia, Dr.Ashish Keche Shiragon Primary Medical
officer, Ms.Sugandha Satam Zila Bank Vice President, Ms.Archana Kalra Spanco’s General Manager, Mr.
Sagar Tope Asst. General Manager Spanco, Mr.Sandeep Uttekar Area Manager Spanco and Mrs. Harsha
Ajit Chahan representative of Maha E Seva Kendra, Shirgaon were present at this function.
About Spanco
Spanco is in the business of creating Technology Infrastructure to help drive governance efficiency across
key sectors.Spanco is SEI CMM Level 3 and ISO 9001:2008 certified. We have more than 12,000
employees working across 4 continents.
Spanco caters to large complex Technology Infrastructure projects across Government, Power, Transport
and Telecom Service Provider’s space. We also have a formidable presence in the BPO space catering to
India, US/Europe, Middle East and African markets
September 23
Pink Ribbon Produce Launching at Price Chopper to Support Susan G Komen for the Cure – WBGH
From Price Chopper:
Pink Ribbon Produce, a unique retail program committed to raising breast cancer awareness, will return to
Price Chopper stores for its fourth year from October 2 through October 29. The educational fundraising
program partners the grocery retailer with produce suppliers in an effort to raise money for local Susan G.
Komen for the Cure® Affiliates.
“Price Chopper is proud to participate in the Pink Ribbon Produce program again this year as part of our
multifaceted year-round initiative to raise funds for breast cancer research and support services,” said Mona
Golub, vice president of public relations, consumer and marketing services for Price Chopper
Supermarkets. “During October, our customers can show their support for Susan G. Komen for the Cure
by buying healthy fruits and vegetables from the branded partners that are participating in the program.”
Barbara Connolly, who once worked at Price Chopper, is a courageous mother of five who was diagnosed
with breast cancer at just 29 years old. Connolly was passionate in her personal fight against breast cancer.
She drew inspiration from support groups led by Komen for the Cure and benefitted from grants to receive
treatment and supplies for Lymphedema, which developed after her breast cancer treatment. Connolly now
gives back to Komen by volunteering for the Northeast Pennsylvania (NEPA) Affiliate of Susan G. Komen
for the Cure. Connolly was awarded the Spirit of Hope Award by NEPA in 2011 and has inspired many by
her participation in “Pink in the Park,” a Northeast Pennsylvania Affiliate walking program. In addition to
walking, Connolly participated in Team Survivor and with just six weeks of training, ran a 5k during the
Susan G. Komen Race for the Cure®. She took third place in the survivor division in September 2010.
Through various fundraising activities, including Pink Ribbon Produce and the Race for the Cure series,
Komen has invested more than $1.9 billion in research and lifesaving community programs.
By bringing together Price Chopper, Komen and produce suppliers, Pink Ribbon Produce provides
shoppers with an easy way to give back to their communities and support efforts to find cures for breast
cancer. The money raised goes to local Komen Affiliates. Stores will direct shoppers to the participating
produce suppliers with a Pink Ribbon Produce program icon on posters and point-of-sale signs at the
product.
Produce partners supporting this year’s Pink Ribbon campaign include:
· Calavo
· Custom Pak
· Del Monte Fresh Produce
· Dole
· Earthbound Farm
· Fowler Packing
· Mastronardi
· POM Wonderful
· Santa Sweets
September 23, 2011
A Walk and a Wedding for Westbury's Nancy Safran - Westbury Times –
Westbury resident Nancy Safran never suspected retirement would be so frenzied.
Recently retired from Nassau BOCES after a 34-year teaching career – the past 24 years of which have
been “extremely rewarding” as a speech teacher for the hearing impaired – Nancy is now focusing on a
speech of a quite different kind.
On Oct. 1, Nancy and her husband, Howard, will proudly deliver some very special words at the wedding
of their daughter, Marnie.
“Helping Marnie to plan her wedding has been a joy,” said Nancy recently. “I miss teaching and the kids
and my colleagues so much, but this year – with the wedding and with Lymphatic Research Foundation’s
(LRF) New York Walk right on top of one another, I’m almost too busy to feel that September back-to-
school pull on the heartstrings.”
In addition to preparing for the wedding and volunteering with LRF, Nancy is finding that retirement gives
her time to pursue long-held interests and reconnect with friends.
She is taking golf lessons, has joined a book club and a canasta club, and tries to find time for frequent
walks on the Jones Beach Boardwalk. Over the summer she has been working extra volunteer hours with
the Glen Cove-based Lymphatic Research Foundation (LRF) to help garner support for their National Walk
for Lymphedema and Lymphatic Diseases at Eisenhower Park on Saturday, Sept. 24.
“As a family we have journeyed with lymphedema since Marnie was a little girl. We have faced serious
health issues, a frustrating lack of knowledge about lymphatic diseases, and a medical system that offers few
treatment options and little hope for reversing the sometimes devastating effects of lymphedema and other
lymphatic disorders,” Nancy explained. “Now I do what I can to inform and support other families facing a
similar situation; and I help LRF because I know that more scientific and medical research offers the best
hope for finding better treatments and cures.”
Born with congenital lymphedema, Marnie Safran, a 1999 graduate of W. Tresper Clarke High School and
now an early childhood special educator with the NYL Gramercy Pre-School in Manhattan, will be married
to Scott Lesser at Temple Chaverim in Plainview on Oct. 1
“Everything is finally all set,” said Marnie. “It’s going to be a great wedding. I’m still working on getting the
right shoes, but I know I’ve got the right life partner – and that’s what’s important,” Marnie added.
In honor of their wedding, Marnie and Scott are making a generous donation to support the work of the
Lymphatic Research Foundation. Founded in 1998 by Roslyn resident Wendy Chaite, LRF has become a
leader in patient advocacy and a primary force behind advancements in lymphatic science worldwide.
LRF’s advocacy programs have been effective in gaining Congressional and National Institutes of Health
(NIH) support for lymphatic research at the National Institutes of Health and at major academic research
centers, elevating lymphatic diseases from relative obscurity to a position on a par with other national health
priorities. The organization directly funds cutting edge lymphatic research by funding Postdoctoral Research
Fellowship Grants, a National Lymphatic Disease Patient Registry and Tissue Bank, a peer-review
biomedical journal in lymphatics, and the first-ever endowed academic Professorship in Lymphatic Research
and Medicine (Stanford University Medical School, 2008).
“I’m glad to be walking for LRF and walking for Marnie the week before the wedding,” said Nancy. “That’
s going to be a great day, too, with all of our friends coming out to support us.”
Visit www.walklrf.org for details and to support Team Safran.
September 22, 2011
Tennis Rally for the Cure, October 2, at the Mountain Home Tennis Center - Baxter Bulletin –
The Third Annual Tennis "Rally for the Cure" will be held Sunday, October 2, at the Mountain Home Tennis
Center. The Tennis Rally is open to women and men who want to help win the fight against breast cancer.
Rally for the Cure is the largest grassroots world-wide network of breast cancer survivors and activists
hosting a Rally that include tennis, golf, running and dining events created to support the promise of Susan G.
Komen for the Cure and spread the message that early detection saves lives. More than 1.3 million people
have participated in Rally for the Cure events across the nation since its inception in 1996. The program was
started by the sister of Susan G. Komen, who died at only 36 of breast cancer.
