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Lymphland International Lymphedema Online
| http://www.fayettefrontpage.com/health-09/4-23-09_hands.htm Piedmont Fayette Hospital Patient Regains Full Use of Hands April is Occupational Therapy Month 4/23/09 While out with her family at the local skating rink, Fayetteville resident Jennifer Smith, tripped over another skater and landed backwards on the edge of her palms. The result: bilateral fractures in both wrists, and shattered bones beneath her thumb and pinky. She was rushed to the emergency room at Piedmont Fayette Hospital (PFH). After X-rays, splints, surgery and a 2-day hospital stay, Smith was sent for occupational therapy. “When I showed up for therapy at Piedmont Fayette Hospital, my hand was straight up and down, I could only move it a quarter of an inch at the very most,” said Smith. “I couldn’t tie my shoes or get dressed, let alone do my job.” Smith underwent 6 weeks of therapy at PFH, with two sessions every week. She participated in flexion, extension and strength building exercises, which included lifting small weights, pushing and pulling objects, circular movements of the wrist to regain rotation, and massages. “The occupational therapy program is designed to help our patients perform day-to-day tasks for themselves, whether that is at home, school, work or play,” said Lisa Caphe, an occupational therapist at Piedmont Fayette Hospital. “But more than boosting motor skills and improving mental acumen, we want them to know they can overcome their injuries or disabilities and lead normal lives.” April is Occupational Therapy (OT) Month and Piedmont Fayette Hospital is recognizing the hospital’s occupational therapy department for its efforts to help individuals, like Smith, lead fulfilling lives. Occupational therapy (OT) is the use of treatments to develop, recover, or maintain the daily living and work skills of patients such as Smith. The therapists help clients not only to improve their basic motor functions and reasoning abilities, but also to compensate for permanent loss of function. The goal is to help clients have independent, productive, and satisfying lives. “Lisa explained everything to my husband so he would know what to do after my sessions were over,” said Smith. “She suggested using things around the house for weights – like canned goods or a hammer to simulate the same exercises.” With continued exercises at home, as suggested by her OT, Smith returned to work and has regained almost full mobility in her left wrist and hand and is 85-90 percent recovered in her right. “You get so much more out of the therapy with a specialist than you can do it at home. Having someone there to tell you when you’re doing it right or wrong, and what exercises to do really helped,” said Smith. “It was a wonderful experience, -- without them I don’t think I’d be back where I am today.” PFH Rehabilitation and Fitness Center offers cardiac rehab, pulmonary rehab, diabetes education, physical therapy, occupational therapy and speech-language pathology. There are also specialty programs including pelvic pain and incontinence therapy, lymphedema therapy, wound care and ostomy management, joint replacement pre-op classes, and Healthy Heart Classes. The fitness center is open to the community and offers a full line of state of the art equipment. Physician referral is required for most rehabilitation services. For more information about PFH's occupational therapy department and other rehabilitation and fitness services, call 770-719-7290. To learn more about Piedmont Fayette Hospital, visit www.fayettehospital. org. ------------------------ http://funjockey.com/help-for-persistent-or-recurring-swelling/ Help For Persistent Or Recurring Swelling Like the arteries, veins and capillaries that transport blood through our bodies, our bodies also contains an extensive drainage system that returns water and proteins from our tissues back to the bloodstream. Called the lymphatic system, it is part of our immune system and works to defend the body from diseases caused by viruses, bacteria, or fungi. The lymphatic system has two major functions. First, it works to regulate the amount of fluids within our bodies. Secondly, it is responsible for “taking out the trash”, that is collecting waste products, such as dead blood cells and pathogens from the interstitial fluid (the fluid that fills the spaces around cells) and filters it before returning it to the bloodstream. The lymphatic system is made up of lymph vessels that carry lymph, a protein-rich fluid that is transported through the lymph vessels, and lymph nodes which filter out germs and toxins. There are over 100 lymph nodes throughout the body, with the majority of them being located in the neck, groin and armpits. Lymphatic vessels contain valves that prevent the lymph from flowing backwards within the system. Within the lymphatic vessels, lymph is transported through the vessels and moves via the squeezing action of their neighboring skeletal muscles. When the movement of lymph through the body becomes impaired, it will leak out of the lymphatic capillaries and cause the surrounding tissues to swell. This condition is called lymphedema. Lymphedema occurs when the amount of lymph fluid in the body exceeds the body’s ability to transport it. This causes the lymph fluid to accumulate in the tissues, where it causes swelling, particularly of the arms and legs. There are two types of lymphedema. Doctors don’t know what causes Primary Lymphedema, but it can be present at birth, or can develop later on in life. Fortunately, this condition is rare. Secondary Lymphedema is a condition that is not often talked about, but often affects individuals who have undergone surgery, such as cancer surgery where lymph nodes are commonly removed. It can also affect individuals who have undergone radiation therapy, which can damage lymph nodes and cause scar tissue to form ultimately interfering with the flow of lymph. It can also be experienced by individuals who have experienced a severe trauma or infection. In the initial stages of this chronic condition, Lymphedema often begins with swelling in a hand or foot, particularly the one closest to where the surgery has occurred or radiation therapy has taken place. If left unchecked, the protein-rich lymph can continue to accumulate, leading to increased swelling and a hardening of the tissues. This increases your risk of developing an infection or may interfere or impair the function of the limb. Lymphedema can develop in any part of the body. If you experience persistent or recurring swelling anywhere in your body, it is important to seek medical advice. Early intervention with this disorder greatly improves the long term outcome of the disease’s progression. Recommendations For Wellness Avoid rigorous, repetitive movements or heavy lifting. Women, if your arm is affected, get rid of extra 50 lbs that you carry over your shoulder and trade it in for a purse that has hand straps. If your arm or leg starts to ache, lie down and elevate it. Wear loose fitting clothes, jewelry, socks and undergarments that may restrict lymphatic flow. Wear a compression sleeve or stocking on the affected limb. Keep your “at risk” limb clean and avoid activities that may irritate or damage the skin. Careful skin care may reduce the risk of lymphedema by helping you to avoid infection. Massage, particularly lymphatic massage has been shown to help increase lymph drainage. You can do this yourself or work with a qualified massage therapist who has been specially trained in how to perform manual lymph drainage techniques. Begin a gentle exercise program. Exercise and muscle movement can help drain lymph fluid. (Consult with your doctor prior to beginning any exercise program). Drink plenty of water. Water is critical for proper lymph drainage. Echinacea has a long history of improving lymph filtration and drainage. Garlic is known for being able to stimulate the lymph system to throw off waste materials. Oregon grape can be used to help reduce the inflammation of the lymphatic system and works to help cleanse the lymph. Poke Root has been known to help stimulate the body and aid its ability to remove waste materials that may be trapped in the tissues. It can also help improve the elasticity of tissues that may have experienced hardening due to congestion. Burdock, red clover and mullein are known to thin lymph fluid and enhance lymphatic drainage. Herbal combinations such as Nature’s Sunshine’s Lymphatic Drainage, Lymphomax or Lymphostim are designed to stimulate the immune system, fight infections and support the lymphatic system. Copyright Body, Mind & SoulHealer 2004. About The Author Dr. Rita Louise, PhD is a Naturopathic Physician and a 20-year veteran in the Human Potential Field, and it is her unique gift as a medical intuitive that enlivens her work. Author of the books “Avoiding the Cosmic 2×4? and “The Power Within: A Psychic Healing Primer”, Dr. Rita Louise, Ph.D. a can help you identify what is really going on and provide you with straightforward guidance and advice. She can be reached by calling 972-475-3393. ------------------------------------------ http://www.integrative-healthcare.org/mt/archives/2009/04/bodywork_after.html Bodywork After Breast Cancer Surgery While more women than ever are able to beat breast cancer, there is still a need to help them recover from breast removal surgery. Despite warnings to avoid bodywork on anyone with a history of cancer, properly prepared massage therapists can help survivors heal from their breast cancer surgery. by Nicole Cutler, L.Ac. Weighing in as one of the diseases women fear most, breast cancer is estimated to affect one in every eight women. Despite breast cancer being the second-leading cause of cancer deaths in American women, its early diagnosis and treatment has drastically improved this illness’ survival rate. When included in a person’s recovery from this illness, massage therapy has the capacity to improve the physical and emotional health of a breast cancer survivor. With compassion, specific training and attention to documentation and legal issues, bodyworkers have the tools to help clients mend the parts of their life fragmented by traditional breast cancer treatment. As one of the leading treatments for breast cancer, the complete or partial surgical removal of breast tissue can make a significant impact on a person’s life. In addition to the side effects from other therapies one may have received, the loss of one or both breasts may congest blood, lymph and energy circulation in the chest and upper extremities. Just as important to an individual’s well-being, breast disfigurement or amputation can take a drastic psychological toll on survivors. Types of Breast Cancer Surgeries Since there are so many variations of type and severity of breast cancer, the treatment approach for this illness is highly individual. Involving a great deal of deliberation between patient and doctor, most women will have surgery and an additional therapy such as radiation, chemotherapy or hormone therapy. In general, breast removal surgeries fall into one of the following four categories: 1. Lumpectomy – A surgical excision of only the palpable tumor mass. 2. Partial Mastectomy – Removes less than the whole breast, such as a quarter of the breast where the tumor resides. 3. Modified Radical Mastectomy – Removes all breast tissue, including the skin, nipple, areola and most of the axillary lymph nodes on the same side while leaving the pectoral muscles intact. As the most common surgery for early stage breast cancer, this is also called a total mastectomy with axillary dissection. 4. Halsted Radical Mastectomy – Removes the breast, skin, both pectoral muscles and all axillary lymph nodes on the same side. Massage Therapy Following Breast Surgery Because of the unknown mechanism for spreading cancerous cells, most massage therapy schools teach that cancer is a contraindication for massage. However, modern research has repeatedly demonstrated that carefully executed bodywork offers measurable benefits to people currently living with or who have survived a bout of cancer. Regardless of the growing acceptance of massage therapy for cancer-related issues, approaching a client with a recent or distant history of breast cancer always mandates the practitioner proceed with caution. · Permission – First and foremost, obtain the permission of your client’s physician prior to administering massage. · Consent – Make certain you have your client’s written informed consent before proceeding with massage therapy. · SOAP notes – Adhere to this conventional form of record keeping, which includes taking subjective, objective and assessment plan notes. · Training – Only proceed with bodywork if you have successfully completed training specific to oncology massage. Following breast cancer surgery, common physical problems may include local pain, swelling and restricted range of motion. If the pectoral muscles have remained intact, the physical effects are likely the result of impaired circulation from removed lymph nodes, scar tissue and adhesions from surgery. Including techniques such as therapeutic touch for acute surgical recovery, lymphatic drainage massage for lymphedema, scapular mobilization for a stiff shoulder, myofascial spreading for tight pectorals and cross- fiber friction to dissolve scar tissue, a therapist trained in oncology massage has many tools to help clients recover from breast cancer surgery. Women who have experienced the trauma of breast cancer surgery can benefit emotionally from touch- centered therapy. When applied with healing intent and compassion, a massage therapist’s touch can function as a bridge to help clients become reconnected to their body. For many breast cancer surgery recipients, the physical contact of massage eases the feeling of being a stranger in their own body, a transition that can help them find comfort in their new physical form. Since a lumpectomy or mastectomy is indicated in a majority of cases, many breast cancer survivors must contend with the consequences of their surgery. Although not outfitted with a medical doctor degree, massage therapists can help clients with a history of breast cancer return to health. By seeking the proper training, taking acceptable notes, getting physician permission and obtaining client written consent, massage therapists can facilitate their clients’ physical and emotional recovery from breast cancer surgery. References: Handley, W. C., Jr., LMT, Massage for Cancer Patients: Indicated or Contraindicated?, Massage Today, January 2007. Manzulli, Sabino L., LMT, Bodywork & Visualization Therapy for People With Cancer, Massage & Bodywork, August/September 2001. Vanderbilt, Shirley, Into the Looking Glass: Massage for Mastectomy Patients, Massage & Bodywork, August/September 2000. Mastectomy Massage, Cheryl Chapman, Eileen Kennedy, American Massage Therapy Association, 2008. About Breast Cancer: Statistics, Causes, Symptoms, Surgery Options, breastcancer.org, 2008. Breast Cancer, Mayo Foundation for Medical Education and Research, 2008. Massage After Mastectomy, Chris E. Barrett, 2008. --------------------------- http://www.newstimes.com/ci_12212807 New Milford mother organizes team for breast cancer charity race By Nanci G. Hutson staff writer Updated: 04/23/2009 08:51:04 PM EDT NEW MILFORD -- Three of Lisa Arasim's best friends -- all seemingly the epitome of good health --were diagnosed with breast cancer last year. Arasim, the 43-year-old mother of three young girls -- Hannah, 8, Emily, 7 and Olivia, 4 -- was daunted by the realities that one out of every seven women is diagnosed with the disease in their lifetime; family history and good health often playing no role one way or another. The one common denominator for her friends was that they were able to even their odds against the disease as it was caught early; each with a strong prognosis for survival after early treatment. Inspired by her friends, Arasim decided this was not their fight alone. She wanted to do something to promote early detection vigilance in other women. So she participated with one of her friends, breast cancer survivor Marianne Colacray, in the Susan G. Komen 5K Race for the Cure in Boston in September. Yet she still longed to do something closer to home. She opted to organize a team, "New Milford Cares,'' for the Susan G. Komen 5K Race for the Cure to be held in Bushnell Park in Hartford on June 6. So far, Arasim said several area businesses have pledged their financial support and she has a few people who have offered to join her team, including a neighbor who was diagnosed with breast cancer last year. "It's personal for me,'' said 44-year-old Colleen Golembeski, Arasim's neighbor and the mother of two children Golembeski praised Arasim for stepping up to show solidarity for all women so that they get the information they need for early screenings and treatment options after diagnosis. She said she is glad she might be able to help "someone like me who is facing this challenge.'' To prepare for the event, Golembeski said she is walking on her treadmill and some other exercise so she will be able to either run or walk the course. Whether someone walks or runs the course matters little, Arasim said. Personally, she said she is training to run, but if more of her team chooses to walk, she'll walk. She jokes that she still has a long way to go to get in shape, "but I will. In truth, Arasim said, this race is far from a competition. It is a support for women with breast cancer even as it promotes education and research to thwart the disease that befalls 3,000 Connecticut women each year, Arasim said. "It really celebrates survivorship,'' Arasim said of the race that engenders thousands to line the streets cheering on the runners and walkers. So far, Arasim said she has been making rounds to local businesses about sponsorships and talking to friends and strangers alike about joining the team. One of her connections was with Denise Mariconda, a registered nurse who is the breast health navigator at New Milford Hospital's Regional Cancer Center. Mariconda has served as something of a cheerleader for Arasim's efforts as the hospital is a long-time recipient of grants from the Susan G. Komen organization. Earlier this month, the cancer center was awarded a $35,255 grant to offer screening mammography and lymphedema care to women 40 and older who are uninsured, underinsured, or medically under served in the hospital's eight-town region. Arasim said she expects the hospital will also field a team for the race. "My goal is saving lives and seeing a cure in our lifetime,'' Arasim said. Contact Nanci Hutson at (860) 354-2274. --------------------------------- http://www.emediawire.com/releases/lymphedema/podiatry/prweb2360324.htm LymphaCare to Exhibit Lymphedema & Wound Care Products at Podiatry Conference LymphaCare will be exhibiting home lymphedema pumps, as well as the new MOBILITY1™ IPC device at the the 60th Annual Region Three Podiatry Meeting in Atlantic City on April 29th-30th. LymphaCare is a leading provider and reimbursement specialist for home compression therapy used in the treatment of lymphedema, chronic venous insufficiency (CVI), wound care, and diabetic