The Mountain Home Tennis Center Rally will begin at 11:00 a.m. at the Tennis Center. A complimentary
luncheon will be served for all participants and donors, followed by more tennis in the afternoon.. The cost
for the day is $25.00 a person ($20.00 for full-time college students) with checks made out to Rally for the
Cure and all proceeds going to the Foundation.
Each participant will receive a goody bag with Komen breast health information, an exclusive Rally bandana,
a pink ribbon pin, a Rally towel, a Rally Charm, Cards for the Cure from Hallmark and a one-year
subscription to a selection of Condi Nast magazines, including SELF, Bon Appetit, Architectural Digest and
other choices. Participants are encouraged to wear pink, the signature color of Rally for the Cure.
"We are proud and happy to again open the Mountain Home Tennis Center for the Cure event which is a
fun way to give our members and people from the area a chance to come together to support an important
cause while playing a sport they love", states Mark Klingelhoets, owner of the Tennis Center.
On October 2, Lisa McBrayer, Flippin, and Debbie Voss, ellvillle, will represent women like them in our
community who have battled breast cancer and survived. Lisa has been a local Ambassador for this cause
and instrumental in organizing the October Tennis Rallys the past two years, along with Maria Acree, Cindy
Holeyfield, Roberta Heldenbrand and Charlotte and Al Wynne. Lisa is grateful to the Komen foundation,
which provided her with a free wig and also a free massage every week while she was undergoing radiation
therapy at Carti.
Up to 75% of the net income from each Rally or Race stays in that local community " The Komen Grant
touches us personally in Mountain Home because of this", states Karyn Klingelhoets, one of the Rally
organizers. "Here is some of what comes home to us from the Komen Grant":
CARTI radiation treatment regardless of income, ability to pay or distance from a CARTI facility.
Treatments typically last 4-6 weeks.
Baxter Regional Medical Center provides schools with a "TELL YOUR MOM, SAVE A LIFE" outreach
program aimed at education and prevention at all ages.
BRMC Mobile Mammography Unit which travels to provide easy access to remote areas and workplaces
to provide reduced cost mammography.
Lymphedema Outreach VI to provide compression garments to survivors after surgery.
The mission of Rally for the Cure has been to emphasize the vital importance of early detection in the
successful treatment of breast cancer and to someday eradicate this life-threatening disease. According to
Komen for the Cure, each year breast cancer is the leading cause of death for women ages 35-54 and
accounts for more then 75% of all cancer deaths in women 55 years of age and older. Since 1996, Komen
has received over $46 million from Rally events nationwide to support their mission.
Rally for the Cure is based in Wilton, Connecticut. They can be reached at 800.327.6811 or at their
website: www.rallyforthecure.com.
To register for the October 2 Rally in Mountain Home, call the Tennis Center at 425-5009 or stop in at the
Tennis Center at 111 CR 27.
Take Hwy 5 No. to Roller Funeral Home. Turn right just past the cemetery onto Canne Baker (Hwy 27).
The Center is located on the immediate right. Donations should be made out to Rally for the Cure and sent
to the Tennis Center, or call to have a Rally organizer pick up your contribution.
September 22, 2011
Doctors' Choice earns accreditation - Daytona Beach News-Journal – by Peggy Ellis
SOUTH DAYTONA -- Doctors' Choice, a home health service, has earned accreditation by the
Accreditation Commission for Health Care Inc. (ACHC) for the services of skilled nursing, home health
aide, therapy and social work.
Doctors' Choice Home Health provides skilled nursing, therapy, medical social work and home health aide
services to clients in Volusia and Flagler counties. The company also offers psychiatric and wound certified
nurses, lymphedema treatment, intravenous therapy administration, cardiac care, balance and low vision
programs, diabetic education and pulmonary rehabilitation.
ACHC, a private, not-for-profit corporation, was developed by home care and community-based providers
to help companies improve business operations and quality of patient care. Accreditation is a voluntary
activity where healthcare organizations submit to peer review for their internal policies, processes and patient
care delivery against national standards.
September 22, 2011
Laurantis Pharma Release: New Treatment for Lymphedema Could Mean Breakthrough for Breast Cancer
Patients - PipelineReview.com
Laurantis Pharma announced that LymfactinTM, adenoviral VEGF-C growth factor therapy, was successful
in rebuilding lymphatic vessels in pre-clinical animal models
STOCKHOLM, Sweden | September 21, 2011 | Laurantis Pharma, a privately held biotechnology
company based in Finland, today announced that LymfactinTM, adenoviral VEGF-C growth factor therapy,
was successful in rebuilding lymphatic vessels in pre-clinical animal models. The use of VEGF-C growth
therapy to regenerate lymphatic vessels over time may be used to assist lymph node transfer surgery as a
technique to treat secondary lymphedema.
The results were presented at the 23rd International Congress of Lymphology in Malmö, Sweden by Kari
Alitalo, MD, PhD, Academy Professor, Molecular Cancer Biology Program
Biomedicum Helsinki, University of Helsinki, and Anne Saaristo, MD, PhD, Consultant Plastic Surgeon,
Turku University Central Hospital, Turku, Finland. The researchers were able to demonstrate VEGF-C’s
ability to induce the spontaneous growth of lymphatic vessels during the first two weeks of treatment, which
then stabilized and matured over the course of the next six months.
The ability of VEGF-C to regulate the growth of lymphatic vessels presents an advantage for the use of
lymph node transfer as a way of treating lymphedema. Currently lymph node transfer is being tested as a
way to rebuild the lymphatic vascular anatomy but no treatment currently helps to assist the spontaneous
growth of lymphatic vessels.
“Breast cancer patients have an urgent need for better treatments for lymphedma,” said Dr. Saaristo. “With
Lymfactin, we see the potential to increase the impact of the operation and reduce the amount of lymphoid
tissue that needs to be removed from other parts of the body. Ideally Lymfactin will result in more durable
lymph node transplants, reducing the need for painful pressure bandages.”
Lymphedema
Lymphedema, localized swelling due to fluid accumulation, is caused by the disruption in the flow of
lymphatic fluid, usually associated with the removal of lymph nodes as treatment for breast cancer. About 20
to 30 percent of patients who have had lymph nodes removed as a part of treatment for breast cancer will
develop chronic lymphedema. Currently, there is no cure for the condition, and treatments are limited in their
ability to reduce swelling and reduce the risk of infection.
About Laurantis Pharma
Laurantis Pharma is a clinical-stage specialty pharmaceutical development company with a broad portfolio
of first-in-class products based on two proprietary technologies. The Company’s lead products target the
treatment of a variety of inflammatory diseases and conditions including atopic dermatitis, dry eye syndrome,
interstitial cystitis, and lymphatic disorders, as well as the treatment of bladder cancer.
The Company’s pipeline includes proprietary and patent-protected formulations and applications of cis-uroc
anic acid (cis-UCA), a locally acting anti-inflammatory and anti-proliferative agent. Laurantis Pharma is also
developing Lymfactin™, a vascular endothelial growth factor C (VEGF-C) in an adenoviral vector, for the
treatment of secondary lymphedema. Laurantis Pharma is located in Turku, Finland. More information can
be found at www.laurantis.com
SOURCE: Laurantis Pharma
September 22, 2011
in, Fatigue, Cognitive Deficits in Breast Cancer Survivors – Medscape –
Sorry you have to be a member of something to get this article
September 25, 2011
Dighton family seeks to raise awareness, a cure for lymphatic diseases - Taunton Daily Gazette – By Joan
Psotto –
Dighton —
With the exception of lymphoma – a cancer of the lymphatic system – most people have never heard of
lymphatic disease. That changed four years ago for one Dighton couple when their daughter, Giana, was
born with a lymphatic malformation of the head and neck.