foot. New York, NY (PRWEB) April 30, 2009 -- More than 40 million Americans suffer from venous or lymphatic disorders, which represent an annual economic cost of over $8 billion of total expenditure on US healthcare. Other than lymphedema, the bulk of peripheral vascular disorder patients suffer from venous ulcers, CVI, DVT, and varicose veins. None of these chronic disorders is currently curable. LymphaPress PBS Pump Patient Sequential Gradient Compression Pump Therapy for lymphedema and venous insufficiency has been utilized for over 30 years throughout the world. Manufacturer's such as LymphaPress & Bio Compression Systems have helped pioneer and perfect this technology by utilizing a 4-12 chambered pneumatic sleeves to gently move the lymph fluid. These devices are recognized treatments and approved by Medicare and most insurance providers in the USA. Mobility-1™ IPC device is the latest compression technology. The Mobility1™ IPC was designed by a technology company in Israel. It is protected by two patents surrounding the use of kinetic energy to drive the pneumatic action, as well as the sophisticated internal mechanisms that allow for the pneumatic action to also be driven by a very small and portable compressor. The product will be the only one of its kind, allowing mobile patients to receive optimal therapy while maintaining their lifestyle, as opposed to being only home bound for treatment. It has been estimated estimated 4.6 million workdays are lost every year in the U.S. due to symptoms associated with CVI. CVI is a disease that affects the legs and is caused by non-functional valves in the leg veins. The normal venous system in the legs contains a series of valves that assist in returning blood flow to the heart. When the valves cease to function properly, blood may pool in the lower leg, leading to swelling, changes in skin color and, eventually, ulcerations near the ankle. Leg vein valve failure is, in many cases, caused by blood clots or vein enlargement due to hereditary causes. The swelling and ulceration is uncomfortable and often painful, making it difficult to move around. The most common treatments for CVI are palliative such as conservative leg rest and use of compression stockings and pumps. Lymphedema symptoms may consist of swelling, heaviness or tightness of the extremity, feelings of discomfort, or a chronic aching in the upper or lower extremities. Lymphedema of the legs may be present at birth, develop at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda). Some cases of lymphedema may be associated with prostate cancer or from other vascular abnormalities. In the lower extremity it will be unilateral or bilateral. If it is bilateral, one leg may be worse than the other. LymphaCare has been providing home compression pump therapy to patients and the medical community for nearly 15 years, and are a clinically proven and cost effective therapy. Treatment compliance is increased as patients can utilize the compression devices on a daily basis in the comfort of their homes. LymphaCare has seen a significant improvement with many patients, especially if conservative therapy such as compression stockings and elevation has been tried prior to receiving a pump. The discomfort, financial, or time constraints of conservative therapies may preclude a physician prescribing home compression therapy for many patients. LymphaCare has had a great deal of success obtaining the lymphedema pumps for patients for home use through Medicare, Aetna, Blue Cross, and most major medical insurance policies. LymphaCare is a national provider and billing and reimbursement specialist for compression therapy devices such as Bio Compression & Lympha-Press Sequential Gradient Lymphedema Pumps, and MOBILITY1™ IPC. LymphaCare compression therapy products can be found on our websites or by calling LymphaCare at 800-288-1801. ### Trackback URL: http://www.prweb.com/pingpr. php/U3F1YS1FbXB0LVNxdWEtRW1wdC1TcXVhLUNvdXAtWmVybw== See the original story at: http://www.prweb.com/releases/lymphedema/podiatry/prweb2360324.htm ------------------------------ Vest designed to aid mastectomy patients By MONICA GRAHAM Sat. Apr 18 - 5:16 AM Pictou County naturopath Dr. Gabrielle Kropp has designed a compression garment that reduces lymphedema in breast cancer surgey patients, but production depends on finding enough hospitals to buy them. (Monica Graham) A Pictou County naturopathic doctor can’t understand why a compression vest she helped develop to aid post breast cancer surgery patients isn’t being used in more hospitals. Known as a mastectomy vest, it is no more expensive than the bandages it replaces and patients have hailed it as a more comfortable alternative. That’s why Dr. Gabrielle Kropp wonders why no one else seems to be using it. "It works, but it will die because no one in the bureaucracy will buy it," she said, adding that she stands to gain nothing personally from the sale of the vests. "It’s hard enough for these women as it is to go through cancer, but then there is lymphedema," she said. "We only want to help them." Dr. Kropp developed the vest after she and nurse Joanne Cumminger, a cancer patient navigator at Aberdeen Hospital in New Glasgow, noticed an increase in the number of women suffering from edema, or swelling, after having breasts removed. The body produces lymphatic fluid in response to surgery, but breast surgery damages or removes lymph nodes that regulate its flow. Without compression by tight bandaging or some kind of garment, the fluid pools around the surgical site and appears as a fluid-filled sac on the chest, underarm, or arm, the doctor explained. The fluid may become infected and painful and if it is not treated the condition becomes permanent. "It’s manageable, but not curable," she said, adding the bra-like garment she and Ms. Cumminger designed can prevent patients from getting lymphedema. Made of a special, stretchable, breathable, latex-free fabric, the vest is soft and lightweight. It has wide shoulders, is cut high to support the underarm and allows for placement of padding over the surgical site. The shoulders and front hook-and-eye fastenings can be adjusted to suit the wearer. The garment comes in seven sizes. Dr. Kropp and Ms. Cumminger tried several commercial designs that did not work and were far too expensive, so they made several models themselves — fitting them on patients over and over until they got the best result. The effect was immediately noticeable. As well as reducing swelling, the garment made women "feel snug again," Ms. Cumminger said, adding that patients and surgeons received it well. "I did not have a lymphedema patient for a long time," said Dr. Kropp, who trained at a specialized lymphedema hospital in Germany before entering naturopathy 15 years ago. She currently practises in New Glasgow and Caribou. In 2004 they surveyed 35 post-mastectomy patients at the Aberdeen Hospital in New Glasgow in order to substantiate their findings. None of the subjects using the vest developed swelling, lymphedema, or infection. Among the patients using bandaging or dressings, 14 had post surgery swelling, six got infections, and six developed lymphedema. "That is dramatic," Dr. Kropp said. "It’s not just coincidence." She searched for a manufacturer, eventually finding a U.S. specialty company to sew the garments. In order to keep the individual price below $100, Dr. Kropp has to order 1,000 vests but the Aberdeen Hospital only does about 60 breast cancer surgeries per year and not all are complete mastectomies needing compression, Ms. Cumminger said. To meet the manufacturer’s requirements and to keep the price down, other hospitals need to join in, but persuading other health districts to use the garments has been more difficult. Once patients and doctors hear more about the vest’s success, they will demand them, Ms. Cumminger said. "The benefit to patients is all that matters," she added. ( mgraham@herald.ca) http://thechronicleherald.ca/forum/read/21/106258/106258#msg-106258 ------------------------------- CENTRAL TEXAS RUNNING: BROM HOBAN A long and painful journey to Boston ends with smiles Tuesday, April 28, 2009 Paul Carmona ran his 15th marathon a week ago in Boston. What made this one special was the decade- long journey to the finish line. Now 45, Carmona's running dates to his time on the Princeton rowing team in the 1980s. He later attended the University of Texas law school and he now works for the Texas attorney general's office as chief of the consumer protection and public health division. Over the years, career and studies left little time for exercise, and Carmona found himself weighing 215 pounds, up from 158 during his rowing days. An entry form for the Statesman Capitol 10,000 in 1996 caught his attention, and his interest in running was renewed. Soon, Carmona ran the 3M Half-Marathon in 2001 and then set his sights on the San Diego Rock 'N Roll Marathon. He ran San Diego in 3:31 and quickly decided he wanted to qualify for Boston, so he added more training miles. Qualifying for Boston separates the serious runners from the recreational ones, and Carmona, then 38, needed a 3:15:59 at the 2002 Austin Marathon to qualify. He missed it by seconds, with a 3:16:38. He ran more marathons but just couldn't get the Boston qualifier. Then a bout of Achilles' tendonitis turned him toward cross training, and then triathlons. It was during a triathlon that he incurred his most serious injury. It started as a staph infection in September 2003 during the Couples Triathlon, when heavy rains forced competitors to remove their shoes and run barefoot (or not run at all). "The mud would so heavily cake on our shoes that we literally could not run with them on," Carmona recalls. "I cut my foot and it got infected, and I ended up hospitalized." The staph infection responded to a course of antibiotics but returned that December. Carmona was hospitalized for four days and couldn't walk. He had swelling in his leg, and his doctor thought (correctly) that the lymph nodes behind his knee and groin were damaged from the infection. Carmona was told he couldn't run until there was no more fluid in his hip. Carmona thinks he may have started running again too soon. Barely a month after his hospital stay, he ran the Distance Challenge 30K, the 3M Half Marathon and then the Austin Marathon He also decided to start coaching, first at RunTex, then at Rogue Training Systems and now with the Twenty-six two Marathon Club. And he upped his running. In one 14-month span from November 2006 to January 2008, he competed in the Ironman Florida, the Houston Marathon, a 50-mile ultra run, the San Diego Marathon, Park City Marathon, Dallas White Rock Marathon and the Disney Marathon. It proved too much for the lymph nodes in his left leg, which had been compromised by the two infections. "Right after that, I noticed a swelling in my leg around my ankle, and it got to be kind of painful. The doctor knew it was the same leg that had the infection, and suspected lymphedema — a fluid accumulation around the lymph nodes, which was draining down to my lower leg," he said. The lymphedema diagnosis led to compression therapy, in which he had to wrap his entire leg in bandages and then wear a compression sock from foot to thigh and sleep with a foam cushion wrap. For Carmona, that therapy continues today. "It was a shock at first, realizing that my leg would never be the same," he said. But Carmona hadn't forgotten his dream, and he told his wife he was going to come out of it and run the Tucson Marathon and qualify for Boston with a 3:30. He started running again a year ago in May and ran an 11-minute mile. A 3:30 marathon was a long way off. He ran all through the summer, wearing the compression sock. He continued to coach runners and to read about training. He changed his diet, concentrating more on fruits and vegetables, and got his weight back again. And he gave it another shot. "I went to Tucson with a specific plan: break the race into five-mile sections, running each at 40 minutes," he said. "If I did it right, it would come out to 3:29:36. It worked to perfection. I ran 3:29:40 and qualified." Boston last week was a 26-mile victory lap for Carmona, who successfully paced his sister there to run under 3:56, with a 3:55 clocking. "Boston was a fantastic experience. It's everything that people tell you about," he said. But what Carmona will always remember was a guy he saw at the marathon expo at Boston — a double amputee with two spring prosthetics with running shoes on. "I saw a picture of him in the Boston Globe the next day," Carmona said. "His name is Richard Whitehead, and he ran 3:02:44, and I realized I may have a problem with my leg, but look at this guy ... ." Round-Up mixup The new route of the Texas Round-Up 5K on Saturday led to some confusion near the finish area. Although the USATF-certified course was accurately measured and correctly barricaded, several runners, including women's winner Chris Kimbrough, inadvertently cut a short distance off the course by stepping over a median strip dividing the eastbound and westbound lanes on 15th Street, yielding an advantage of 15 to 25 meters, which translates into a 5- to 10-second faster time. Kimbrough acknowledged that she cut the corner because she became confused about which lane to use after making the turn and at one point came to a complete stop. Kimbrough figures her 16:27 winning time would still put her well under 17 minutes, her goal for the race, even with the extra 15-25 meters. She was awarded first place despite taking the wrong side of the road. The next women's finisher was more than two minutes back. http://www.statesman.com/sports/content/sports/stories/other/04/28/0428hoban.html --------------------------------- http://www.philly. com/philly/health_and_science/cancer/20090423_You_ve_survived_cancer__Now_what_.html You've survived cancer. Now what? Facing the long-term side effects By STACEY BURLING Inquirer Staff Writer WHEN GWEN DARIEN was treated for non-Hodgkin's lymphoma 15 years ago, no one gave much thought to how she might feel if she lived. "Everything was focused on treating the disease and getting the cancer out of your body," said Darien, now director of survivor and patient advocacy at the Philadelphia-based American Association for Cancer Research. Long-term survival after cancer treatment was still so unusual that no one considered that the radiation and chemotherapy she received might cause side effects years later. No one talked to her about work or the psychological impact of her treatment. "Nobody talked to me about fertility," Darien said. "Nobody talked to me about potential long-term events." Increasingly, cancer experts are devising ways to warn patients like Darien - there are 12 million cancer survivors in this country - about problems their treatments or the cancer itself can cause later on. The information is crucial because primary-care doctors often do not connect a new heart or nerve problem to cancer treatment that occurred years ago. The "survivorship" phase is a hot topic. The Institute of Medicine pushed for greater attention to post- treatment needs in an influential report called Lost in Transition in 2005. Cancer centers are forming survivor clinics that help patients watch for new cancers and manage treatment-related symptoms. They are studying survivors' needs and improving coordination of care by cancer specialists and other doctors. "It's really a culture change that has to occur in terms of how patients view themselves, how providers view the patients they're following," said Linda Jacobs, director of the University of Pennsylvania's LIVESTRONG Survivorship Center of Excellence. In this region, a computerized survivorship program from Penn's OncoLink, a Web site devoted to cancer, recently got a big boost from the Lance Armstrong Foundation (LAF). The foundation will give $2.3 million over four years to OncoLink, which creates individualized treatment plans for survivors. Andy Miller, LAF's vice president of programs and policy, said OncoLink was ahead of the curve in creating survivorship care plans that many people can use easily. "What we've heard from survivors, this is what they need," he said. "This is what the Institute of Medicine is calling for." LAF is joining with Penn to market the computerized-care plan, which will be called the LIVESTRONG Care Plan Powered by Penn Medicine's OncoLink. "The reach of the Lance Armstrong Foundation is so great that we have an ability to get this out to many more people," said James Metz, a Penn radiation oncologist who is editor in chief of OncoLink. Patients need such reports, Metz said, because cancer care increasingly involves multiple types of drugs, often combined with radiation and surgery. It's saving lives, but patients need to be aware of the long-term consequences. "These treatments we give are the gifts that keep on giving," he said. "Toxicities can happen months, years, decades after treatments were given." At OncoLink, cancer patients can type in information about their cancer and treatments. The program generates a report outlining medical tests they should receive, possible side effects of their treatments, and what they can do to keep cancer at bay. Breast-cancer patients who have taken the chemo drug Adriamycin, for example, can later develop heart problems. People who have had surgery risk lymphedema, which causes tissue swelling, even years later. Many patients are unprepared for sexual and fertility problems that cancer treatment can cause. It doesn't seem fair, but if you have had one cancer, the report will tell you that you are more likely to get another one. Ellen Stovall, acting president and chief executive of the National Coalition for Cancer Survivorship, has been advocating for better care planning since 1994 and is still pushing Medicare to pay for the time- consuming work of producing good treatment summaries and care plans. Stovall's chest was radiated to treat Hodgkin's disease in 1971. In 2007, doctors found cancer in both breasts "along the fault lines" of her radiation treatment. She also has a type of blood-vessel damage often found in people who have received radiation. Stovall said she was "very excited" about the OncoLink project. "It's very easy to use," she said. "I really liked it." Darien checked out her OncoLink care plan earlier this month. She already knew that her chemotherapy could damage the heart. She has had gum problems she traces to her treatment. Much of the OncoLink care plan was old news to her, but she thought many patients who had just finished treatment would find it helpful. She had not previously heard of connections between her treatments and bladder cancer or blood-vessel and swallowing problems. She liked the section on chemo brain, the fuzziness many cancer patients say they experience after treatment. "It's wonderful to see that taken seriously," she said. Denise Shaw urged her husband, Bob, an esophageal-cancer survivor who was treated at Penn, to try the care plan. "I wanted him to see in print what some of these poisons they gave him to kill the cancer could do to him," the Drexel Hill woman said. The information was not a surprise, but she said she thought it was helpful for her husband to see in writing that