Initially diagnosed at birth with a bronchial cyst, a fairly common congenital anomaly, little Giana was sent
home at one week of age. But with a mother's instinct, Wendy Richard knew something more serious was
interfering with Giana's breathing. When she was two weeks old Giana was admitted to Children's Hospital
Boston where specialists diagnosed the lymphatic malformation.
“It was a nightmare,” says Wendy now. “My son was 21 months old and my infant daughter had a life-
threatening condition that was preventing her from breathing normally.”
Giana underwent schlerotherapy (injections to break down the cystic mass); and at one month old was sent
home with a tracheotomy to open her airway. “At first they told us the trach would be removed by her
second birthday; but she's 4 now, and now we're hoping that it will come out next summer,” said her mother.
Wendy recalls the first few difficult months at home: “It was terrifying ... not only did Giana have special
medical needs and infection risks because of the tracheotomy and breathing difficulties, (but) she could not
make any sound. You had to be looking at her to know she was crying. Someone had to be with her all the
time, even when she slept.”
The family had home nursing assistance for Giana's first three years.
The family struggled — and continues to struggle — with the difficulties of having a child with a rare disease.
“Giana's first year was a very difficult time, a terrible strain on our family — emotionally and financially,”
recalls Wendy. “I wasn't able to go back to work. There was so much to learn about and so much to worry
about. And no one could tell us what kind of future our little girl would have. We felt like pioneers, but we
also felt guilty thinking that — as parents — it was somehow our fault. That was the hardest thing. There is
just no way to know why this happened to Giana and still happens to other children. At this point there isn't
enough known about lymphatic diseases and malformations to know what causes them or what will cure
them.”
Giana's father Chris agrees, but says that their daughter's condition has also been a blessing to the family.
“Giana's struggle with this lymphatic malformation has helped our family grow closer together and closer to
God,” he said. “We just keep believing that God will help us to work it all out.”
Now 4 years old, Giana runs and plays with other children, but doesn't understand why she cannot romp in
the waves at the beach or play in the pool with her brother and cousins. She began pre-K this September,
and her brother Zachary is in kindergarten.
Her parents and grandmother, Taunton resident Karen Castro, have become advocates for lymphatic
disease awareness. They have reached out to the Lymphatic Research Foundation, a non-profit organization
supporting biomedical research of the lymphatic system and advocacy for lymphatic disease patients.
“It's amazing to me that no one has heard of this,” says Castro, Wendy’s mom. “They ask why Giana has
the tracheotomy ... and no one's ever heard of lymphatic malformations or even knows what the lymphatic
system is. Aside from worrying about Giana, that's the most frustrating thing ... no one has even heard of
what she has!”
The family will be walking with Giana to raise awareness of lymphatic diseases and to raise funding for
lymphatic research at the Oct. 2 National Walk for Lymphedema and Lymphatic Diseases in Melrose.
“Giana's Dream Team will be out there walking for our girl,” says Castro.
To learn more about the Walk, and to support the Richard family's efforts, visit www.walklrf.org or www.
lymphaticresearch.org.
Joan Psotto is affiliated with the Lymphatic Research Foundation.
Copyright 2011 The Taunton Gazette. Some rights reserved
September 25, 2011
Telemedicine Service Launched at Shirgaon through Spanco's Maha E ... - IT News Online
This is a duplicate article see above September 24, 2011
September 25, 2011
Andrew set for gruelling fundraiser - NW Evening Mail –
A SEVERELY disabled man will complete a gruelling solo wheelchair push to raise money for other people
affected by his condition.
Double amputee Andrew Stevens, who has spina bifida and hydrocephalous, will push himself on a six-mile
route around Barrow on October 15.
The 40-year-old, who lost both legs to lymphedema in 2005, will set off from The Forum, in Duke Street,
and travel around Holbeck, Roose and town centre streets.
His friend Bryn Tyson, 17, will be accompanying him to provide moral support.
Mr Stevens completed a five-mile push last year in memory of a friend who died 20 years ago. This year he
was determined to do it to raise money and awareness for people with spina bifida.
It took him around three hours to complete the task last year, and Mr Stevens has a similar target for when
he does it this time round.
Mr Stevens, of Ewan Close, Barrow, is now drumming up support for the challenge, which will raise money
for the Association for Spina Bifida and Hydrocephalus.
He said: “Last time, I did it in memory of a friend, but as spina bifida affects people around the world, I
wanted to do something for that.
“ASBAH has helped so many people in my situation with help and advice, I think it’s important to give
something back so they can continue helping people.
“I got a real sense of achievement from it last time, but this time it has been a real struggle getting people to
sponsor me. Everybody has got financial problems or worries.
“I have been in a wheelchair all my life. I was born with spina bifida and because there was a hole in my
spine, my mother was told they could either operate to close it, which would paralyse me, or I would not
survive.
“I’ve been training for a few months for it. I try and get out and do a couple of miles in my chair whenever I
can motivate myself, because you need a lot of strength in your arms. I just keep pushing until I’m tired.”
To sponsor Mr Stevens, visit www.justgiving.com/Andrew-Stevens0.
September 26, 2011
Traveling? Veterans share the lowdown on flying after cancer treatment - MLive.com – by Sue Schroder
Karen Hogan puts it well: You decide how much risk you let into your life.
Hogan, a breast cancer survivor who has been cancer-free for three years, is no stranger to risk, but there’s
one she won’t take: air travel.
She had 18 lymph nodes removed following breast cancer surgery, and two more nodes five months later.
As a result of that and radiation, she says air travel, with its changes in air pressure, would increase her risk
of developing lymphedema.
For her, that would be a painful and debilitating swelling of her right arm and hand, which could be, she says,
even disfiguring.
“I don’t know what percentage of risk that could be, but I have met too many women with lymphedema,
and when I ask them if they have traveled via an airplane, they have all said yes. So, I am very scared to
potentially trigger this lifetime side effect for me.
“I treat my arm like having a special needs child with me,” said Hogan, who calls it a small price to pay for
being alive. She took part in a one-year clinical trial designed to prevent lymphedema through the Lemmen-
Holton Cancer Pavilion, Spectrum Health and Mary Free Bed Rehabilitation Hospital.
“Maybe I know too much now. But I follow the instructions/tips to a T — carrying my purse on my
nonaffected side, not carrying anything (that weighs more than) a gallon of milk, no manicures on my right
side — wearing my (compression) sleeve when I exercise, etc.”
She’s given up air travel, but she’s still on the go on her terms: She drives, or in the case of a cross-country
business trip, takes a train.
“I guess I would love to know — now, three years later — if those restrictions on travel have changed? And
am I being too overkill on this or not?”
The risk has not gone away.
“Lymphedema can flair up on airplanes, so the National Lymphedema Network has some precautions,” said
Deb Bisel, oncology nurse and manager of Cancer Program Compliance for Spectrum Health Cancer
Services.
“There are many considerations (about traveling and cancer),” Bisel wrote in an email. “We have a fair
amount of people who winter in warmer climates, and have part of their treatment here and part elsewhere.
Due to our electronic environment, it is becoming easier for physicians to communicate and set up treatment
plans.
“If (a patient is) under active treatment, there should be some pre-planning to know where the hospitals and
local resources are for your destination.