his fatigue is likely a result of his treatment. About 5,000 people have tried the computerized plan since its debut in May 2007. Only about 12 percent had received any previous survivorship information. Carolyn Vachani, a nurse practitioner who works with OncoLink, spearheaded the project because doctors told her they had too little time and money to produce care plans for their patients. That left patients "out there with no information and experiencing these problems with no knowledge at all that they could be related to the treatment they received." A weakness of the system is that information about the long-term effects of cancer treatment in adults is spotty, said Patricia Ganz, a UCLA oncologist whose work has focused on cancer survivorship. OncoLink also is not precise enough about the treatment patients received to suit her. As a result, she says she finds the resulting care plans too generic, though improving. Ganz has been developing computerized programs that make it easier for doctors to give patients a precise record of all the treatments they have received, another key aspect of survivorship planning. It includes much more detail than OncoLink's care plan currently requires. The two complement each other, she said. OncoLink's program already is in its fourth version, and the Web site's leaders plan regular revisions. Ultimately, patients may have less need to go to places like OncoLink for survivorship advice. Penn, Fox Chase Cancer Center, and Cancer Institute of New Jersey all are developing or expanding nurse-run survivorship clinics that give patients similar information in person. E-mail sburling@phillynews.com or call 215-854-4944. ---------------------------------- http://www.newswise.com/articles/view/551720/ Professor Using Night Vision Technology to Learn More About Lymphatic System Libraries Medical News Keywords LYMPHEDEMA Description The director of the new Center for Molecular Imaging at The University of Texas Health Science Center at Houston is using near-infrared night vision technology made famous by American soldiers in the First Gulf War to shed light on the lymphatic system. Eva Sevick, Ph.D. Newswise — The director of the new Center for Molecular Imaging at The University of Texas Health Science Center at Houston is using near-infrared night vision technology made famous by American soldiers in the First Gulf War to shed light on the lymphatic system. While much is known about the blood system, Eva Sevick, Ph.D., who leads the 20-person research team in the university’s Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases (IMM), said that until recently comparatively little was known about the lymphatic system, which is a network of vessels that act as the body’s sewer system picking up excess debris and fluid from tissues. Unlike blood, lymphatic fluid is clear, which makes it hard to see. In addition, lymphatic vessels are so small that it is difficult to inject the amount of contrast agents needed for traditional Magnetic Resonance Imaging or X-rays. While lymphatic fluid can be seen with nuclear techniques, actual fluid movement is hard to observe because it typically takes several minutes to acquire an image. Sevick’s solution to these medical imaging issues was to inject micro amounts of fluorescent dye below the skin where the lymphatic system would sweep it up. Then with the aid of a small laser and a night vision camera designed to pick up small amounts of light, Sevick’s team was able to observe the dye move through the lymph system below the surface of the skin. This was possible because the night vision camera can acquire images in less than one second. “No one had ever watched this before,” said Caroline Fife, M.D., clinical associate professor of medicine at The University of Texas Medical School at Houston and director of clinical research for the Memorial Hermann - TMC Wound and Lymphedema Center. “This was like Christopher Columbus discovering America. Until now, we’ve never had a good way to study the lymph system. It felt like being a doctor before antibiotics.” When the lymphatic system is functioning properly, it picks up fluids that leak from blood vessels into the spaces between cells. As this fluid passes between cells it gathers cell waste and debris. The fluid is subsequently taken up by tiny lymphatic capillaries and propelled through lymphatic ducts and nodes until it is returned to the blood. The lymphatic system also contains immune cells named lymphocytes, which guard the body against invading viruses and bacteria. The lymphatic system is of particular interest to cancer specialists because malignant cells will often end up in lymphatic filters. “Lymph nodes filter out bacteria and tumor cells,” said Fife, noting that the lymphatic system processes six liters of fluid every day. Much like plumbing when it backs up, lymphatic drainage problems can cause fluid retention or swelling, which results in a condition called lymphedema. About one in 200 are born with lymphedema, according to the Lymphatic Research Foundation (LRF); however, most in the United States acquire it as result of surgery, infection or trauma that interferes with the lymphatic system. About 30 percent of breast cancer survivors develop lymphedema, the LRF states. While there is no cure, lymphedema symptoms can sometimes be treated with massage and compression bandaging. “The Center for Molecular Imaging is poised to develop and translate molecular imaging agents, instruments and computer algorithms for improving patient care in a variety of diseases,” Sevick said. “With our optical technologies, we could image disease before the onset of symptoms. We also investigate the impact of breast cancer therapy on lymphatic function in order to evaluate how long-term treatments impact quality of life for cancer survivors.” Sevick is working to translate her bench discoveries into patient care. With the approval of the U. S. Food & Drug Administration, the researchers in her lab have begun patient trials using this medical imaging technique, which could aid in the diagnosis and treatment of many diseases including those of the lymphatic system. In one trial, Sevick’s team is recruiting 18 subjects for a clinical study to determine the effect of an automated massage device on lymphatic flow in persons with lymphedema of either one arm or one leg. In a second study, her research team is evaluating the effect of genetic makeup in persons with hereditary lymphedema and acquired lymphedema. More information is available at 713.500.3561. Sevick is professor and Cullen Chair in Molecular Medicine at the IMM. Her research is supported in part by the National Institutes of Health and the Longaberger Foundation through the American Cancer Society. Prior to joining the IMM faculty in 2008, Sevick served as a professor of radiology at Baylor College of Medicine and led that department’s division of molecular imaging. Sevick earned her Ph.D. at Carnegie Mellon University and did postdoctoral work at the University of Pennsylvania. Her honors include the American Cancer Society Research Scholar, Sylvia Sorkin Greenfield Award, Fellow of the American Institute of Medical and Biomedical Engineering and DuPont Young Faculty Award. photos are available on request. ------------------------------ Superior Student Raises Money For Disease Research It was an exciting night for Meagan Barnard. She got to see her hard work pay off, and was feeling mostly pain free. "I'm in high heels for probably the first time in a year and a half," she said. Four years ago, the Superior High School senior was diagnosed with primary lymphedema. It's a condition where under developed lymph nodes cause severe swelling in her right leg. After nine months of therapy, she found out it was incurable. "Because of my leg, I've had to quit everything that meant the world to me," said Meagan. "Basketball, dancing--I mean I used to be there on the stage with those girls dancing. But instead of it, I coach basketball and I coach dance." For her senior project, Meagan organized a benefit dinner and silent auction to spread the word about lymphedema, and raise money for research. Her friends say she has gone above and beyond expectations, both with her project and in her daily life. "She's had some adversity, and she's really taken that in and owned it," said Eric Nordrum, another Superior High School senior. "Meagan is by far one of the strongest people I know." "She's a fighter," said Lee Nagorski, also a senior at Superior. "It's a condition that could put you down for the rest of your life as far as how you feel about yourself. And she has pushed past that and found a positive side to it." All proceeds from the event will go to the Lymphatic Research Foundation, a non-profit group seeking a cure for Meagan's condition and other lymphatic diseases. "Trying to make everything work out and find a cure," Meagan said. "That's my whole goal." As part of that same project, Meagan also started a magazine dedicated to people with uncommon conditions. She says she's hoping to make it a semi-annual publication. http://www.wdio.com/article/stories/S896044.shtml?cat=10349 ---------------------------- Wound care: Giving your body's healing powers a helping hand Published: Monday, April 27, 2009 By Dr. Dennis Monteiro, Pottstown Memorial Medical Center Have you ever watched a scar heal and marveled at the power your body has to repair itself? Or worried over a cut or sore that simply won't go away? The body's ability to heal after illness or injury is a complex process. Many chronic diseases or conditions can compromise our body's restorative capabilities. Unhealed wounds can not only diminish quality of life, but also raise the risk of additional infection and complications. For this reason, wound care is a critical part of disease management or surgical recovery - and a growing medical specialty. Approximately 5 million Americans suffer from chronic wounds that will not heal or heal slowly, from accidents, burns, surgery or disease. Chronic wounds are most often found among the senior population, patients who are bed-ridden, and those who suffer from diseases that affect the circulation and skin, such as diabetes or peripheral artery disease (PAD). According to the Centers for Disease Control & Prevention, diabetes affects 23.6 million Americans or 7.8 percent of the population, and one-third of all diabetics suffer from lower extremity wounds or PAD. These wounds increase the likelihood of foot problems and the potential for amputation. Other conditions that can lead to slow-healing wounds include traumatic injury, complications after surgery, congestive heart failure, lymphedema, and compromised immune systems, including HIV or AIDS infection. Many hospitals have a wound care team, center or clinic, with specialists trained in advanced therapies that help to speed the healing process and promote or rebuild skin integrity. Chronic wounds that are treated in this way include diabetic skin sores, pressure sores, persistent skin irritations, peripheral arterial disease, surgery wound breakdown, traumatic wounds, burns, venous insufficiency, radiation injuries, spinal injury wounds and other non-healing wounds. Many of these wounds become problematic due to limited blood flow in the area, which can slow the body's healing process. Some patients may require treatments that differ from the standard. Wound care treatments may include dressing changes, hyperbaric oxygen therapy to invigorate oxygen-starved tissues and promote healing, and wound debridement (removal of dead tissue). These specialized therapies are administered in conjunction with other medical or surgical treatment for the skin condition. A patient's doctor generally refers a patient to a wound care team or treatment center where specialists evaluate the wound and review the patient's health and medical history. Tests may be conducted to learn more about the patient's blood flow and tissue oxygenation, as well as determine if there is any infection. The team then develops a treatment program based on the patient's individual needs and is part of the patient's comprehensive medical treatment with the primary care doctor. Once the wound is healed, follow-up care is important and should be in conjunction with any care the patient may be receiving for the condition that originally caused the wound, such as diabetes or hypertension. For more information about wound care, visit www.pottstownmemorial.com or the American Diabetes Association (http://www.diabetes.org/home.jsp). Dr. Dennis Monteiro is a member of the medical staff at Pottstown Memorial Medical Center and co- medical director of the Wound Care Center at PMMC. He is a graduate of Jefferson Medical College and both his internship and residency programs were completed at Graduate Hospital. He served a fellowship in plastic surgery at the Hospital of the University of Florida. Monteiro is board certified by the American Board of Plastic Surgery. He is in practice with Plastic Surgery Specialists, PC, 420 W. Linfield-Trappe Road, Limerick. http://www.pottsmerc.com/articles/2009/04/27/life/srv0000005184585.txt ------------------------------------- Bethpage's Schessler copes with lymphedemaBY KIMBERLEY A. MARTIN | kimberley. martin@newsday.com 10:53 PM EDT, April 20, 2009 Curious eyes often watch Jordan Schessler. But she doesn't mind. In fact, she welcomes the stares, the puzzled looks at her tan-colored knee-highs. "People have said, 'Look at the girl with the funny socks.' . . . When I go to Six Flags, I count the stares. It's almost like a game between me and my friends," the 17-year-old Bethpage junior said, laughing. "If someone is looking, I'll say, 'Would you like to know what it is?' And often times, people are like, 'Yeah.' " At the age of 9, Schessler's feet began to swell, turning dark shades of red and purple. But doctors couldn't explain why. "It was annoying and upsetting that most doctors don't even know what it is," she said. "There was a lot of confusion. You didn't know where to turn." A year later, Schessler was diagnosed with lymphedema, a condition that often causes swelling in both the arms and legs because blockages in the lymphatic system prevent lymph fluid from draining properly. As a result she must wear compression stockings and toe socks at all times - except when in the shower - to prevent swelling. But the condition hasn't hampered her playing ability. The centerfielder is batting .571 (24-for-42) for the Golden Eagles (4-3 ABC-II), and she also plays for the Long Island Bandits 18-under Gold travel team. "My feet go to sleep sometimes in the outfield. I can be running and moving, but my feet may be asleep," Schessler said. "But I just ignore it. I don't let it stop me. I don't like when people use that excuse." She has to change her garments twice a day and do half-hour elevation exercises, where she lies on her back and flexes her legs in and out, each morning and night to help circulate the fluid in her legs. "I try not to think about being an old woman trying to put these garments on. Now I'm mobile and flexible, so it's no problem. I'm actually more uncomfortable without them because I start swelling immediately," she said. "I would love to be the guinea pig if there was ever some cure treatment because someone has to be it." But rather than feel sorry for herself, Schessler says she prefers to raise awareness about lymphedema. "When I was first diagnosed, it was upsetting," she said. "But I've come to the realization that I am going to have it for the rest of my life. So now I'm just trying to act like an advocate." With the help of Bethpage social worker Christine Kennedy, Schessler organized "Scavenger Hunt for a Cure" in February to raise money for lymphedema research. The one-hour event after school generated $1,000, which she donated to the National Lymphedema Network. The more stares Schessler encounters, the more opportunities she gets to educate. "Everyone knows what the yellow 'Livestrong' bracelets are about," said Schessler, who also plays varsity volleyball. "The rubber bracelets we have say, 'We Are Here' because it's unknown. But at least in my school, it's very well known." http://www.newsday.com/news/health/ny-skcove2112676253apr20,0,7219223.story?track=rss ----------------------------------------------- http://www.cantonrep.com/lifestyle/advice/x1092980194/Family-Doctor-Orthopedic-massage-may-help- frozen-shoulder Family Doctor: Orthopedic massage may help frozen shoulder -------------------------------------------------------------------------------- By Peter Gott, M.D. United Media Posted Apr 25, 2009 @ 12:00 PM -------------------------------------------------------------------------------- Q: With regard to your column about “frozen shoulders,” I would like to recommend an alternative treatment, orthopedic massage. My 49-year-old husband had a frozen shoulder for 24 years. His right shoulder would go no further than 90 degrees laterally from his body. Ten months ago, he volunteered to be a “demo” for my massage class, and his frozen shoulder was completely cured in less than 15 minutes, no cutting, no drugs, no anesthesia and no pain. The instructor said that it sometimes takes two sessions. My husband did follow-up self-care exercises for about a month, but hasn’t done any since and still has full range of motion. My 82-year-old mother-in-law has also benefited from orthopedic massage. She had chronic pain (to the point of tears) despite taking Ultracet twice a day. She could only walk short distances with a walker. She received orthopedic massage once a week from my instructor and three times a week from me, and, in a couple of weeks, her pain was tolerable. Within a few months, she was off all pain medication and no longer needed a walker. It has been eight months, and she still receives massage three times a week, but she’s happy to be off the pills and able to enjoy life again. I have been a registered nurse for 28 years and was a director of nursing at a long-term-care facility for five years. I now work for a health-insurance company. I originally took the 600-hour massage-therapy training class as a fun bonding experience with my youngest daughter, who wanted to be a massage therapist. To be an orthopedic massage therapist, you must undergo special training. What was supposed to be just a bonding experience has turned into something else. I never knew that so many people who have pain issues could be helped with this simple therapy. Please let your readers about this amazing therapy. A: You have provided two positive cases for this therapy. However, as I am sure you already know, there are several instances where this therapy can cause more damage than good. While many orthopedic conditions, such as muscle or ligament strain, can be treated successfully with massage, there are instances where more serious conditions can mimic the benign symptoms. Heart attack and stroke can cause muscle pain in some sufferers, so it is vital that the therapist be trained to tell the difference. Certain cancers can also be caused to spread by massage therapy. It is also vital to have a properly trained masseuse, because improper technique can lead to problems such as lymphedema. In this condition, the lymph fluid accumulates in the extremities (usually the legs). Lymph fluid flows through the body similarly to blood. If damage is done to a blood vessel, bleeding, bruising and more can occur. With the lymphatic system, the fluid often backs up and accumulates in the tissues leading to swelling, pain and more. I believe this is an appropriate option for people who have persistent pain due to muscular or joint problems. I urge anyone interested in pursuing this avenue of treatment to speak first with his or her physician to discuss whether this is a viable option for the specific condition to be treated. If it is, then it’s time to do homework. In order to get the best treatment, pick an orthopedic massage therapist who has documentation of certification, noting where and how long they trained. Also, if possible, ask for references and speak to past or present clients. --------------------------------------- http://professional.cancerconsultants.com/oncology_main_news.aspx?id=43432 Sentinel Axillary Node Biopsy: Results of a Randomized Trial Reported Researchers from Italy have reported the results of a randomized trial that confirms that sentinel lymph node biopsy with axillary lymph node dissection performed only for women with a positive biopsy does not compromise outcome in women with localized breast cancer. The details of this study appeared in an early online publication in the Annals of Oncology on January 27, 2009.[1] Axillary lymph node dissection is the traditional method for staging women with clinically localized breast cancer. Unfortunately, the removal of axillary lymph nodes (approximately 25 nodes) is associated with chronic side effects, including pain, infection, limited shoulder motion, numbness, and lymphedema. Because these complications can become debilitating, sentinel lymph node biopsy has emerged as an alternative method of staging and is currently being used in most medical centers treating breast cancer. When performed appropriately, there is a 95% correlation between the results of sentinel node biopsy and lymph node dissection. There is also emerging evidence that women who have microscopic positive lymph nodes and receive adjuvant chemotherapy and/or adjuvant hormonal therapy may not benefit from removal of affected nodes. Although sentinel lymph node biopsy has become an accepted practice, there have been few randomized trials to confirm this approach to treating localized breast cancer. The Italian study began in 1998 and randomly allocated 115 women with localized breast cancer to have an axillary lymph node dissection and 110 to have a sentinel lymph node biopsy with an axillary lymph node dissection only if positive. A positive sentinel lymph node was found in 27 patients assigned to axillary lymph node dissection and 31 in the sentinel lymph node biopsy arm of the study. Overall accuracy of sentinel lymph node biopsy was 93%. At a median follow-up of 5.5 years, no axillary recurrences occurred in women undergoing sentinel lymph node biopsy. Overall and event-free survivals were not different between women undergoing sentinel lymph node biopsy and women undergoing primary axillary lymph node dissection. Comments: This is one of the few randomized trials with a long enough follow-up to confirm the relative effectiveness of sentinel lymph node biopsy in women with a clinically negative axillary lymph node status. One of the main unresolved issues is whether or not women with microscopic nodal disease receiving adjuvant therapy benefit from an axillary lymph node dissection. Reference: [1] Canavese G, Catturich A, Vecchio C, et al. Sentinal node biopsy compared with complete axillary dissection for staging of early breast cancer with clinically negative lymph nodes: results of a randomized trial. Annals of Oncology [early online publication]. 2009; January 27. ----------------------------------- DEAR STACY: Whatever became of actress Joanne Dru? — C.D., Kearny, NJ DEAR C.D.: Dru, best- known for such films as "She Wore a Yellow Ribbon" and "All the King's Men" died in 1996 at age 74, of lymphedema. She was survived by her son and two daughters from her marriage to Dick Haymes, and by her younger brother, former "Hollywood Squares" host Peter Marshall I also found only one further paragraph anywhere that explained anything else about the reference to lymphedema and her death, though I did find it on a couple of different sites : Biography: Joanne Dru (January 31, 1922 - September 10, 1996) was an American film actress. She also was the sister of actor Peter Marshall, best known for being the host of "Hollywood Squares." She died in Los Angeles, California at the age of 74 from lymphedema, a disease "which is especially common after surgery or radiation therapy were used in combination to treat cancer", which indicates that she probably had undergone these treatments for cancer (likely breast cancer) prior to her death. found at: http://www.mysticgames.com/famouspeople/JoanneDru.htm ---------------------------------- Massage Therapy works for cancer patients, too May 1, 2009 by Bill Eagle photo by Gloria Eagle It is always a pleasure to do stories about people who help others and Jeni Quiriconi makes a living being helpful. Jeni is a licensed massage therapist of over ten years. My wife and I visited Jeni. Her shop is located on 9th Ave in a quiet residential section of Longview; she calls her business “Heartsong Massage.” Jeni greeted us. She was slim and tall, and seemed to radiate energy. I asked Jeni how she became a Massage therapist. “I originally was in the Army Signal Corps,” sparkled Jeni. “I worked with mainframe computers. I was on active duty for 7 years. Thanks to the Army, I earned a BS in Business Administration at the University of Central Texas. At that time I thought I wanted to be a CPA. I even worked a while in Hawaii as an auditor.” Jeni smiled and looked intently at my wife and I. “Ever since I was a small child, I have always liked touching people…I could not keep my hands off of them. I used to give friends massages, and I seemed to be able to help people feel better. I started to think that it might fun for me to make a healthier, happier life change. I thought it might be the right time for me to consider becoming a massage therapist. I moved from Hawaii to Portland and enrolled in the East West College of the Healing Arts. I graduated in December of 1998.” I told Jeni that I heard that she worked with cancer patients. Jeni said: “About 10% of my customers are cancer patients. When I first graduated from school there used to be a prohibition against working with cancer patients.” I asked Jeni. “This prohibition no longer exits?” “That’s true,” replied Jeni. “Science has changed how we view cancers. We have found that massage increases circulation. Increased circulation does not cause cancer to spread. If it did, Lance Armstrong would have died a long time ago.” I nodded in agreement and Jeni continued. “Massage controls pain, controls stress, and replaces noxious stimulation messages that people can get from being treated for cancer. It gives compassionate touch and reduces the sense of isolation that cancer patients often face.” I asked Jeni if she works with the local hospital. Jeni replied: “I used to volunteer at “Our House of Portland” where I worked with AIDS patients. I did that almost immediately after I left school. I made a similar offer to our local hospital, but they seemed reluctant. They seemed to think that if they allowed me to volunteer, they would appear to be endorsing me and/or my business.” I raised my eyebrows. “Could it be that the medical establishment might be afraid of being accused of endorsing ‘Alternative Medicine?’” Jeni looked directly at me. “Alternative Medicine? We were around first.” The origins of massage go back to well before 3000 BC. According to Wikipedia: Writings on massage have been found in many ancient civilizations including Rome, Greece, India, Japan, China, Egypt and Mesopotamia. A biblical reference from C.493 BC documents daily massage with olive oil and myrrh as a part of the beauty regimen of the wives of Xerxes (Esther, 2:9-12). Hippocrates wrote in 460 BC that “The physician must be experienced in many things, but assuredly in massage.” Other writings seem to indicate that both India and China started practicing massage prior to 3000 BC. Tomb paintings in Egypt depict individuals being kneaded by others. Furthermore, Egyptians are credited with creating reflexology as early as 2500 BC. Jeni shares some patients with an acupuncturist and often receives referrals from medical doctors and chiropractors. Jeni will, at times, refer patients back to doctors. “I know where my skills end, and I know that I can’t help everyone.” Jeni is presently working with people who suffer from consequences from cancer therapy such as Lymphedema. Lymphedema is what happens when the transport system for lymph is disrupted by radiation treatment. Jeni has a webpage: “Healthcare that feels good.” http://www.heartsongmassage.biz/ According to her webpage: Jeni has worked with a wide range of clients and patients including infants and people with lupus, cancer, HIV AIDS, Alzheimer’s, and fibromyalgia. Jeni has much experience working with automobile collision injuries and is a Washington State Dept. of Labor and Industries health care provider. Heartsong Massage is also a preferred provider for Blue Cross, Aetna, the Uniform Medical Plan, American Specialty Health and other insurance companies. Jeni is licensed and certified by both the states of Oregon and Washington. As part of the certification process, she was required to pass both written and hands on tests. She is also required to complete 15 hours a year continuing education to maintain her certification. Jeni considers her profession a ‘calling’. She told us: “Massage has given my life a sense of purpose and meaning I never had. I am honored and privileged to be allowed to have such closeness with people. I can’t see anyone not having a massage. We even work on people who are dying, people who have just a few hours left. It is good to help people relax, and give them some comfort. People need a personal touch, a little bit of warmth…Our hands can become marvelous transmitters for loving kindness.” It is always a pleasure to write about people who help others and Jeni Quiriconi is that sort of person. If you are interested in reading more about Massage: Massage therapy foundation: www.massagetherapyfoundtion.org Searchable database National Society of Medicine: www.pubmed.gov America Massage Therapy Association: www.amtamassage.org/ http://www.valleybugler.com/2009/05/massage-therapy-works-for-cancer-patients-too/ ----------------------------------------------------------------- Let me tell you a little about a side effect called lymphedema Published: Sunday, May 10, 2009 By Ann DeMatteo News Let me tell you a little about a side effect called lymphedema Published: Sunday, May 10, 2009 1 comment(s) | Email to a friend | Print version | ShareThis| RSS Feeds By Ann DeMatteo I’ve been lucky, in this breast cancer battle, to have been educated about the side effects because of the women who’ve suffered before me. After I was diagnosed almost a year ago, my friend Mary Hayashida, who had breast cancer 20 years ago, warned me about something called lymphedema, swelling that occurs when you lift something too heavy or get an infection in the arm from which lymph nodes were dissected. I learned a little bit more about lymphedema from Quinnipiac University physical therapy doctoral candidate Ashley Glenn, who helps breast cancer patients keep lymphedema at bay through a gentle exercise program known as the Lebed Method. (Congratulations to Dr. Ashley, Miss Connecticut 2008, as she receives her well-deserved diploma today.) And, I also learned along the way that if one is obese and has lymph nodes removed as part of breast cancer treatment, the risk for lymphedema is higher. So, I automatically expected that the combination of my rotundity and continuing breast-cancer-related bad luck would bring it on. Almost immediately upon getting radiation — which thankfully was completed on Thursday — my underarm flab started to feel heavy, and the right side of NuBoob, where it meets the armpit, felt swollen. I mentioned this to my radiation technologists, Roseann Perito and Shalene Neeman (miss you guys already), and reported my suspicions to Dr. Joseph Cardinale and nurse Vanna Dest, who take care of me at the St. Raphael’s Father Michael J. McGivney Center for Cancer Care. Dr. Joe and Vanna agreed, and off I went to the Therapeia Lymphedema Center in Hamden for an evaluation. Owner Linda M. Hodgkins measured my right arm versus my left arm and determined that I was in the early stages of lymphedema. So, after the compression sleeve and glove Linda ordered for me arrived, I started my wonderful week of water withdrawal with occupational therapist Janice Catrone. Janice, Linda and Kelly Hochstetler are certified lymphedema therapists through the Lymphology Association of North America. They believe that the treatment they give is part of wellness and recovery for cancer patients, and they are proud of the relaxed, spa-like, family atmosphere they provide. Let’s back up a bit. What is lymphedema? The lymphatic system is made up of a network of vessels that remove fluid, protein and waste from the body. When these vessels or the lymph nodes are removed or damaged, waste fluid begins to accumulate, causing swelling known as lymphedema. The condition usually occurs in the arms or legs but can show up anywhere. Besides occurring after radiation therapy or surgery, it can also occur after an injury, infection, or as a result of obesity or a genetic condition. It can occur soon after or many years after cancer surgery. The guesstimate is that 30 percent of women with breast cancer will have lymphedema in their lifetime because the lymph nodes that remain may not be sufficient to drain the fluid daily. The guesstimate is as high as 40 percent if the person gets radiation. So, if you’re feeling tightness, stiffness, heaviness, fullness or discomfort in your chest, upper back or armpit following surgery, then you probably need to get checked out for lymphedema. Linda and Janice had been occupational therapists at Gaylord Hospital who were treating outpatients, some for lymphedema. About 4½ years ago, Linda started her practice because she "wanted to follow the standard of care and create an environment unique from a hospital setting." Lymphedema treatment started in Europe in 1936 and came to America in 1985. Most Connecticut hospitals have trained lymphedema therapists and there are one or two other private practices in the state. I can attest that it works. In the week that I was treated by Janice, I lost fluid in my arm and chest, and now have to wear a compression sleeve and glove daily so that the fluid doesn’t build up. The therapy included gentle skin stretching along the neck, breast area and abdomen, and Janice gave me a daily at-home guide to follow. It was also fun to get to know Janice, a cheerful, caring therapist. And, she now knows more about me than any human would want to. But, as she says, everyone who crosses the threshold at 3074 Whitney Ave., is family. And, you get a free cup of coffee on the way out. What can be better? ‰On another note, I wanted to say happy Mother’s Day to all and to mention a fundraiser and two health- related items. ‰The CUREChief Foundation will be holding a fundraiser at 7 p.m. Saturday at the High Lane Club in North Haven. For more information, call (866) 868-2873 or e-mail founder Sandy Centorino at sandy@curechief.org. ‰The Jewish Community Center of Greater New Haven wants to start a 10-week fitness plan for breast cancer survivors. Group classes will be tailored for different surgeries and fitness levels. "The Pink Program" is the only breast cancer recovery program approved by the American Council on Exercise. For details, call Susan Donovan at (203) 387-2522, ext. 265. ‰"Are Your ‘Fat’ Pants Too Tight?" is the name of a June 9 program presented by my friends at the New Haven Hair and Skin Studio in North Haven. It will benefit the Get in Touch program and will be an informative and interactive presentation about health and nutrition with the Transitions Lifestyle System. It will be hosted by Kristin Huffman, a former Miss Ohio and runner-up to Miss America and Broadway performer, and Nutraceutical consultant Andrew Reimann. More info? Call (203) 776-6447. Ann DeMatteo can be reached at (203) 789-5716. http://nhregister.com/articles/2009/05/10/news/doc4a04dea1d0c86019264220.txt --------------------------------------- MEDICALLY SPEAKING: Lymphedema clinic helps patients cope with cancer treatment side effect By Dr. Anthony Jennings Tuesday, May 12, 2009 3:14 AM CDT You know that your lymph nodes swell when you get an infection, but do you know that they're just part of the lymph system, which is responsible for moving excess fluid and proteins from the tissues to the bloodstream? Usually the lymph system functions well, but it's not infallible. When the lymph system is damaged or blocked, fluid builds up and results in swelling. This is called lymphedema. One of the most common triggers for lymphedema is cancer treatment, and as much as 30 percent of breast cancer patients develop lymphedema of the arm and hand. "Radiation treatments or scar tissue due to surgery can disrupt the lymph system," says Melissa Thess, PT, a lymphedema therapist. Thess works in the new Lymphedema Clinic, developed by SSM Rehab, in the SSM Cancer Care building on the campus of SSM St. Joseph Hospital West. While cancer treatment is one of the main culprits causing lymphedema, it may also occur in the legs if an individual has poor vascular flow because of diabetes, smoking, obesity or genetics. Thess uses a combination of approaches, customized for each patient, to help control lymphedema. "Lymphedema can't be cured, but it can be managed," she says. Thess' tools include exercises, manual lymphatic drainage (a type of massage therapy), range of motion and strength training, and pain management. She also educates patients about how to care for their skin in affected areas, which is important for avoiding infections, and advises them on the use of compression garments or bandages to prevent further fluid buildup. "Lymphedema can cause patients to experience trouble moving their joints, difficulty wearing regular clothing, and uncomfortable sensations of skin tightness, itching or burning that can disrupt sleep," she says. "But by using one or more therapeutic approaches, we can minimize and control the symptoms, which is very important for helping people achieve the best quality of life possible." A report presented at the American Association of Plastic Surgeons annual meeting this month identifies a new microsurgery procedure that can "reduce the fluid buildup in women with lymphedema by 25 percent to 39 percent in a year." The procedure reroutes lymph fluid to open vessels, enabling it to drain. If the procedure continues to show positive results, it could become another type of standard treatment. However, the best approach is prevention, and Thess also works to help cancer patients avoid lymphedema in the first place. Preventive measures include