“I’ve personally contacted an oncology nurse in the area where a patient is traveling, if I have concerns that
they could get in trouble while away. The patient then has a local contact number to seek help or advice for
an unplanned side effect, for example.”
Advice which takes on extra significance for those of us who have experienced blood clots: On long flights,
wear compression hose. I just traded up to full foot-to-knee compression socks by Zensa.
Sue Schroder, former features editor for The Grand Rapids Press, was diagnosed with non-Hodgkin’s
lymphoma in late 2009. Email her at livenow.ss@gmail.com.
September 25, 2011
Cancer survivor joins CIBC Run for the Cure - Calgary Herald –
CALGARY — Active, healthy and a hard-working career woman in her late 40s, Diane Martin had always
avoided mammograms, figuring she was too young to worry about breast cancer.
In May 2000, her doctor finally convinced her to go for a routine ultrasound as part of her annual physical,
which revealed swollen lymph nodes under her arm, near her left breast.
A biopsy soon after confirmed stage 3 breast cancer, and Martin’s breath was taken away.
“I remember my doctor came into the room and sat down, pulling her chair very close to me,” she said.
“I knew something was up. But you can never prepare yourself.
“When she said the two words ‘breast cancer,’ I lost my breath. I didn’t hear much of anything else she said
after that.”
About two months before her diagnosis, Martin had lost her own father to lung cancer. He died just two
weeks after checking into the hospital, worried about pneumonia-like symptoms.
“I thought I would end up the same. I thought, that’s it, I have two weeks left to live. What am I going to
do?”
But the next few weeks brought on what Martin likes to call her “warrior face” and she took her battle head
on, realizing she had too much to live for.
“I thought, ‘I want to live, I want to meet more people. And I want people to meet me, because I’m a pretty
special person,’” she said.
A lumpectomy, followed by six weeks of chemotherapy and one month of radiation left her exhausted,
shaken and plagued by constant nausea.
But a life once devoted to career, collecting money and material wealth, changed completely for Martin.
She still remembers one night during her recovery “I was sitting outside one summer night. It was 4 a.m. and
I couldn’t sleep. I looked around at the trees and the flowers and I thought, ‘have these always been here?
Because I’d never really noticed them before.’”
She quickly became involved in volunteer work, the CIBC Run for the Cure, and helping other women
battling breast cancer.
But her difficult road wasn’t over.
A year later, a small cut on her left hand led to massive, painful swelling all along her left arm.
Because lymph nodes had been damaged during her surgery, lymphatic fluid was building up as it reacted to
infection in her hand.
It wasn’t cancer, but a case of lymphedema few doctors were able to help her with.
After hundreds of phone calls, Martin was able to finally find a lymphedema therapist that was able to
massage the fluid out of her arm and into the rest of her body.
Although the ailment is typical in breast cancer survivors, help is hard to find. So Martin and her therapist
created the Alberta Lymphedema Association to provide support for sufferers and better education and
awareness within the medical community.
Over the next several years, Martin continued her volunteer work and also helped her sister battle kidney
cancer.
But, by 2007, Martin found another lump near her left breast as she lathered up in the shower.
It was only days before her annual check up.
A mammogram, followed up by another biopsy confirmed, again, stage 3 cancer.
And while Martin, “warrior-face” on was ready to fight once more, it was her husband Doug, that found the
news really hard to take.
“I could tell it was really hurting him this time.”
Her second bout of chemotherapy was much more difficult than the first, forcing her to lay in bed for up to
eight hours at a time, connected to an IV, being fed an even harsher concoction this time.“The pain was like
my bones were being squeezed together, three or four days at a time,” she said. “It was terrible. Every time
I came back for the next round, I knew how bad it was going to be.”
After her final round in late 2007, Martin found yet another lump in the same area and was sent straight to
surgery.
But this time doctors confirmed it was benign.
The good news and her clean bill of health since has Martin now working as co-run director for the CIBC
Run for the Cure for the Prairies and NWT region.
Up to 5,300 runners are already registered for this year’s run, eager to beat last year’s fundraising total of
$1.7 million.
Martin looks forward will be run alongside other survivors like her, ready to lend a helping hand, and a
supportive ear.
“When you go you have to just stop and look around. It’s a sea of pink,” she said. “And everyone is there
to support each other.
“It’s a wonderful feeling.”
September 24, 2011
Lymfactin™ Found To Significantly Increase Growth Of Lymphatic Vessels In Animal Study –
Laurantis Pharma, a privately held biotechnology company based in Finland, announced that LymfactinTM,
adenoviral VEGF-C growth factor therapy, was successful in rebuilding lymphatic vessels in pre-clinical
animal models. The use of VEGF-C growth therapy to regenerate lymphatic vessels over time may be used
to assist lymph node transfer surgery as a technique to treat secondary lymphedema.
The results were presented at the 23rd International Congress of Lymphology in Malmö, Sweden by Kari
Alitalo, MD, PhD, Academy Professor, Molecular Cancer Biology Program Biomedicum Helsinki,
University of Helsinki, and Anne Saaristo, MD, PhD, Consultant Plastic Surgeon, Turku University Central
Hospital, Turku, Finland. The researchers were able to demonstrate VEGF-C's ability to induce the
spontaneous growth of lymphatic vessels during the first two weeks of treatment, which then stabilized and
matured over the course of the next six months.
The ability of VEGF-C to regulate the growth of lymphatic vessels presents an advantage for the use of
lymph node transfer as a way of treating lymphedema. Currently lymph node transfer is being tested as a
way to rebuild the lymphatic vascular anatomy but no treatment currently helps to assist the spontaneous
growth of lymphatic vessels.
"Breast cancer patients have an urgent need for better treatments for lymphedma," said Dr. Saaristo. "With
Lymfactin, we see the potential to increase the impact of the operation and reduce the amount of lymphoid
tissue that needs to be removed from other parts of the body. Ideally Lymfactin will result in more durable
lymph node transplants, reducing the need for painful pressure bandages."
Lymphedema
Lymphedema, localized swelling due to fluid accumulation, is caused by the disruption in the flow of
lymphatic fluid, usually associated with the removal of lymph nodes as treatment for breast cancer. About 20
to 30 percent of patients who have had lymph nodes removed as a part of treatment for breast cancer will
develop chronic lymphedema. Currently, there is no cure for the condition, and treatments are limited in their
ability to reduce swelling and reduce the risk of infection
September 26, 2011
Lymphedema Depot Fundraising for Lymphedema Association of Ontario - Wire Service Canada –
It’s that time of year again! It's time for Team Niagara to put on their walking shoes to support the
Lymphedema Association of Ontario in their annual fundraising 5K walk/run.
On October 16, 2011, Lymphedema Depot and Team Niagara will be participating in a local fundraising
event. This local event in St. Catharines, Ontario, is a satellite event to the annual Scotiabank Toronto
Waterfront 5k Run/Walk.
Lymphedema Depot will be raising funds for The Lymphedema Association of Ontario (LAO) as we take a
5K walk (you can run if you like) along the scenic Welland Canal in St. Catharines, Ontario.
The work of the LAO supports the lymphedema community in Ontario and beyond.