protecting the limb from any type of injury or trauma, avoiding strenuous activity while recovering from surgery or radiation therapy, avoiding heat and tight clothing, and elevating the limb. If you or someone you know has lymphedema and would like to schedule a consultation with Thess at the Lymphedema Clinic, call 636-695-2070 or 636-498-7474. Help is available to ensure you return to health and well-being as soon as possible. Dr. Anthony Jennings is director of the Department of Emergency Medicine at SSM St. Joseph Hospital West in Lake Saint Louis. He is board-certified in emergency medicine and is a fellow of the American College of Emergency Physicians and is president-elect of the American College of Osteopathic Emergency Physicians. http://suburbanjournals.stltoday.com/articles/2009/05/16/stcharles/news//0513stc-jennings0.txt ------------------------ The sky's the limit for Superior teen fighting debilitating disease Wed, 05/06/2009 - 9:10pmCommunity Health Twin Ports By Nicolette Helling, FOX 21 News SUPERIOR - Nearing the end of her freshman year at Superior High School, Meagan Barnard was ready to conquer the world. But one year was all she would get before her ideas about a normal high school experience were turned upside down. "When I was thinking about my high school years I was thinking about, you know, prom queen, homecoming queen," said Meagan. Meagan woke up one morning with swelling in her right leg. It was gone the next day, but then came back. It kept coming back until it stayed and Meagan spent the next five months seeing doctors. She was finally diagnosed with lymphedema in December of her sophomore year. "When they told me, the Mayo Clinic told me, that it was not going away, that was when everything actually came clear to me that I was going to live with this for the rest of my life," said Meagan. Her diagnoses means the lymph nodes in her right leg cannot drain fluid adequately. Fluid goes in, but it doesn't come out. The devastating realization that her illness was chronic and incurable brought Meagan to a new low. "My personality definitely changed from it. Everything about me changed," said Meagan. Meagan says she used to be critical of other students wearing sweatpants to school, but now that her leg was swollen, regular pants caused her pain. "To stay away from the pain it was either, look nice and have pain, or just be underdressed and not have to worry about my leg so much," said Meagan. Dressed in clothes she hated, Meagan went to school everyday feeling different. Family members say she never wanted to talk about her disease. "We didn't realize how sensitive she was to it," said Meagan's sister Kaitlyn Barnard. "So it was hard for everybody." As the months passed, Meagan continued to change. She stopped playing basketball because the running caused her leg to swell. She stopped dancing and twirling baton because the costumes revealed her leg. She even stopped hanging out with friends as much as she used to. "I just kinda felt like, at 15 years old my life was over," said Meagan. As her painful junior year faded into summer and summer into fall, Meagan began preparing for her senior year. Most teenage girls enjoy shopping for back to school clothes, but Meagan was constantly reminded of her condition in every store. "I've never been able to go and look for pants or look for bottoms," Meagan said. "I always buy tons of shirts but I have nothing to wear them with." Beyond frustrated, Meagan stayed up late that night searching the internet for clothes that would fit her. At midnight, Meagan found a website that caught her attention. She read about a company that made clothes for people with broken bones, amputees and for people with lymphedema. But as Meagan continued searching The Cast Clothing Company's website, her heart sank when she noticed there were no clothes for young women. She wrote the company's president and the response she received changed her life. Mike Harding is the president and founder of The Cast Clothing Company in Palm Springs, Florida. When he read Meagan's late-night plea for help, he knew he had to act. "It was all about giving her something that she can feel good about," said Harding. "It was about taking away the self-consciousness that she's went her whole high school career with and giving back the dignity that's important to all of us. We all take clothing for granted. We don't have anything wrong so we take it for granted. Well these people, they need it." Harding asked Meagan what she liked and what she wanted to wear. A few weeks later, she received a pair of custom-made jeans. "They're exactly what I like to wear," said Meagan. "And you can't even notice that I'm wearing cast clothing. So, it's amazing." Meagan was in jeans heaven. "I wanted it to look as much like everybody else is wearing as possible. I didn't want the focus to go to my leg," said Meagan. "When they sent me my first pair of jeans it kinda like made me realize that I can overcome things." A year later, Meagan's life is completely different thanks to that first pair of jeans. "It made me think, well maybe I can do sports again, maybe I can do everything else that I've let go of," said Meagan. "So they kinda gave me that little bit of courage to try harder and to work around things." Meagan started looking forward to the future, instead of being frightened by what her disease had in store for her. Meagan decided to start playing recreational basketball. Then, she started coaching younger dancers at the same studio where she used to dance. But one final hurdle sat in the way of Meagan's graduating and moving on: a senior project. With new found courage and optimism, Meagan decided she wanted to learn more about the disease that had changed her. Working with The Cast Clothing Company, Meagan decided to create a magazine that would provide the same kind of information she had needed so badly. "Right now in the media it's, fit in, look this way, be beautiful, and if you have an abnormality you definitely don't fit that description," said Meagan. "I think that's pretty much why I started it because I was like, I needed this, I needed this tool to help me." But after working on the magazine for five months, Meagan realized it wasn't enough. "Learning about all of the things that I'm going to have to face if there isn't a cure, scared me. So I was like, what if I threw a fundraiser?" The same young woman who had been stalled and side-tracked by lymphedema was now enthusiastic about finding a cure. At her fundraiser last month at Superior Middle School, Meagan, the girl who never wanted to talk about her condition, took the stage to tell others how far she had come. Her benefit for lymphedema was a success. "That night it just clicked, that people actually saw that this was going to help them," said Meagan. The disease that had caused her so much pain is now pushing Meagan to bring healing and hope to others. And in the process, Meagan is healing. "It made her realize that she can make a difference and that's made her feel like she has more of a place in this world," said Meagan's sister Kaitlyn. Meagan says the journey from freshman to senior year has taught her how to look for the positive in the most negative of situations. "I don't have cancer. I don't have something that's going to kill me," said Meagan. "I do have something that has no cure, I don't know how I got it or if it will ever go away, but it could be a lot worse. And so I like to try and think that way, and it makes my problem seem a lot smaller." By the age of 18, Meagan Barnard has learned that no problem is without an answer and no illness is without the possibility of healing. Meagan's fundraiser raised more than $3,000, but she continues to receive donations from people who have heard her story. She hopes to raise a total of five thousand dollars before writing a check to the Lymphadic Research Foundation. If you would like to help Meagan find a cure for lymphedema, email her at Meaganbarnard@ymail.com. -------------------- Moves combat lymphedema Lisa Newman • Special to The Clarion-Ledger • May 12, 2009 Side Tricep Extension with Lateral Leg Lifts ... Purpose: The Steel Magnolia series is designed to raise awareness for breast cancer while providing support and hope for those who have been diagnosed. It is believed that gradual progression of flexibility and resistance exercises can help survivors regain their normal range of shoulder and arm movement. Working out may help prevent lymphedema by pumping lymph fluid out of the arm through the undamaged lymph vessels. Plan: The sixth exercise of the Power and Perseverance combination in the Steel Magnolia fitness series is the alternating side tricep extension with lateral leg lifts. This exercise works the arm and shoulder, helping with lymphedema, and strengthens the hip/buttocks area. Start with your feet shoulder- width apart and dumbbells (1-5 pounds) in the hands. You can use an ankle weight (1-5 pounds) on each ankle for added resistance to better shape the buttocks and thigh muscles. Inhale to start, then exhale while lifting one leg out to the side in combination with extending the same arm or opposite arm for a counter balance. Inhale returning to start, then exhale to rest 3-5 seconds or repeat combination sequence 1-2 set of 10-15 repetitions. PERFIT Trainer's Tip: Try to stay upright through the core (torso and spine) with movement. Think tighten tricep and lift upward with the heel. Variations: Depending on tolerance, use no resistance to ensure that the arms/shoulders are ready and capable of the exercise range of motion. Progression with resistance should be gradual. POWER Points to Ponder: "Never, ever, ever, ever, ever, ever, ever give up!" Lisa Newman is a personal fitness trainer, exercise physiologist and owner of Perfit Inc. E-mail questions to perfitlisanewman@aol.com. http://www.clarionledger. com/article/20090512/HEALTH/905120322/1242/health/Moves+combat+lymphedema ---------------------- Team Tracks Nanotube Cancer Killers in Live Tissue CANCER, NANOTECHNOLOGY, LASERS, IN VIVO. Description Collaboration between scientists at medical school and nearby metropolitan campus in Arkansas detected, tracked and killed cancer cells in real time in living system with carbon nanotubes. Newswise — Nanotechnology scientists at two Arkansas research institutions have developed a method of detecting, tracking, and killing cancer cells in real time with carbon nanotubes. The discovery opens the prospect of a new, major front in the fight to eradicate cancer with promise for a new generation of cancer treatment beyond surgery, radiation, and chemotherapy. Dr. Alex Biris, University of Arkansas at Little Rock (UALR) chief scientist at the Nanotechnology Center and assistant professor of applied science in University's Donaghey College of Engineering and Information Technology, and Dr. Vladimir P. Zharov, professor and director of the Phillips Classic Laser and Nanomedicine Laboratories in the University of Arkansas for Medical Sciences (UAMS) Winthrop P. Rockefeller Cancer Institute, published their findings in the latest issue of the Journal of Biomedical Optics. “Until now, nobody has been able to fully understand and study in vivo and in real time how these nanoparticles travel through a living system,” Biris said. “By using Raman spectroscopy, we showed that it is possible not only to monitor and detect nanomaterials moving through the circulation, but also to detect single cancer cells tagged with carbon nanotubes. In this way, we can measure their clearance rate and their biodistribution kinetics through the lymph and blood systems.” Zharov emphasized that in vivo Raman flow cytometry is promising for the detection and identification of a broad spectrum of various nanoparticles with strong Raman scattering properties, such as cells, bacteria, and even viruses. “Before any clinical application of nanoparticles, it is imperative to determine their pharmacological profiles,” Zharov said. “And this tool will provide this function as a supplement or even an alternative to the existing methods.” In their research, Biris, Zharov, and UAMS colleague Ekaterina Galanzha, M.D., injected a single human cancer cell containing carbon nanotube material in the tail vein of a test rat. They were able to follow the circulation of the carbon nanotubes in the blood vessels to the rat’s ear, tracking the cell through the rat’s blood stream, lymphatic system, and tissue with a Raman spectrometer. In the same issue of the scientific journal, Biris and Zharov published a second paper discussing how nanoparticles can tag cancer cells. A laser then heats the nanoparticles, killing the cancer cell. “If we are able to target cancer cells using these nanomaterials, we can monitor where the cancer cells are specifically located, and then we can kill them,” Biris said. He said the live rat experiment shows how the cancer killing process leaves only a dead cell and nanoparticles that, within a matter of hours, disintegrate and die. Dr. Mary Good, dean of UALR’s Donaghey College of Engineering and Information Technology, said the medical and economic ramifications of the discovery are significant. “The research Dr. Biris and Dr. Zharov have conducted indeed is significant and promising,” said Good, former technology undersecretary of Commerce in the Clinton administration. “It points to a whole new direction for medical applications for nanoparticles. There still is extensive time needed for research into the ultimate utility for these approaches and for human subject experiments. But this early work is exciting and provides long-term hope for more effective cancer treatments.” Biris, 34, said the UALR Nanotechnology Center’s aim is to accelerate the development of commercial applications of nanotechnology and its potential to revolutionize medical advancements and the next generation of manufacturing of other products. “The close location of UALR with its cutting-edge analytical chemistry and nanotechnological tools, along with UAMS and its established biological and medical infrastructures, provides unique opportunities for comprehensive pre-clinical evaluation of nanotechnological products,” Zharov said. “That allows for us to accelerate Nanotechnology advances from bench to bedside, providing breakthroughs in early diagnosis, prevention and effective treatment of cancers, stroke, heart attack, infections, and neurological disorders which remain the leading cause of death in the U.S.” About the scientists Zharov obtained his Ph.D and DSc degrees at Moscow State Technical University and completed a postdoctoral fellowship at Lawrence National Laboratory of the University of California. He served as professor and chairman of the Biomedical Engineering Department at Moscow University. Since 2000, he is a professor and director of the Phillips Classic Laser and Nanomedicine Laboratories at the UAMS Winthrop P. Rockefeller Cancer Institute. Zharov has authored and co-authored five books, 40 patents, and published close to 200 papers. He is the principle investigator in 12 grants from the NIH, NSF, and DoD. He has unique interdisciplinary skills in physics, biology and medicine. Zharov’s research interests include the development and medical application of advanced laser, nanotechnology and imaging and he was the first recipient of the United States Maiman Award, named after the inventor of the first laser. His laboratories have pioneered laser-ultrasound microsurgery, phototherapy of post-mastectomy lymphedema, photoacoustic tweezers, multiplex imaging of cancer cells, laser-gene therapy, laser-based chemosensitivity and radiosensitivity tests, in vivo noninvasive photoacoustic cytometry and blood and lymph cancer tests. In particular, Zharov invented one of the first applications of nanotechnology for treating cancer and infections using laser-activated gold nanoparticles (U.S. Patent, 2000). Recently, he was awarded by the $1.5 million five-year grant from the National Cancer Institute supporting one of the first clinical application of nanomedicine technology for early cancer diagnosis. Biris earned his Ph.D. at UALR and joined the faculty in 2006. He and his team have filed 11 patent applications in nanotechnology, bio-nanotechnology, space exploration, and materials science areas. He is fully involved in studying the interaction of nanomaterials with biological systems and using use such novel nanostructures for targeting and killing cancer cells. He has more than 160 papers published in peer reviewed journals or presented at international conferences. He was part of the team that designed and developed a newly patented electrodynamic screen for space exploration in collaboration with NASA. Patent applications are pending on his new method and technology for producing large quantities of carbon nanotubes with high purity. He led the design and development of carbon nanostructures-based filters to efficiently remove bio-chemical contaminants from air and water. Biris also developed a unique tissue regeneration system that has been used successfully in 33 clinical studies to grow bone tissue. The work has been licensed to a spin-off company, Orlumet LLC, in which Biris serves as Chief Technical Officer.The co-founder is Peder Jensen. Biris is honorary president and co-founder of the Romanian Nanomedicine Institute in his native country. In addition to his groundbreaking research and work with graduate and undergraguate students, Biris works one-on-one with gifted middle- and high school students in Arkansas. He said the key to the Nanotechnology Center at UALR is its aggressive outreach program to train and educate young people and other world-class scientists who will serve and attract business and industry to Arkansas from the region and the nation. http://www.newswise.com/articles/view/552591/ ----------------------------- Breast Cancer Patients May be Spared Additional Surgery NorthShore University HealthSystem Researcher reports in the Journal of Clinical Oncology. The surgical community now has confirmed evidence to demonstrate there is no need for aggressive surgery if limited microscopic breast cancers are detected Evanston, IL (Vocus) May 20, 2009 -- A recent study in the Journal of Clinical Oncology, authored by David J. Winchester, FACS, M.D., Chief of General Surgery and Surgical Oncology, NorthShore University HealthSystem, concludes that women whose breast cancer has spread to the lymph nodes may not need a radical lymph node surgery. The observational study of more than 97,000 women whose breast cancer spread to the lymph nodes indicates that women with microscopic lymph node metastases detected on sentinel lymph node (SLN) biopsy, shared the same benefit and survival rate as those who underwent a SLN biopsy with a more invasive completion axillary lymph node dissection (ALND). The analysis was conducted using the National Cancer Database of the American College of Surgeons and was published in the Journal of Clinical Oncology, May 2009. Dr. Winchester, along with the other study authors, analyzed data from approximately 1,400 hospitals. The women whose breast cancer cases were analyzed underwent SLN biopsy for clinically node-negative breast cancer from 1998 to 2005 and were found to have nodal metastases. The authors