According to John Mulligan, a registered massage therapist and certified lymphedema therapist, and Clinical
Specialist with Lymphedema Depot, "The LAO gives a voice to lymphedema patients and connects them
with therapists, goods and services and, most importantly, connects them with one another. The LAO has
been putting on conferences and publishing a newsletter for 15 years now, and they need our support to
continue.The LAO gives a voice to lymphedema patients and connects them with therapists, goods and
services and, most importantly, connects them with one another. The LAO has been putting on conferences
and publishing a newsletter for 15 years now, and they need our support to continue."
"Not only does the LAO support lymphedema patients and therapists but their work crosses over into
helping patients with lipedema, venous insufficiency and other related conditions. Not only do they support
lymphedema patients and therapists but their work crosses over into helping patients with lipedema, venous
insufficiency and other related conditions."
Mulligan states, "If you are in the Niagara region and you would like to come out on October 16 and join
Team Lymphedema Niagara in this awareness and fundraising event for the Lymphedema Association of
Ontario, the Team would love to hear from you!"
Contact team captain, John Mulligan
at John@LymphedemaTherapist.com or (905) 687-1828.
If you can’t make it, please consider making a donation online in support of the LAO using the link provided
here:
http://my.e2rm.com/TeamPage.aspx?teamID=259759&langPref=en-CA.
You can learn more about the Lymphedema Association of Ontario here:
http://www.torontowaterfrontmarathon.com/en/charity/lao.htm.
"I can’t overstate the importance of the Lymphedema Association of Ontario and the work they do, and
have done for the past 15 years," Mulligan continued. "Through their persistent efforts they have made the
general public and the medical profession more aware of lymphedema."
"No donation is too small and every dollar helps this wonderful non-profit organization to accomplish their
important objectives. Any donation cheque must be made out to the Lymphedema Association of Ontario,
or simply LAO."
All pledges will receive an official tax receipt.
September 27, 2011
Cancer Patient Carrying Out Voluntary Work to Help Other Patients - French Tribune –
Most of the women do not go for mammograms and end up with cancer diagnosed at advanced stages, this
is what happened with Diane Martin who did not underwent mammograms thinking that it was too early to
get the check-up done.
But finally in 2000, she underwent ultrasound where swollen lymph nodes under her arm besides her breast
were discovered, which was later identified as stage-three breast cancer.
Her doctor had many a times asked her to go for the check-up but she delayed the issue which resulted in
breast cancer at advanced stage. If she would not have been thinking much, she would have got her cancer
detected timely. Similar is the case with lot of women who due to some reasons do not consider it as
necessary and end up in screwing up their lives.
After undergoing treatment, she is now working as volunteer at the Canadian Breast Cancer Foundation
CIBC Run for Cure and has been providing help to women in need.
Even after the surgery, lymphatic fluid was building up in her arm, so she finally found a lymphedema
therapist who helped her take the fluid out.
Now, she and her therapists have joined hands with Alberta Lymphedema Association that make the
women aware about the early diagnosis and help them in related problems.
inful surgery to remove the lymph nodes is not necessary for some women – Ocala – By Molly Larmie -
For more than 100 years, standard treatment for breast cancer has included a painful surgery: the removal of
lymph nodes under the armpit. But a new study finds that for 20 percent of invasive breast cancer patients
— around 40,000 women in the U.S. each year — radiation and chemotherapy treat the cancer just as
effectively as removing the nodes.
The study, conducted by the American College of Surgeons Oncology Group, throws the traditional view of
breast cancer treatment "out the window," said Dr. Uma Swamy, a radiation oncologist at North Florida
Regional Medical Center.
Once breast cancer reaches the lymph nodes, it has the potential to spread to other vital organs. If cancer is
detected in the armpit, wary surgeons typically remove about 10 nodes.
"The thought with cancer has usually been ‘Cut, cut, cut — take as much out as possible,'" Swamy said.
Painful complications can accompany node removal surgery, including infection, limitation of motion and
lymphedema, a chronic swelling in the arm. These side effects have long been considered necessary evils in
the successful treatment of breast cancer.
But the study, published in The Journal of the American Medical Association, finds there is no difference in
overall survival rate between women who had 10 or more lymph nodes removed and those who had only
one or two removed for testing.
The findings turn over a new leaf in the much-evolved history of breast cancer treatment.
Forty years ago, the standard of treatment for breast cancer was the Halsted radical mastectomy, in which
surgeons removed the whole breast and surrounding muscles. Lymph nodes in the armpit were removed in a
procedure called axillary lymph node dissection, or ALND.
Over time, as research shed new light on the disease, rates of mastectomy declined. Most breast cancer
patients today undergo a lumpectomy, in which doctors remove large tumors in the breast and treat
microscopic disease with radiation and chemotherapy.
A technique called sentinel lymph node dissection, or SLND, is commonly used to detect cancer in the
lymph nodes. Using SLND, physicians inject dye into the breast and observe the path the dye takes to the
lymph nodes. If cancer has spread from the breast to the lymph nodes, this is the route it would have taken.
The illuminated or "sentinel" lymph nodes are removed and tested for cancer. If the nodes test negative, the
patient will not require further surgery in the armpit. If a positive result comes back, surgeons usually remove
eight to 10 additional nodes.
After armpit surgery, some women experience numbness, limited range of motion or lymphedema, a painful
swelling in the arm that occurs when scar tissue blocks the flow of fluid. Radiation increases the risk for
lymphedema, which has no cure.
The lead author of the study, Dr. Armando Giuliano, and his team worried that physicians were ordering
painful surgeries for patients with no proof that removing the lymph nodes actually increases the chance of
survival.
With funding from The National Cancer Institute, the researchers enrolled 891 patients at 115 medical
centers into the study. All patients had early invasive breast cancer with tumors less than 2 inches across and
no more than two cancerous sentinel lymph nodes.
After undergoing lumpectomies and whole-breast radiation, the women were randomly assigned to either
undergo ALND, with 10 or more lymph nodes taken out, or no further surgery.
The reduced risk of complications could help sway their decision. With radiation and SLND alone, patients
have a less than 5 percent risk of lymphedema, Swamy said.
"As a patient, you must be careful and talk to your physicians to make sure the study applies to you,"
Swamy said. "And it is the physician's responsibility to make sure patients understand as much as they need
to make an informed decision."
Marshall Browning & SIH Reach Affiliation Agreement - Du Quoin Evening Call –
Du Quoin, Ill. —
Marshall Browning Hospital (MBH) in Du Quoin and Southern Illinois Healthcare (SIH) in Carbondale
today announced a formal affiliation between the two facilities.
Under the affiliation, patients of Marshall Browning Hospital will continue to receive high-quality care from
the providers they know and trust at the hospital they have long relied upon. MBH will remain as a separate
entity with its own Board of Directors, identity and endowment.
"Marshall Browning Hospital is pleased to partner with a highly regarded organization such as SIH to
enhance services for the residents of Perry County through outreach, development and clinical integration,"
says William Huff, CEO, Marshall Browning Hospital. Huff emphasized that “this is not a merger or
acquisition and that Marshall Browning Hospital would retain its own identity. The affiliation will provide a
rich spectrum of educational, administrative, and clinical opportunities in the healthcare professions, meet
community needs for high quality, cost-effective healthcare and develop new regional linkages among
healthcare providers.”
A significant benefit of the affiliation is for patients with complex medical needs who require tertiary care or
specialty services unavailable at MBH. The affiliation will offer better coordination of care and services
through such means as an expanded pool of consulting subspecialists. In addition, SIH will work closely with
the hospital to identify opportunities to enhance the services available at MBH.