report that some patients with lymph node metastases identified on sentinel node biopsy may not need to have the rest of their lymph nodes removed. "The surgical community now has confirmed evidence to demonstrate there is no need for aggressive surgery if limited microscopic breast cancers are detected," said Dr. Winchester. "Treating cancer is as much about improving quality of life for our patients as it is about long-term survival." We have relied upon that operation too much, and this paper points out we may not need to do it in terms of a survival difference or a regional recurrence difference, Winchester explained. This is an operation associated with significant morbidity. Among the morbidities linked to ALND are a lifetime risk of lymphedema, problematic cosmetic outcomes, longer recovery times and more postoperative pain than SLN biopsy alone. The National Cancer Data Base, which is a joint program supported by the American College of Surgeons Commission on Cancer and the American Cancer Society, is recognized as the largest clinical registry in the world. It is a nationwide oncology outcomes database for more than 1,460 Commission on Cancer accredited cancer programs in the United States and Puerto Rico, and captures approximately 70 percent of all new invasive cancers diagnosed annually. About NorthShore University HealthSystem Headquartered in Evanston, Ill., NorthShore University HealthSystem (NorthShore) is a comprehensive, fully integrated, healthcare delivery system that serves the greater North Shore and northern Illinois communities. The system includes four Hospitals - Evanston Hospital, Glenbrook Hospital, Highland Park Hospital and Skokie Hospital. In addition, the health system has more than 2,400 affiliated physicians, including a 600-physician, multispecialty physician group practice with over 70 office locations - NorthShore University HealthSystem Medical Group. Further, NorthShore is committed to excellence in its academic mission and supports teaching and research as the principal teaching affiliate for the University of Chicago Pritzker School of Medicine. The NorthShore University HealthSystem Research Institute focuses on clinical and translational research, including leadership in outcomes research and clinical trials. The NorthShore University HealthSystem Foundation is a leading philanthropic entity of NorthShore. It raises charitable contributions, engages volunteer friends and invests in community partnerships. NorthShore has annual revenues of $1.5 billion and a staff of more than 8,000. The HealthSystem has significant capabilities in a wide spectrum of clinical programs, including cancer, heart, orthopaedics, high- risk maternity and pediatrics. NorthShore is a national leader in the implementation of innovative technologies, including electronic medical records, (EMR ). In 2003, the HealthSystem was among the first in the country to successfully launch a systemwide EMR with demonstrable benefits in quality, safety, efficiency and service to patients. NorthShore has been recognized by multiple national organizations for this notable achievement. ### Trackback URL: http://www.prweb.com/pingpr. php/U3VtbS1GYWx1LUNvdXAtSGFsZi1IYWxmLUNvdXAtWmVybw== See the original story at: http://www.prweb.com/releases/2009/05/prweb2446044.htm ============================== BraveHearts Dragon Boat Team Courier-IslanderMay 27, 2009 The BraveHearts Dragon Boat Team was formed in 2006 under the North Island Dragon Boat Society, a registered non-profit Society. In the beginning, the team was little more than just an idea of the founding members, who were all Breast Cancer survivors. Traditionally, Dragon Boats have been embraced by women who have survived Breast Cancer, and what started in Vancouver as a medical experiment has become an international phenomenon and today, there are Breast Cancer teams all over the world. These founding members, having experienced the sport themselves, began to think that anyone who had experienced any type of cancer could benefit from the supportive and healthy lifestyle derived from these ancient Chinese boats, because the long term emotional and physical effects of any cancer can be the same. Dragon Boats were initially used as a medical research project on Lymphedema, a side effect on Breast Cancer survivors who had their lymph nodes removed. Besides reaffirming the obvious physical benefits, particularly in increasing upper body strength, researchers also found that the sport could provide a much needed positive attitude in these patients, get them to exercise, and certainly uplift their spirit. These are crucial elements in the treatment for these individuals and empowers them to face their illness with greater confidence. Most importantly, it provided them with a supportive and healthy environment. Since that initial study, research has confirmed that patients with other cancers can derive the same benefits as those Breast Cancer patients had realized. Thus, the idea became a reality as a few members became many as the word spread. The BraveHearts Dragon Boat Team would become Canada's first co-ed Dragon Boat team for survivors of ALL cancers! Together, the BraveHearts fundraised for their paddles, their life vests, and most importantly, their very own Dragon Boat, complete with the beautiful dragon head and tail and the scales along the boat in green, the chosen colour to represent themselves with. Soon, a custom trailer was added that could take them and their 48 foot, 800 pound vessel to a number of Dragon Boat festivals and racing events all over the west coast. The BraveHearts invite all cancer survivors to join them and experience this life changing and positive activity. This is one that just about anyone can do. There are no limits as to your age, gender, or physical strength. We are also now accepting applications from "supporter" Associate members who wish to participate with us while helping us to bring a kinder experience to cancer survivors. For membership or for more information about sponsoring our team please call Marianne at 287-2327 The BraveHearts are very grateful to the people and businesses in their community of Campbell River for having believed in their idea, and for their generosity in giving this team the means to make this idea a reality. We proudly display their business logos on our boat. We are immensely proud to represent our community at the events we participate in. Our hope is that other communities will follow our lead and form similar teams in their own towns. Most importantly, these cancer survivors are grateful for the means with which we can enrich our lives and prove to ourselves and to others that there can be LIFE after cancer. Together, we all can win the battle against cancer. As we say... "Paddles Up!" http://www.canada.com/BraveHearts+Dragon+Boat+Team/1633561/story.html ============================== http://www.stamfordplus.com/stm/information/nws1/publish/health/New-cancer-survivor-clinic-created-by- the-Connecticut-Challenge-and-St-Vincent-s-Medical-Center5084.shtml New cancer survivor clinic created by the Connecticut Challenge and St. Vincent’s Medical Center By St. Vincent’s Medical Center Chuck Mattes, St. Vincent’s Medical Center Foundation board member and capital campaign co-chair, and Bob Mazzone, executive director of the CT Connecticut Challenge discuss plans for the future cancer survivor clinic at St. Vincent’s Medical Center St. Vincent’s Medical Center of Bridgeport, Connecticut has formed a new partnership with the Connecticut Challenge of Fairfield. The partnership will result in the formation of a survivor clinic at the new Elizabeth M. Pfriem SWIM Center for Cancer Care due to open January 2010. The new survivor clinic will include wellness and fitness education, free lectures, nutritional counseling, psychosocial support, and complimentary spa therapies such as massage, yoga and reiki. St. Vincent’s has begun recruiting physicians who are interested in the needs of survivors. St. Vincent’s Medical Center Foundation Board Member and Co-chair of St. Vincent’s Capital Campaign, Chuck Mattes of Redding helped create the partnership. “It seemed only natural for these two organizations to partner together. In addition to providing cancer screening and education programs, St. Vincent’s SWIM Across the Sound’s mission is also to help cancer patients and their families both in the form of financial assistance while they are in treatment, and also in the form of support programs throughout both treatment and recovery. With the help of the Connecticut Challenge that commitment will continue long after they’ve completed treatment. Many survivors experience recurrences of cancer and this clinic will direct them to change behaviors and reduce their risks,” said Mattes. Founded by Jeffrey Keith, a cancer survivor of Fairfield, John Ragland of Westport and Matthew Vossler of Darien, the Connecticut Challenge is a non-competitive bike ride that raises money for cancer survivors. The relationship between Keith, Vossler and St. Vincent’s dates back to 1987 with St. Vincent’s first SWIM Across the Sound. Corporate Senior Vice President of St. Vincent’s Medical Center and President of the St. Vincent’s Medical Center Foundation Ronald J. Bianchi had worked closely with Jeff Keith in the early days of the SWIM Across the Sound. “It is very rewarding to be working with Jeff again and sharing a commitment to help cancer survivors in Connecticut. Both the SWIM and the Connecticut Challenge share a vision of helping those at risk and making a difference in their lives,” he said. “The Connecticut Challenge is honored to support St. Vincent’s. They have a vision for caring for cancer survivors that is unique and far-reaching,” said Keith. “Their exceptional work will improve the lives of cancer survivors and that is the mission of our organization. This will also mean a lot to our thousands of cyclists, volunteers and donors from the greater Bridgeport community. We are excited to move forward,” he added. There are an estimated 120,000 cancer survivors living in Connecticut today. Many of them will battle long- term medical problems as a result of their chemotherapy and radiation treatments, including lymphedema, heart disease, nerve damage, sexual dysfunction and early menopause in women. By screening for long-term health and psychosocial effects from the disease and treatments, the goal of the CT Challenge survivor clinic at St. Vincent’s will be to educate and empower survivors to optimize their health, quality of life and longevity. Connecticut is among the very few states with a comprehensive program dedicated to meeting the needs of cancer survivors. About St. Vincent’s Medical Center St. Vincent’s Medical Center in Bridgeport, CT is a 473-bed community teaching and referral hospital with a Level II trauma center and a 76-bed inpatient psychiatric facility in Westport. St. Vincent’s provides a full range of inpatient and outpatient services with regional centers of excellence in cardiology, surgery, cancer care, orthopedics, diagnostics, women’s and family services, behavioral health, senior health and an array of specialized services. St. Vincent’s Medical Center is a subsidiary of St. Vincent’s Health Services, which include St. Vincent’s Behavioral Health Services, Westport Campus, St. Vincent’s College, St. Vincent’s Special Needs Services, St. Vincent’s Medical Center Foundation and St. Vincent’s Immediate Health Care Centers. It is a member of Ascension Health, the nation's largest Catholic healthcare system. St. Vincent's is a teaching affiliate of the University of Connecticut’s School of Medicine and of New York Medical College. The Medical Center is also sponsor of SWIM Across the Sound, one of the nation’s largest hospital-based cancer prevention and patient support programs. For referral to a St. Vincent’s physician or about programs and services, call the toll-free Care Line at 1-877-255-SVHS (7847) About the Connecticut Challenge The Connecticut Challenge is a non-competitive bike ride based in Fairfield, CT that raises money for the cancer survivorship programs of the Connecticut Challenge, including survivorship clinics, research grants, symposiums and survivor education and awareness events. Riders of all ages and skill levels can register for a 12, 25, 50, 75 or 100-mile ride and raise funds from personal sponsors to support their efforts. The 2009 Connecticut Challenge will take place on Saturday, July 25th, starting and finishing in Fairfield, CT. To register to ride, volunteer or make a contribution to the 2009 event, please visit www.ctchallenge.org. ====================== Program offers camaraderie for breast cancer survivors May 20, 2009 - by Karen Longwell A program offering fellowship, fitness and education for women who have had breast cancer surgery came to Bracebridge this spring. A pilot of YWCA’s Encore program, the eight-week, specifically designed program of gentle land and water exercises for women who have had breast cancer surgery, ran at the sportsplex. The final class for this first session took place on May 12. Program facilitator Silvia Smith said the 12 women in the class are remarkable. “I just think they are very brave women who have to deal with the reality of a compromised health scenario. They wake up every day and realize that life is never going to be the same, but sometimes it can be better,” said Smith. “It (breast cancer) has really helped them focus on what is important.” The program is offered free of charge. It aims to improve upper body mobility and flexibility, boost self- esteem and help prevent or manage lymphedema. Lymphedema, which can occur after breast cancer surgery, is a condition of localized fluid retention caused by a compromised lymphatic system. The lymphatic system is often referred to as the body’s second circulatory system. Participants, some of whom were not comfortable giving their name, enjoyed hearing from informative guest speakers and learning exercises geared toward regaining mobility after surgery. In surgery, nerves and muscles are cut. Encore participant Marilyn said she lost the use of her right arm. “The exercises stretch the muscles and ligaments — everything that went to sleep (after surgery),” said Marilyn. Recovery is different for everyone, depending on the extent of the surgery, said Nancy, another participant. “The exercises have been helpful. They help us get back into shape,” said another participant. Smith teaches therapy pool classes at the sportsplex, but the exercises for breast cancer recovery are different. They focus on the lymphatic system. “This is a unique course because the lymphatic system is so different from the circulatory system,” said Smith. “The lymphatic moves a lot slower … so the exercises are much slower. It would be more like yoga or tai chi.” Participants also learned land-based exercises, which they can take home with them. Any woman who has had breast cancer surgery at any time in their lives can join an Encore program. Women in this first group in Bracebridge ranged from less than one year after diagnosis up to 30 years, said Smith. While the women enjoyed learning exercises and hearing from speakers every two or three weeks, they also learned a lot from each other. The camaraderie in the group was wonderful, said one participant. “We have learned that we are not alone,” said Marilyn. Smith found the women enjoyed swapping stories. “They love to share information,” said Smith. “Other people just don’t understand what they have gone through.” Encore facilitators Smith and Sarah Hill took training for the program in the fall. They are hoping to continue with more sessions. This session was partially funded through the Canadian Cancer Society and YWCA Muskoka, said Hannah Lin, youth programs facilitator for the YWCA. The program was held in partnership with the Town of Bracebridge. http://www.gravenhurstbanner.com/article/136355 --------------------------------- http://suburbanjournals.stltoday.com/articles/2009/05/20/stcharles/news//0513stc-jennings0.txt MEDICALLY SPEAKING: Lymphedema clinic helps patients cope with cancer treatment side effect By Dr. Anthony Jennings Tuesday, May 12, 2009 3:14 AM CDT You know that your lymph nodes swell when you get an infection, but do you know that they're just part of the lymph system, which is responsible for moving excess fluid and proteins from the tissues to the bloodstream? Usually the lymph system functions well, but it's not infallible. When the lymph system is damaged or blocked, fluid builds up and results in swelling. This is called lymphedema. One of the most common triggers for lymphedema is cancer treatment, and as much as 30 percent of breast cancer patients develop lymphedema of the arm and hand. "Radiation treatments or scar tissue due to surgery can disrupt the lymph system," says Melissa Thess, PT, a lymphedema therapist. Thess works in the new Lymphedema Clinic, developed by SSM Rehab, in the SSM Cancer Care building on the campus of SSM St. Joseph Hospital West. While cancer treatment is one of the main culprits causing lymphedema, it may also occur in the legs if an individual has poor vascular flow because of diabetes, smoking, obesity or genetics. Thess uses a combination of approaches, customized for each patient, to help control lymphedema. "Lymphedema can't be cured, but it can be managed," she says. Thess' tools include exercises, manual lymphatic drainage (a type of massage therapy), range of motion and strength training, and pain management. She also educates patients about how to care for their skin in affected areas, which is important for avoiding infections, and advises them on the use of compression garments or bandages to prevent further fluid buildup. "Lymphedema can cause patients to experience trouble moving their joints, difficulty wearing regular clothing, and uncomfortable sensations of skin tightness, itching or burning that can disrupt sleep," she says. "But by using one or more therapeutic approaches, we can minimize and control the symptoms, which is very important for helping people achieve the best quality of life possible." A report presented at the American Association of Plastic Surgeons annual meeting this month identifies a new microsurgery procedure that can "reduce the fluid buildup in women with lymphedema by 25 percent to 39 percent in a year." The procedure reroutes lymph fluid to open vessels, enabling it to drain. If the procedure continues to show positive results, it could become another type of standard treatment. However, the best approach is prevention, and Thess also works to help cancer patients avoid lymphedema in the first place. Preventive measures include protecting the limb from any type of injury or trauma, avoiding strenuous activity while recovering from surgery or radiation therapy, avoiding heat and tight clothing, and elevating the limb. If you or someone you know has lymphedema and would like to schedule a consultation with Thess at the Lymphedema Clinic, call 636-695-2070 or 636-498-7474. Help is available to ensure you return to health and well-being as soon as possible. Dr. Anthony Jennings is director of the Department of Emergency Medicine at SSM St. Joseph Hospital West in Lake Saint Louis. He is board-certified in emergency