"The Marshall Browning Hospital Board took extensive steps to consider the affiliation prior to formal
adoption and feels confident that the alignment is proper and in the best interest of the hospital and the
patients it serves," stated Harold Rice, President of the Marshall Browning Hospital Board. William Huff,
CEO, added that a key benefit of the affiliation is allowing the hospital to remain a local facility with "local
citizens serving on the Board to work to provide services for the citizens in its service area."
The affiliation builds on and expands the various collaborations that already exist between SIH and MBH
such as its partnership with SIH and Prairie Cardiovascular through its Prairie STATHeart program.
STATHeart identifies, treats, and transfers acute heart attack patients to a cardiac cath lab within 90 minutes
of arriving in Marshall Browning Hospital’s emergency room. The STATHeart program melds cooperation
and collaboration between the community hospital emergency department, EMS ground and air transport,
Memorial Hospital of Carbondale and cardiologists of Prairie Cardiovascular.
In addition, SIH physicians have long consulted at MBH, seeing patients in such specialties as cardiology,
oncology/hematology, and pulmonology.
“The affiliation is not meant to be disruptive of pre-existing clinical relationships or referral patterns. Rather
we want to work closely with the hospital to identify gaps in care and determine how SIH can help fill in
those gaps as well as reinforce or add services that will be helpful to Perry County” said SIH President and
CEO Rex Budde.
Marshall Browning Hospital is a not-for-profit Critical Access Hospital providing a broad range of services
to citizens of Perry County and the surrounding communities. Founded in 1919, the 25-bed hospital
maintains a deep tradition of providing high-quality care to a service area of over 20,000.
The hospital also includes Marshall Browning Therapy Center, located on the hospital campus. Services
offered at the center include Physical Therapy, Occupational Therapy, Speech Therapy, Athletic Training,
ImPACT Concussion Testing, Aquatic Therapy, Lymphedema Therapy, Vestibular Therapy, Hand
Therapy, Pediatrics and Hippotherapy. Marshall Browning Therapy Center also has become the only facility
in southern Illinois to have certified instructors to offer the highly acclaimed Sportsmetrics™ Training
Program, effective in reducing the risk of knee injuries in female athletes.
The campus also includes a 22-unit Independent Living Center and Marshall Browning Medical Clinic that
includes the practices of Dr. Gladstone Tucker, Dr. Terrence Hall, Dr. Beth Bigham, and Family Nurse
Practitioner, Felicia Kimbrough. Marshall Browning Hospital is fully accredited by The Joint Commission.
The hospital has in excess of 43,000 patient visits which include inpatient, outpatient and ER visits per year.
Southern Illinois Healthcare includes Memorial Hospital of Carbondale, Herrin Hospital, St. Joseph
Memorial Hospital, the SIH Cancer Institute and Miners Memorial Health Center.
Copyright 2011 Du Quoin Evening Call. Some rights reserved
September 28, 2011,
Life After Breast Cancer Can Be Difficult: Dr. Pearman - MyFox Chicago -
Chicago - More women than ever before are surviving breast cancer, but some still struggle to feel normal
and healthy after beating their disease. Dr. Timothy Pearman, a clinical psychologist and director of the
supportive oncology program at Northwestern Medicine and the Robert H. Lurie Comprehensive Cancer
Center, joined us.
Pearman said after battling breast cancer, woman may struggle with fatigue, cognitive problems (sometimes
known as chemobrain), nutrition, depression and side effects that may present themselves years after
treatment. Quality of life for breast cancer survivors, in particular, is often affected by lymphedema,
premature menopause and concerns about their risk of recurrence and libido.
A lot of these issues, which may be either disease related or treatment related, tend to revolve around
emotional support. Anywhere from 30 to 50 percent of patients will be clinically depressed or experience
clinical anxiety at some point during their treatment, Pearman said.
To make the transition to life after breast cancer easier, woman can take care of their mental and physical
health, Pearman said. Specialists like social workers, cancer rehabilitation therapists, nutritionists and health
educators can be a big help in helping women striving to live healthy lives after cancer.
The free Lynn Sage Breast Cancer Town Hall Meeting on Sunday, Oct. 2 is open to the public from 1 p.m.
until 4 p.m. in the Arthur Rubloff Building’s Thorne Auditorium, 375 East Chicago Avenue, on
Northwestern University’s Chicago Campus. Exhibits and registration start at noon.
Recovery Club: Pro-Level Training Tools for Weekend Warriors - Wired News – By Joe Lindsey -
I lean back in a chaise lounge while what look like the world’s largest blood pressure cuffs slowly inflate
around my legs. But this is no medical test: This is the future of active recovery for amateur athletes.
Professional athletes have for years had access to better training tools and techniques than us workaday
amateurs. They benefit from more sophisticated approaches because the price, complexity, or simple rarity
of many of these modalities puts them out of reach of the rest of us.
Josh Shadle hopes to change all that. A longtime massage therapist, Shadle earlier this year opened
AllSports Recovery Club, which he believes is the first open-to-the-public recovery center in the world.
And while his clientele includes pro athletes, he’s targeting amateurs, giving them access to the same tools as
elite competitors.
“I’ve been doing massage for five years,” he says, “and the next step, to me, was a walk-in recovery center
where people could go and use these tools themselves, without anyone having to do it for them.”
AllSports is focused on FDA-approved products that you can use without medical supervision. The suite of
tools runs a broad range, from cold lasers to a custom temperature-controlled ice bath that circulates
saltwater at a constant 50 degrees. One ingenious hack is a $25 Ryobi six-inch orbital buffer, perfect for
self-massage.
But the star of the show is clearly the NormaTec MVP boots, a compression therapy that Shadle likens to
an extremely effective massage. You can buy static compression clothing, but the research on its
effectiveness is mixed.
The NormaTec system, by contrast, uses dynamic sequential gradient compression, which is a fancy way of
saying it pressurizes five separate chambers in sequence; you can control intensity and duration to match
your needs.
Clinical research in sports recovery hasn’t caught up to use yet, but the system — invented for hospital
patients — has been shown effective in medical settings at counteracting lymphedema, the painful and
dangerous pooling of lymphatic fluid in tissues.
Dynamic compression’s action mechanism for sports recovery is unclear. It may help speed toxins and
promote circulation; it may enhance muscles’ thixotropic properties — their ability to become more flexible
when used.
Mesa State University’s Bill Sands, a physiologist who formerly ran the United States Olympic Training
Center’s recovery facility, says compression — particularly dynamic compression like the NormaTec
system — is one of the few recovery modalities he’s studied that show clinical promise for producing an
actual performance benefit.
Anecdotally, results are more emphatic. Mirinda Carfrae, the reigning Ironman World Triathlon Champion,
and an AllSports client, says that ice baths AND NormaTec boots are her top choices for post-workout
recovery.
So what’s to stop you from getting this stuff yourself? Well, a pair of boots is $5,000, for one. An ice bath
from iCool, one of the cheapest available, will set you back another $4,990 or more. Cold lasers are cheap
by comparison, starting around $300 for a basic model.
Shadle’s club offers unlimited walk-in access to all that for $60 a month, plus discounted à la carte services
like chiropractic, massage and Graston technique. “I’ve been to the USOC’s recovery room,” says
NormaTec vice-president Gilad Jacobs, “and what Josh has going is every bit as good as that.”
For a retail model, Shadle is less focused on the gym or yoga studio model and more on an icon from the
tech industry: Apple. “I envision it like the Genius Bar,” Shadle says. “You come in and tell us what
problems you’re having and we set you up with the tools and a recovery protocol to help. It’s free advice,
so that we can help educate people to get the kind of help they need to be healthy and improve their
performance.”
That’s great, I think, but I still have two questions.
First, do amateur athletes really need all that? After all, we don’t work out as hard as pros.
Sure, replies Shadle. “In fact, we think amateur athletes have more to gain here. Pros are already focused on
recovery and are looking at single-percent performance gains. But amateurs often don’t have time for
recovery workouts; when they work out they go hard every time. So muscles get tight from all that
metabolic waste, and it builds up and people never really recover. With amateurs, the room for improvement
is so much bigger.”
Second, right now the only location is in Boulder, Colorado, a town known for being packed wall-to-wall
with endurance athletes at 4 percent body fat. Will it play, as they say, in Peoria?
Shadle hopes so. He realizes not every city could support an AllSports, but that’s part of why the price is
set where it is. “This is the same price as a one-hour massage,” he points out, “but you can come here every
day if you like.”
And because everything is in one place, AllSports might be all you need. Carfrae has a set of NormaTec
boots at home, but comes in anyway, she says, because of what else AllSports offers. “I can go in for a
massage, do some Graston, or jump in the ice bath and use the boots,” she says of the range. “It’s a one-
stop shop.”
Carfrae defends her title on Oct. 8. You can bet Shadle will be watching closely.
September 28, 2011
Nomograms can predict 5-year lymphedema risk - Oncology Nurse Advisor –
Estimating the risk of lymphedema after axillary dissection for breast cancer is difficult, but a group of
researchers has used a large data set to develop graphical statistical tools known as nomograms to help
predict 5-year probability.
Jose L. Bevilacqua, MD, PhD, a surgical oncologist at Hospital Sírio-Libanês in São Paulo, Brazil, and
colleagues collected clinicopathologic features from a prospective cohort study of 1,054 women with
unilateral breast cancer. All subjects had undergone axillary dissection, between August 2001 and
November 2002, as part of their surgical treatment
The investigators determined the cumulative incidence of lymphedema and predicted the risk of developing
the condition based on the available data at each of three timepoints: preoperatively, within 6 months
postoperatively, and 6 months or more postoperatively. They defined lymphedema as a volume difference of
at least 200 mL between arms at 6 months or more after surgery.
As reported at the American Society of Clinical Oncology 2011 Breast Cancer Symposium, held
September 8-10, 2011, in San Francisco, California, Bevilacqua and associates found the 5-year cumulative
incidence of lymphedema to be 30.3% (www.asco.org/ASCOv2/Meetings/Abstracts?
&vmview=abst_detail_view&confID=111&abstractID=86647). Independent risk factors for the condition
were age, body mass index (BMI), ipsilateral arm chemotherapy infusions, level of axillary dissection,
location of radiotherapy field, development of postoperative seroma, infection, and early edema.
The predicted 5-year risks calculated by the nomograms were more than 70% accurate for all three
timepoints assessed—70.6% for the preoperative model, 72.9% for the within-6-months-postoperatively
model, and 73.6% for the 6-months-or-more-postoperatively model.
The investigators concluded that the proposed nomograms can help clinicians and patients predict the 5-year
probability of lymphedema after axillary dissection for breast cancer, knowledge that could identify patients
who may benefit from early intervention.
September 29, 2011
QH Medical Supply Joins G'Town Chamber – Memphis Daily News – By JOHN LINTNER
QH Medical Supply hasn’t moved to a new location, but the company will celebrate its membership into the
Germantown Chamber of Commerce with a ribbon-cutting ceremony Tuesday, Oct. 4.
That event will be followed by an open house at QH Medical Supply’s headquarters, 2965 N. Germantown
Road in Bartlett.
QH Medical is a durable medical equipment company specializing in mastectomy products and pain
management. It also carries a host of other items such as lymphedema sleeves, compression hose, adult
diapers and wheelchair cushions.
All employees are certified to fit mastectomy products such as bras and forms.
The company, which works directly with patients, providing them with much-needed supplies that are
ordered by a physician, also has a retail location.
“I have 25 years’ experience doing medical billing and medical software,” said Patricia Barnett, co-owner of
QH Medical Supply. “So, I’m a certified vendor – not QH – but I’m a certified vendor with Medicare as far
as medical software. (Co-owner) Jan (Freudenberg) and I both have been in the (durable medical
equipment) business with another company. We have extensive backgrounds in DME as well as medical
billing.”
The medical supply company now offers Freedom Alert, which is a two-way emergency pendant
communicator that allows wearers to call 911, family members or remotely answer incoming calls. It carries
no monthly maintenance fee.
QH is Medicare-accredited and carries most insurance. It is also a member of the Bartlett Chamber of
Commerce.
September 30, 2011
NJ med firm, office manager admit fraud charges - Houston Chronicle –
TRENTON, N.J. (AP) — State authorities say a southern New Jersey medical firm and its office manager
have admitted defrauding Medicaid and Medicare of $3 million.
Attorney General Paula Dow announced the guilty pleas Friday, one day after The Center for Lymphatic
Disorders, based in Egg Harbor Township, and 54-year-old Farah Iranipour Houtan appeared in state
Superior Court in Atlantic County. Houtan admitted that between 2004 and 2007, she billed the health care
programs for treatment that wasn't provided.
In a related matter, 45-year-old Khashayar Salartash of Linwood, a surgeon and company owner, agreed
Thursday to repay the $3 million as part of a separate consent agreement with the state.
The company treated patients with lymphedema, a disorder that causes fluid accumulation and swelling of
the arms and legs.
St. John's Cancer Center of Ventura County Offers Several Free Classes and Support Groups Each Month
- Ventura County Star -
St. John’s Cancer Center of Ventura County offers various free classes and support groups to help those
affected by cancer. For more information or to register for a class, please call (805) 988-2641.
The following classes are offered at St. John’s Cancer Center of Ventura County, located at 1700 North
Rose Avenue, Suite 145 in Oxnard, unless otherwise indicated:
Colorectal Cancer Support Group: second and fourth Thursdays of each month from 6 to 7:30 p.m. Co-
sponsored by the American Cancer Society. Facilitated by MaryAnna Palmer, MS, MFT from The
Wellness Community.
The Color of Love Group: first and third Thursdays of each month from 7 to 8:30 p.m. This group is
designed to allow cancer patients and their families to express themselves through art. Facilitated by local
artist Kathleen Hagen, who has over eight years of experience in leading this group.
Exercise is Wise—an After Breast Cancer Surgery Exercise Class: Wednesdays from 4 to 5 p.m. Classes
are held at St. John’s Outpatient Therapy Center, 961 N. Rice Avenue, #3, Oxnard.
Free Wigs, Hats and Scarves
Individual Bilingual Counseling for Patients and Caregivers: By appointment only. Call (805) 988-2641.
Kids with Relatives with Cancer Support Group: Tuesdays from 6:30 to 8 p.m. Facilitated by Diane Martell,
LMFT. Co-sponsored by The Wellness Community.
Latina Breast Cancer Support Group: first and third Thursdays of each month from 12 to 1 p.m. Facilitated
by Rosie Hernandez, MSW.
Latina Women’s Support Group: second and fourth Mondays of each month from 10 to 11:3-0 a.m. for
Latina women with any kind of cancer. Facilitated by Diane Martell, LMFT. Co-sponsored by The
Wellness Community.