medicine and is a fellow of the American College of Emergency Physicians and is president-elect of the American College of Osteopathic Emergency Physicians. ------------------------------ http://www.ecancermedicalscience.com/news-insider-news.asp?itemId=580 Sentinel node biopsy is an effective option for early-stage cervical cancer Published: 31/05/2009 A prospective multicenter study conducted by researchers in France suggests that the majority of women with early-stage cervical cancer can safely undergo sentinel node (SN) biopsy – a technique in which only one to three lymph nodes are removed to determine whether cancer has spread – in lieu of the traditional, more invasive pelvic lymph node removal. This study, presented at the American Society of Clinical Oncology 2009 meeting, showed that SN biopsy was just as useful as full pelvic lymph node removal for identifying even small amounts of cancer cells that spread to lymph nodes in atypical areas of the pelvis. "Sentinel node biopsy is a good option for women with cervical cancer because it enables us to remove fewer lymph nodes to get information about cancer spread, and could decrease the risk of complications from surgery, such as lymphedema," said Dr. Fabrice Lecuru, professor at George Pompidou European Hospital in Paris, and the study’s lead author. "Previous studies have shown that sentinel node biopsy can be used to assess cancer spread in usual areas of the pelvis, but our findings add to this growing body of research by showing that this approach is also effective for identifying cancer spread in less common areas of the pelvis and the abdomen. This approach may become a new standard of care for early-stage cervical cancer." Ten to 15 per cent of patients with early-stage cervical cancer experience recurrence. Some are due to lymph nodes that were missed during surgery or because of undetected cancer spread to other lymph nodes. During standard surgery, several pelvic lymph nodes are removed and examined for the presence of cancer cells. During SN biopsy, however, a blue dye and radioactive substance that can be traced with imaging techniques are used to locate the first lymph node (the sentinel node) where cancer cells would travel after leaving the cervix. If this node is free of cancer cells, no other lymph nodes should be removed. Since the removal of lymph nodes may impair lymphatic drainage and cause uncomfortable swelling in the legs called lymphedema, doctors have been assessing SN biopsy (which is routinely used for breast cancer and melanoma patients) to see if it can be used to gauge cervical cancer spread. Prior studies have shown that SN biopsy can be used in cervical cancer patients to predict cancer spread to lymph nodes in the pelvis most likely to contain cancer cells. But in this study, Dr. Lecuru and his colleagues also evaluated the biopsy of sentinel nodes in atypical areas of the pelvis in 128 women with early-stage cervical cancer who also had full pelvic lymph node removal for comparison. They then analysed sentinel nodes for micrometastastic cancer (0.2 to 2 mm in size) and isolated tumour cells as well as areas of cancer greater than 2 mm (macrometastases). After analysing these nodes, researchers demonstrated that full pelvic lymph node removal and its associated complications could have been avoided in 81.2 per cent of women. Researchers also found that in nearly 40 per cent of women, SN biopsy alone would have provided additional, important information about patients’ disease; for example, SN biopsy was more useful than routine techniques for showing that lymphatic drainage occurred via unusual pathways to less commonly explored areas of the pelvis or of the abdomen, and for detecting micrometastases or isolated tumour cells. ---------------------- 1. Clin Exp Dermatol. 2009 May 18. [Epub ahead of print] Localized bilateral lymphoedema of the ear lobes secondary to mesothelioma. Gudi V, Chan SK, Laroche C, Ford HE, Darrah R, Love K. Department of Dermatology, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk, IP33 2QZ, UK. PMID: 19456781 [PubMed - as supplied by publisher] ================ 2. Int J STD AIDS. 2009 Jun;20(6):437-9. Vulval lymphoedema following pulmonary tuberculosis. Talwar A, Puri N, Sandhu HP. Department of Surgery & Dermatology, GGS Medical College & Hospital, Faridkot 151203, Punjab, India. Acquired lymphoedema of the vulva is induced by impaired lymph flow. We present the case of a 35-year- old woman having lymphoedema of the vulva following pulmonary tuberculosis, which she had developed four years back for which she had taken a full course of antitubercular treatment for nine months from the Chest and Tuberculosis department. The biopsy taken from the perianal swellings showed hyperkeratosis and acanthosis with multiple dilated lymph specs. PMID: 19451336 [PubMed - in process] ====================== 3. Dermatol Online J. 2009 Apr 15;15(4):13. Lympangiectasia of the vulva accompanying congenital lymphedema. Okur MI, Köse R, Yildirim AM, Cobanoglu B. Lymphangiectasia is a benign condition with multiple dilated lymph vessels in the dermis. Vulvar localization is rare and mostly depends on disturbing the lymphatic flow. We present a patient with vulvar lesions and ipsilateral congenital lower extremity lymphedema. Surgical excision eliminated the lymphangiectasia and improved the appearance of the edematous vulva. Publication Types: Letter PMID: 19450406 [PubMed - in process] ============================ 4. Circ Res. 2009 May 14. [Epub ahead of print] Activated Forms of VEGF-C and VEGF-D Provide Improved Vascular Function in Skeletal Muscle. Anisimov A, Alitalo A, Korpisalo P, Soronen J, Kaijalainen S, Leppänen VM, Jeltsch M, Ylä-Herttuala S, Alitalo K. Molecular/Cancer Biology Laboratory, Biomedicum Helsinki, Department of Pathology, Haartman Institute and Helsinki University Central Hospital, University of Helsinki, Finland; and Department of Biotechnology and Molecular Medicine, A. I. Virtanen Institute for Molecular Sciences, University of Kuopio, Finland. The therapeutic potential of vascular endothelial growth factor (VEGF)-C and VEGF-D in skeletal muscle has been of considerable interest as these factors have both angiogenic and lymphangiogenic activities. Previous studies have mainly used adenoviral gene delivery for short-term expression of VEGF-C and VEGF-D in pig, rabbit, and mouse skeletal muscles. Here we have used the activated mature forms of VEGF-C and VEGF-D expressed via recombinant adeno-associated virus (rAAV), which provides stable, long-lasting transgene expression in various tissues including skeletal muscle. Mouse tibialis anterior muscle was transduced with rAAV encoding human or mouse VEGF-C or VEGF-D. Two weeks later, immunohistochemical analysis showed increased numbers of both blood and lymph vessels, and Doppler ultrasound analysis indicated increased blood vessel perfusion. The lymphatic vessels further increased at the 4-week time point were functional, as shown by FITC-lectin uptake and transport. Furthermore, receptor activation and arteriogenic activity were increased by an alanine substitution mutant of human VEGF-C (C137A) having an increased dimer stability and by a chimeric CAC growth factor that contained the VEGF receptor-binding domain flanked by VEGF-C propeptides, but only the latter promoted significantly more blood vessel perfusion when compared to the other growth factors studied. We conclude that long-term expression of VEGF-C and VEGF-D in skeletal muscle results in the generation of new functional blood and lymphatic vessels. The therapeutic value of intramuscular lymph vessels in draining tissue edema and lymphedema can now be evaluated using this model system. PMID: 19443835 [PubMed - as supplied by publisher] ========================= 5. Indian J Dermatol Venereol Leprol. 2009 May-Jun;75(3):290-2. Kaposi's sarcoma in an HIV-positive person successfully treated with paclitaxel. Dongre A, Montaldo C. Medicines sans Frontieres Belgique, HIV/AIDS Khar Clinic, Mumbai, India. atul507@yahoo.co.in Epidemic Kaposi's sarcoma is one of the malignant neoplasms, which can develop in HIV-infected patients. Although the prevalence of HIV infection is reported to be high in Asian countries, Kaposi's sarcoma is rarely reported. We report a case of Kaposi's sarcoma involving the skin and oral mucosa along with extensive bilateral lymphedema of lower extremities, treated successfully with paclitaxel and antiretrovirals. PMID: 19439884 [PubMed - in process] ============================== 6. J Pak Med Assoc. 2009 May;59(5):282-7. Post mastectomy adjuvant radiotherapy in breast cancer: a comparision of three hypofractionated protocols. Shahid A, Athar MA, Asghar S, Zubairi T, Murad S, Yunas N. Institute of Nuclear Medicine & Oncology (INMOL), Wahdat Road, Lahore, Pakistan. OBJECTIVES: To compare three hypofractionated protocols in postmastectomy cancinoma breast in terms of local control, toxicity and work load. METHODS: A total of three hundred patients suffering from cancer breast stage T2-4, N any were randomized into three arms after mastectomy. All the patients were treated with four fields on Co60 i.e. two tangential portals for chest wall, one anterior supraclavicular and axillary field and a posterior axillary boost and were randomized into three arms i.e. 2700 CGy in 5 fractions (one week) arm A, 3500 CGy in 10 fractions (2 weeks) arm B and 4000 CGy in 15 fractions (3 weeks) arm C. Skin, cardiac, pulmonary and haematological toxicities and lymphoedema were compared in addition to local control and work load. RESULTS: The locoregional relapses were 11%, 12% and 10% in arms A, B and C respectively. 26%, 24% and 28% patients developed metastatic disease and 17%, 18% and 20% died in the three arms. G3 and G4 skin toxicities were 37%, 28% and 14%. G2 and G3 lymphedoema was 21%, 22% and 27%. Cardiac toxicity was 5%, 6% and 5% while pulmonary toxicity was 4%, 5% and 5% respectively. All the differences except skin toxicity were statistically insignificant. There were no cases of haematological depression or rib fractures. CONCLUSION: All the three short protocols were equally effective in locoregional disease control and toxicity was also comparable. They were helpful in reducing the work load and can be safely recommended for routine clinical use. PMID: 19438129 [PubMed - in process] ============================= 7. Zhong Xi Yi Jie He Xue Bao. 2009 May;7(5):418-21. [Relationship between ultrasound imaging and traditional Chinese medicine syndrome in limb lymphedema.] [Article in Chinese] Liu M, Zhang Y, Song FC, Cheng ZX. Department of Peripheral Vascular Surgery, Affiliated Hospital, Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China; E-mail: liuming404@sina.com. Objective: To study the correlation between traditional Chinese medicine (TCM) syndrome type and the ultrasound imaging changes in patients with limb lymphedema, and to provide evidence for TCM syndrome differentiation. Methods: Syndrome typing was done and ultrasonography was performed in 107 patients with limb lymphedema. The thickenings of derma, hypodermis and deep-fascia were measured. The ultrasound echo intensity and the morphology of the hypodermis were classified into five degrees according to the ultrasonogram. The ultrasound indexes in the limb lymphedema patients with different syndromes were compared, and the relationship between TCM syndromes and the ultrasound indexes was analyzed. Results: There were specific ultrasound image features in different TCM syndromes of limb lymphedema. The thickenings of derma, hypodermis and deep-fascia in the limb lymphedema patients with downward migration of damp-heat or phlegm stagnation and blood stasis were more significant than those in the patients with collateral obstruction due to cold-dampness (P<0.05, P<0.01). The thickenings of derma and hypodermis in the patients with phlegm stagnation and blood stasis were obviously more severe than those in the patients with downward migration of damp-heat (P<0.01). The maximum and minimum ultrasound echo intensities of hypodermis were in phlegm stagnation and blood stasis and downward migration of damp-heat respectively (P<0.05), and there was a significant difference in the hypodermal morphology among the three syndrome types (P<0.05). The most obvious structure disturbance was observed in the patients with phlegm stagnation and blood stasis syndrome. Conclusion: TCM syndrome type of limb lymphedema is related to ultrasound image changes. The imaging data can be regarded as new objective indexes for TCM syndrome defferentiation, and it has an important value for diagnosis and treatment of limb lymphedema. Publication Types: English Abstract PMID: 19435554 [PubMed - in process] ================================ 8. Aesthetic Plast Surg. 2009 May 12. [Epub ahead of print] Suction-Assisted Lipectomy for Treatment of Lower-Extremity Lymphedema. Eryilmaz T, Kaya B, Ozmen S, Kandal S. Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University School of Medicine, Ankara, Turkey, mdtolgaer@yahoo.com. Lymphedema typically occurs on the extremities and affects millions of people throughout the world. Although currently there is no single treatment proven effective for lymphedema in every patient, suction- assisted lipectomy has been shown to be effective in some patients. Suction-assisted lipectomy offers patients with lower-extremity lymphedema a less invasive, less morbid surgical option compared with traditional excisional techniques. In this article we present a case of lymphedema reduction with suction- assisted lipectomy in a patient with bilateral lower-extremity lymphedema. PMID: 19434444 [PubMed - as supplied by publisher] ==================================== 9. Ann Diagn Pathol. 2009 Jun;13(3):147-50. Epub 2009 Apr 1. Angiosarcoma of the breast: a clinicopathologic analysis of cases from the last 10 years. Wang XY, Jakowski J, Tawfik OW, Thomas PA, Fan F. Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA. Breast angiosarcoma may occur de novo, or as a complication of radiation therapy, or chronic lymphedema secondary to axillary lymph node dissection for mammary carcinoma. In our effort to characterize the clinicopathologic features of breast angiosarcoma, we reviewed all breast angiosarcoma cases in the University of Kansas Medical Center and Ohio State University Medical Center archives from 1997 to 2007. Clinical histories and follow-up data for identified patients were reviewed. The tumors were graded histologically according to Rosen's method. Only 11 angiosarcomas were identified among more than 5000 malignant breast neoplasms (0.1%-0.2% incidence) for the last 10 years. Eight cases (6 high grade, 1 intermediate grade, 1 low grade) were identified as postradiation angiosarcoma (postradiation time interval, 4-12 years), and 3 cases were identified as primary angiosarcomas (1 high grade, 2 low grade). Follow-up (median, 36 months) revealed that 3 cases of postradiation angiosarcoma recurred as skin and/or chest wall lesions and 1 case of primary angiosarcoma developed liver metastases (all high-grade). In conclusion, breast angiosarcoma remains a rare disease. Rosen's method for grading breast angiosarcoma is easy to implement and correlates well with clinical outcome. There are no distinct clinical or histologic differences between primary and postradiation breast angiosarcomas. PMID: 19433291 [PubMed - in process] ============================================ 10. Int J Palliat Nurs. 2009 Apr;15(4):162, 164, 166-9. Understanding the management of lymphoedema for patients with advanced disease. Honnor A. Loros Hospice, Leicester, England. AmandaHonnor@loros.co.uk The problems associated with lymphoedema can be devastating, particularly for patients with lymphoedema and advanced disease. All lymphoedema treatment is palliative in nature as the underlying condition is incurable; however, much can be done to relieve the symptoms associated with the oedema. It is important to remember that the burden of treatment on the patient should not exceed the benefit gained and, therefore, treatment may have to be adapted and modified to suit patients individual needs. This article describes the classification, aetiology and nursing management of lymphoedema with an emphasis on the management of lymphoedema in the patient with advanced disease. PMID: 19430411 [PubMed - in process] ================================== 11. Hum Mol Genet. 2009 May 9. [Epub ahead of print] Vascular defects in a mouse model of hypotrichosis-lymphedema-telangiectasia syndrome indicate a role for SOX18 in blood vessel maturation. Downes M, François M, Ferguson C, Parton RG, Koopman P. Institute for Molecular Bioscience, Brisbane, QLD 4072, Australia. Mutations in the transcription factor gene SOX18 cause vascular, lymphatic and hair follicle defects in humans with dominant and recessive forms of hypotrichosis-lymphedema-telangiectasia (HLT) syndrome. Here, we clarify the role of SOX18 in the vascular dysfunction in HLT by ultrastructural, immunofluorescence, molecular and functional analysis of vascular anomalies in embryos of the naturally occurring Sox18-mutant mouse strain ragged-opossum (Ra(Op)). Early genesis and patterning of vasculature was unimpaired in Ra(Op) embryos, but surface capillaries became enlarged from 12.5 dpc and embryos developed massive surface haemorrhage by 14.5 dpc. Large focal breaches in the endothelial barrier were observed, in addition to endothelial hyperplasia associated with impaired pericyte recruitment to the microvasculature. Expression of the genes encoding the endothelial factors MMP7, IL7R and N- cadherin was reduced in Ra(Op) embryos, suggesting these are downstream targets of SOX18. Together our results indicate that vascular anomalies in HLT arise from defects in regulation of genes required for the acquisition of structural integrity during microvascular maturation. PMID: 19429912 [PubMed - as supplied by publisher] =================================== 11. Hum Mol Genet. 