Latino Cancer Support Group: fourth Thursday of each month from 6:30 to 8 p.m. for patients and family
members. Facilitated by Mario Cepeda, MA. Co-sponsored by The Wellness Community.
Latino Men’s Support Group: first and third Mondays of each month from 10 to 11:30 a.m. Facilitated by
Diane Martell, LMFT. Cosponsored by The Wellness Community.
Lymphedema Education and Screening Clinic: third Friday of each month from 2 to 3 p.m. Individual risk
assessments and valuable information for the prevention of chronic lymphedema will be provided by
Cassandra Norton, PT.
Nutrition Counseling: Thursdays from 9 a.m. to 3 p.m. Individual one-hour sessions with Susan J. Speer,
MS, RD, FADA, CSO a certified nutritionist specializing in diets for cancer patients that can help you eat
better and feel better. She can explain problems related to your individual condition and develop a dietary
plan to meet your special needs.
Prostate Cancer Support Group: third Tuesday of each month from 10 to 11:30 a.m. Facilitated by Helmut
K. Hoenigsberg, a volunteer with the American Cancer Society. Co-sponsored by the American Cancer
Society.
Relaxation Therapy in the Reiki Tradition: see the Cancer Center calendar for days and times. Practitioners
strategically place their hands on various positions of the body so Reiki Energy can begin to flow. Patients
often report they have less pain and nausea and are able to sleep better and think more clearly.
Reinhabiting You Yoga Classes: Gentle Yoga for Your Journey with Cancer—Thursdays from 1:45 to 3 p.
m.; Feeling Better and Stronger with Yoga—Thursdays from 3 to 4:30 p.m. Taught by Audrey Waltzer,
owner and director of the Camarillo Yoga Center.
Women with Cancer Support Group: Tuesdays from 1 to 2:30 p.m. Facilitated by Joyce Boucher, LCSW,
MFT. Co-sponsored by The Wellness Community.
October 1, 2011
Occupational Therapist - Minot Daily News –
MEDICAL HELP WANTED
OCCUPATIONAL THERAPIST
Full-time position. Mon.- Fri. day shift with some weekend coverage required. Job duties include but not
limited to: Orthopaedics, Vestibular, Incontinence, Fibromyalgia, Lymphedema, Pool Therapy, Skilled,
Home Health and Care Center. Occupational Therapy License required. Sign-on bonus and paid CEU's.
HOSPITAL PHARMACIST
Full-time position. Mon.- Fri. 9:00 a.m. - 5:30 p.m. but will require flexibility. Job will primarily be in the
hospital pharmacy at both Wright Medical Center and Belmond Medical Center and will float as needed in
the retail pharmacy at Wright Medical Center. Position will be required to be on a call rotation and work
every fourth Saturday morning. Hospital pharmacy experience preferred.
Positions offer outstanding wages & fringe benefits. Please stop by and pick up an application, apply on-line
at www.wrightmed.com or contact the Human Resouces Department at 515-602 9801 to receive an
application by mail. All positions are subject to criminal/department adult abuse background checks, pre-
employment physical and drug testing.
WRIGHT MEDICAL CENTER
1316 S. MAIN STREET
CLARION, IA 50525
Wright Medical CENTER
Breast cancer 'not a death sentence' - Taunton Daily Gazette – By Deborah Allard –
FALL RIVER —
In the waiting room of Charlton Memorial Hospital’s Southcoast Center for Cancer Care, Juanita
Thompson sang softly to a tune that she alone could hear from her iPod.
Thompson, a breast cancer survivor, had a mastectomy about a year ago and several rounds of
chemotherapy. Despite losing her hair and a breast, the spiritual woman has found a renewed sense of joy.
“I’ve come out of this with a brand new mind, body and spirit,” Thompson said. “It’s really not a death
sentence. It’s made me think about life and make every minute of it count.”
Thompson, like most who suffer from breast cancer, has gone on to live a long and healthy life — a far cry
from what women endured not so many years ago when little was known about breast cancer.
Today, there are some 50 forms of chemotherapy, hormonal agents and targeted therapies that work
together to kill breast cancer cells, not to mention surgical options, radiation therapy and clinical trials,
according to materials from Saint Anne’s Hospital’s Regional Cancer Care center.
Susan O’Brien, an oncology nurse practitioner at Saint Anne’s Hospital, said breast cancer has become
more chronic than fatal.
“Once a woman is diagnosed, it’s a journey that she undertakes,” O’Brien said. “It’s so wonderful that these
women with breast cancer are living so long.”
O’Brien said breast cancer survival rates have been incredibly improved even since she started at Saint
Anne’s Hospital 25 years ago. Because of advances made in drugs and in education, more women are
diagnosed with curable Stage I and II cancers, rather than at more advanced stages.
The five-year survival rates for Stage I and II breast cancer now ranges from 74 to 88 percent, according to
the American Cancer Society. The survival rates for stage III and IV breast cancer are as high as 67 percent.
Until the 1960s — and later, in some cases — survival rates were very low, and the disease often resulted in
death. People thought breast cancer was embarrassing, and it was a hushed topic that often resulted in a
late, if any, diagnosis.
Dr. William Stewart Halsted is credited with being one of the fathers of modern American surgery at Johns
Hopkins University Hospital in the late 1800s. He developed the radical mastectomy, which consisted of
removing the entire breast, the underlying chest wall muscles and all lymph nodes in the armpit, according to
the National Surgical Adjuvant Breast and Bowel Project.
The deforming operation resulted in a concave appearance, O’Brien explained. Women who underwent the
procedure often sought to wear a heavy prosthetic breast afterward.
This procedure was the standard breast cancer surgery for decades, until brothers Drs. Bernard and Edwin
Fisher challenged the radical mastectomy in the 1960s.
Today, doctors know that mastectomy has the same end result as lumpectomy plus radiation for most
women. Those undergoing mastectomy do not lose as much tissue as in decades past.
Until 25 years ago, women also underwent 14 cycles of chemotherapy lasting for 14 months, as opposed to
today’s roughly four months of chemotherapy.
“I never thought I would die,” said Margaret McCaffrey, who had breast cancer in 1995. Now retired, she
is a greeter at the Hudner Oncology Center at Saint Anne’s Hospital.
Because most women live with breast cancer, there is a whole new population of women in follow-up care
for years after their surgery or treatments. For them, living with breast cancer is the new normal.
For Thompson, follow-up care has included doctor’s visits every three months and monthly blood work.
Breast cancer can also result in complications. Thompson experienced lymphedema in her arm, a swelling of
the tissue, due to the surgery.
O’Brien said there are many “immediate and long-term effects.”
Besides lymphedema, patients can suffer from cognitive difficulties, low energy and depression. They may
also suffer effects to the heart and lungs, or go into early menopause, which can lead to osteoporosis.
Follow-up care generally consists of following any side effects, and includes hormone therapy for some.
Support groups, yoga, meditation and spiritual retreats are also part of what is offered at local hospitals.
Thompson attends a monthly support group where she is free to talk about her experience with breast
cancer and other topics.
“I love it,” Thompson said. “Talking about it helps other women through it. We lift each other up.”
Thompson plans to have reconstructive surgery in the near future, and is also planning on getting gastric
bypass surgery to lose weight. Now 51, she has begun computer programming classes at Bristol Community
College, something the mother of five has wanted to do for decades.
“I want to live,” Thompson said. “I want to enjoy the rest of my life. I feel wonderful.”