2009 May 9. [Epub ahead of print] Related Articles, Links Vascular defects in a mouse model of hypotrichosis-lymphedema-telangiectasia syndrome indicate a role for SOX18 in blood vessel maturation. Downes M, François M, Ferguson C, Parton RG, Koopman P. Institute for Molecular Bioscience, Brisbane, QLD 4072, Australia. Mutations in the transcription factor gene SOX18 cause vascular, lymphatic and hair follicle defects in humans with dominant and recessive forms of hypotrichosis-lymphedema-telangiectasia (HLT) syndrome. Here, we clarify the role of SOX18 in the vascular dysfunction in HLT by ultrastructural, immunofluorescence, molecular and functional analysis of vascular anomalies in embryos of the naturally occurring Sox18-mutant mouse strain ragged-opossum (Ra(Op)). Early genesis and patterning of vasculature was unimpaired in Ra(Op) embryos, but surface capillaries became enlarged from 12.5 dpc and embryos developed massive surface haemorrhage by 14.5 dpc. Large focal breaches in the endothelial barrier were observed, in addition to endothelial hyperplasia associated with impaired pericyte recruitment to the microvasculature. Expression of the genes encoding the endothelial factors MMP7, IL7R and N- cadherin was reduced in Ra(Op) embryos, suggesting these are downstream targets of SOX18. Together our results indicate that vascular anomalies in HLT arise from defects in regulation of genes required for the acquisition of structural integrity during microvascular maturation. PMID: 19429912 [PubMed - as supplied by publisher] =========================== 12. Int J Radiat Oncol Biol Phys. 2009 May 8. [Epub ahead of print] Related Articles, Links Time Course of Mild Arm Lymphedema After Breast Conservation Treatment for Early-Stage Breast Cancer. Bar Ad V, Cheville A, Solin LJ, Dutta P, Both S, Harris EE. Departmentof Radiation Oncology, University of Pennsylvania, Philadelphia, PA. PURPOSE: Arm lymphedema is a potential consequence of the treatment for breast carcinoma. The objective of this retrospective study was to characterize the progression of mild arm lymphedema after breast conservation treatment for breast cancer. METHODS AND MATERIALS: The study cohort was drawn from 1,713 consecutive Stage I or II breast cancer patients who underwent breast conservation therapy, including axillary staging followed by radiation. Arm lymphedema was documented in 266 (16%) of 1,713 patients. One hundred nine patients, 6% of the overall group and 40% of the patients with arm lymphedema, presented with mild arm lymphedema, defined as a difference of 2 cm or less between the measured circumferences of the affected and unaffected arms. RESULTS: Among the 109 patients with mild arm lymphedema at the time of arm lymphedema diagnosis, the rate of freedom from progression to more severe lymphedema was 79% at 1 year, 66% at 3 years, and 52% at 5 years. The patients who were morbidly obese, had positive axillary lymph nodes, or received supraclavicular irradiation at the time of breast cancer treatment were at higher risk of progression from mild arm lymphedema to more severe edema. CONCLUSIONS: Mild arm lymphedema, generally considered to be a minor complication after breast conservation treatment for breast cancer, was associated with a risk of progression to a more severe grade of arm lymphedema in a substantial fraction of patients. PMID: 19427748 [PubMed - as supplied by publisher] ================================ 13. Int J Radiat Oncol Biol Phys. 2009 Jun 1;74(2):349-54. Related Articles, Links Extrapulmonary soft-tissue fibrosis resulting from hypofractionated stereotactic body radiotherapy for pulmonary nodular lesions. Kawase T, Takeda A, Kunieda E, Kokubo M, Kamikubo Y, Ishibashi R, Nagaoka T, Shigematsu N, Kubo A. Department of Radiology, Keio University School of Medicine, Tokyo, Japan. PURPOSE: To clarify the incidence, symptoms, and timing of extrapulmonary fibrosis developing after hypofractionated stereotactic body radiotherapy. PATIENTS AND METHODS: We analyzed 379 consecutive patients who underwent stereotactic body radiotherapy for lung tumors at four institutions between February 2001 and March 2007. The median follow-up time was 29 months (range, 1-72). We investigated the subjective and objective characteristics of the extrapulmonary masses, redelineated the origin tissue of each on the treatment planning computed tomography scan, and generated dose-volume histograms. RESULTS: In 9 patients (2.4%), extrapulmonary masses were found 3-36 months (median, 14) after irradiation. Coexisting swelling occurred in 3 patients, chest pain in 2, thumb numbness in 1, and arm edema in 1 patient. Extrapulmonary masses occurred in 5 (5.4%) of 92 and 4 (1.4%) of 287 patients irradiated with a 62.5-Gy and 48.0-Gy isocenter dose, respectively. The mean and maximal dose to the origin tissue was 25.8-53.9 Gy (median, 43.7) and 47.5-62.5 Gy (median, 50.2), respectively. In 5 of 9 patients, the standardized uptake values on 18F-fluorodeoxyglucose-positron emission tomography was 1.8- 2.8 (median, 2.2). Percutaneous needle biopsy was performed in 3 patients, and all the specimens showed benign fibrotic changes without malignant cells. CONCLUSION: All patients should be carefully followed after stereotactic body radiotherapy. The findings of any new lesion should prompt an assessment for radiation-induced extrapulmonary fibrosis before an immediate diagnosis of recurrence is made. Careful beam-shape modification and dose prescription near the thoracic outlet are required to prevent forearm neuropathy and lymphedema. Publication Types: Multicenter Study PMID: 19427551 [PubMed - indexed for MEDLINE] ===================================== 14 Gynecol Oncol. 2009 Jun;113(3):299-300. Related Articles, Links Comment on: Gynecol Oncol. 2009 Jun;113(3):301-5. Patient-reported outcomes in sentinel lymph node procedure versus inguinofemoral lymphadenectomy: what is the next step? Wenzel L. Publication Types: Comment Editorial PMID: 19426884 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- 14. J Helminthol. 2009 May 8:1-10. [Epub ahead of print] Related Articles, Links A cohort study on anti-filarial IgG4 and its assessment in good and uncertain MDA-compliant subjects in brugian filariasis endemic areas in southern Thailand. Jiraamonnimit C, Wongkamchai S, Boitano J, Nochot H, Loymek S, Chujun S, Yodmek S. Filaria Division, Ministry of Public Health, Nonthaburi Province, Thailand. The prevalence of Brugia malayi was surveyed in three highly endemic provinces in southern Thailand as part of an ongoing evaluation of the effectiveness of two rounds of mass drug administration (MDA). Prior to MDA IV, and thereafter every 6 months up to 18 months, including MDA V at 12 months, nocturnal blood sampling was assayed for microfilaria (mf) and IgG4 antibodies in 200 subjects from Nakorn Srithammarat and Surathani provinces. From an additional 300 subjects from Narathiwatt province, daytime blood was also examined for IgG4 antibodies for 1 year. Subjects who tested positive, with reciprocal IgG4 titres above 100, were dichotomized in the 'good compliant' or 'uncertain compliant' groups. Stool samples were examined for intestinal parasites from all 500 subjects simultaneously. Only two subjects (1%) tested positive for mf, while 98 subjects (19.6% of 500) tested positive for IgG4. In general, the good drug- compliant subjects were less likely to exhibit the IgG4 response than subjects in the uncertain compliant group. Only six subjects (1.2%) exhibited lymphoedema while 68 subjects (13.6%) had a total of 105 parasitic infections, with female instances of protozoan infections exceeding male instances of helminth infections. It was concluded that the two MDA rounds were highly successful in not only in reducing mf to negligible levels but also in lowering antifilarial IgG4 titres in the good compliant subjects. The IgG4 assay is a sensitive and cost-effective surveillance tool for the early detection of brugian infections that is not contingent on nocturnal blood collections. PMID: 19422729 [PubMed - as supplied by publisher] =================================== Forsch Komplementmed. 2009 Apr;16(2):117-22. Epub 2009 Apr 9. Related Articles, Links [Inpatient treatment for CRPS I by use of complementary medicine] [Article in German] Schencking M, Bohmhammel J, Keller C. Kneipp'sche Kliniken, Kneippstrasse 8, Bad Wörishofen, Germany. dr.schencking@barmherzige-bad- woerishofen.de INTRODUCTION: Complex regional pain syndromes (CRPS) are mainly characterized by a burning, intense spontaneous pain,mechanical allodynia of the affected limb, disorders of the skin,local hyperhidrosis, lymphedema as well as trophic disorders of the skin, bones and joints. The overall clinical appearance is dominated by a dysfunction of the sympathetic nervous system. One dominant etiological hypothesis is that major mechanisms for CRPS symptoms, which might be present during the course of CRPS, are trauma- related cytokine release, exaggerated neurogenic inflammation, sympathetically maintained pain, and cortical reorganization in response to chronic pain. CASE REPORT: We report the case of a 33-year-old female patient who suffered from a CRPS type I (cold type) of the left foot which had been traumatically induced 9 months before. The patient presented with a severe pain syndrome, an allodynia of the dermatomes L5 and S1 left with significant trophic skin disturbances, followed by a lymphedema and a malposition (pronation) of the left dorsum pedis. METHODS: In the course of a 10-week in-house treatment the patient received a multidisciplinary therapy-management based on complementary medicine with intensive use of hydrotherapy according to Kneipp, and physiotherapy. RESULTS: Pain intensity over treatment decreased from 8 (initial) to 2 (after 8 weeks) ona 10-point numeric rating scale. Furthermore, local symptoms of the left foot, i.e. hyperhidrosis, trophic skin disorders and lymphedema decreased significantly. CONCLUSIONS: Therapeutic strategies derived from complementary medicine may be an effective approach to the complex treatment of CRPS. Their effects should be further investigated in controlled clinical trials. Copyright (c) 2009 S. Karger AG, Basel. Publication Types: English Abstract PMID: 19420958 [PubMed - in process] ==================== 15. J Helminthol. 2009 May 8:1-10. [Epub ahead of print] Related Articles, Links A cohort study on anti-filarial IgG4 and its assessment in good and uncertain MDA-compliant subjects in brugian filariasis endemic areas in southern Thailand. Jiraamonnimit C, Wongkamchai S, Boitano J, Nochot H, Loymek S, Chujun S, Yodmek S. Filaria Division, Ministry of Public Health, Nonthaburi Province, Thailand. The prevalence of Brugia malayi was surveyed in three highly endemic provinces in southern Thailand as part of an ongoing evaluation of the effectiveness of two rounds of mass drug administration (MDA). Prior to MDA IV, and thereafter every 6 months up to 18 months, including MDA V at 12 months, nocturnal blood sampling was assayed for microfilaria (mf) and IgG4 antibodies in 200 subjects from Nakorn Srithammarat and Surathani provinces. From an additional 300 subjects from Narathiwatt province, daytime blood was also examined for IgG4 antibodies for 1 year. Subjects who tested positive, with reciprocal IgG4 titres above 100, were dichotomized in the 'good compliant' or 'uncertain compliant' groups. Stool samples were examined for intestinal parasites from all 500 subjects simultaneously. Only two subjects (1%) tested positive for mf, while 98 subjects (19.6% of 500) tested positive for IgG4. In general, the good drug- compliant subjects were less likely to exhibit the IgG4 response than subjects in the uncertain compliant group. Only six subjects (1.2%) exhibited lymphoedema while 68 subjects (13.6%) had a total of 105 parasitic infections, with female instances of protozoan infections exceeding male instances of helminth infections. It was concluded that the two MDA rounds were highly successful in not only in reducing mf to negligible levels but also in lowering antifilarial IgG4 titres in the good compliant subjects. The IgG4 assay is a sensitive and cost-effective surveillance tool for the early detection of brugian infections that is not contingent on nocturnal blood collections. PMID: 19422729 [PubMed - as supplied by publisher] ============================ 17. Forsch Komplementmed. 2009 Apr;16(2):117-22. Epub 2009 Apr 9. Related Articles, Links [Inpatient treatment for CRPS I by use of complementary medicine] [Article in German] Schencking M, Bohmhammel J, Keller C. Kneipp'sche Kliniken, Kneippstrasse 8, Bad Wörishofen, Germany. dr.schencking@barmherzige-bad- woerishofen.de INTRODUCTION: Complex regional pain syndromes (CRPS) are mainly characterized by a burning, intense spontaneous pain,mechanical allodynia of the affected limb, disorders of the skin,local hyperhidrosis, lymphedema as well as trophic disorders of the skin, bones and joints. The overall clinical appearance is dominated by a dysfunction of the sympathetic nervous system. One dominant etiological hypothesis is that major mechanisms for CRPS symptoms, which might be present during the course of CRPS, are trauma- related cytokine release, exaggerated neurogenic inflammation, sympathetically maintained pain, and cortical reorganization in response to chronic pain. CASE REPORT: We report the case of a 33-year-old female patient who suffered from a CRPS type I (cold type) of the left foot which had been traumatically induced 9 months before. The patient presented with a severe pain syndrome, an allodynia of the dermatomes L5 and S1 left with significant trophic skin disturbances, followed by a lymphedema and a malposition (pronation) of the left dorsum pedis. METHODS: In the course of a 10-week in-house treatment the patient received a multidisciplinary therapy-management based on complementary medicine with intensive use of hydrotherapy according to Kneipp, and physiotherapy. RESULTS: Pain intensity over treatment decreased from 8 (initial) to 2 (after 8 weeks) ona 10-point numeric rating scale. Furthermore, local symptoms of the left foot, i.e. hyperhidrosis, trophic skin disorders and lymphedema decreased significantly. CONCLUSIONS: Therapeutic strategies derived from complementary medicine may be an effective approach to the complex treatment of CRPS. Their effects should be further investigated in controlled clinical trials. Copyright (c) 2009 S. Karger AG, Basel. Publication Types: English Abstract PMID: 19420958 [PubMed - in process] ================================= 18. Arch Phys Med Rehabil. 2009 May;90(5):803-9. Related Articles, Links Validity for the simplified water displacement instrument to measure arm lymphedema as a result of breast cancer surgery. Sagen A, Kåresen R, Skaane P, Risberg MA. Cancer and Surgical Division, Department of Breast and Endocrine Surgery, Ullevaal University Hospital, Oslo, Norway. aase.sagen@uus.no OBJECTIVES: To evaluate concurrent and construct validity for the Simplified Water Displacement Instrument (SWDI), an instrument for measuring arm volumes and arm lymphedema as a result of breast cancer surgery. DESIGN: Validity design. SETTING: Hospital setting. PARTICIPANTS: Women (N=23; mean age, 64+/-11y) were examined 6 years after breast cancer surgery with axillary node dissection. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The SWDI was included for measuring arm volumes to estimate arm lymphedema as a result of breast cancer surgery. A computed tomography (CT) scan was included to examine the cross-sectional areas (CSAs) in square millimeters for the subcutaneous tissue, for the muscle tissue, and for measuring tissue density in Hounsfield units. Magnetic resonance imaging (MRI) with T2-weighted sequences was included to show increased signal intensity in subcutaneous and muscle tissue areas. RESULTS: The affected arm volume measured by the SWDI was significantly correlated to the total CSA of the affected upper limb (R=.904) and also to the CSA of the subcutaneous tissue and muscles tissue (R=.867 and R=.725), respectively (P<.001). The CSA of the subcutaneous tissue for the upper limb was significantly larger compared with the control limb (11%). Tissue density measured in Hounsfield units did not correlate significantly with arm volume (P>.05). The affected arm volume was significantly larger (5%) than the control arm volume (P<.05). Five (22%) women had arm lymphedema defined as a 10% increase in the affected arm volume compared with the control arm volume, and an increased signal intensity was identified in all 5 women on MRI (T2-weighted, kappa=.777, P<. 001). CONCLUSIONS: The SWDI showed high concurrent and construct validity as shown with significant correlations between the CSA (CT) of the subcutaneous and muscle areas of the affected limb and the affected arm volume (P>.001). There was a high agreement between those subjects who were diagnosed with arm lymphedema by using the SWDI and the increased signal intensity on MRI, with a kappa value of .777 (P<.001). High construct validity for the SWDI was confirmed for arm lymphedema as a volume increase, but it was not confirmed for lymphedema without an increase in arm volume (swelling). The SWDI is a simple and valid tool for estimating arm volume and arm lymphedema after breast cancer surgery. Publication Types: Research Support, Non-U.S. Gov't PMID: 19406300 [PubMed - in process] =================================== 19. Microsurgery. 2009 Apr 27. [Epub ahead of print] Related Articles, Links Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Demirtas Y, Ozturk N, Yapici O, Topalan M. Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey. Recent supermicrosurgical techniques have developed the possibility for vascular anastomosis of smaller vessels and it is now safe and sound to perform precise anastomoses between lymphatics and venules. Reported here is the 2 years experience on supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation combined with a nonoperative physical therapy for treatment of lower extremity lymphedema. Microlymphatic surgery was performed in 42 patients with unilateral lower extremity lymphedema. Thirty patients were women and 12 were men with a mean age of 34. Lymphaticovenular anastomoses were performed in 37 patients with an average of 2.5 anastomoses per patient, and lymphaticovenous implantations were made in 36 patients with an average of 2.4 implantations per patient. The lymphatics that were larger than 0.3 mm were anastomosed to venules with supermicrosurgical technique. Lymphaticovenous implantation technique was used for thinner lymphatics in a particular incision. Postoperatively, 18 patients used continuous compressive garments, 9 patients used garments but discontinued after 6 months, and no compression was used in 9 patients. The results of surgery were assessed both clinically with volume measurements and by lymphoscintigraphy and were classified as good, moderate, or ineffective. The mean decrease in the volume of the edema was 59.3% at an average follow- up of 11.8 months. Six outcomes were classified as ineffective, eight outcomes as moderate, and 28 outcomes as good. Supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation seems to be highly beneficial, especially in the early stages of peripheral lymphedema and may be offered as the treatment of choice in selected patients. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009. PMID: 19399890 [PubMed - as supplied by publisher] =========================== 20. Microsurgery. 2009 Apr 27. [Epub ahead of print] Related Articles, Links Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Demirtas Y, Ozturk N, Yapici O, Topalan M. Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey. Recent supermicrosurgical techniques have developed the possibility for vascular anastomosis of smaller vessels and it is now safe and sound to perform precise anastomoses between lymphatics and venules. Reported here is the 2 years experience on supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation combined with a nonoperative physical therapy for treatment of lower extremity lymphedema. Microlymphatic surgery was performed in 42 patients with unilateral lower extremity lymphedema. Thirty patients were women and 12 were men with a mean age of 34. Lymphaticovenular anastomoses were performed in 37 patients with an average of 2.5 anastomoses per patient, and lymphaticovenous implantations were made in 36 patients with an average of 2.4 implantations per patient. The lymphatics that were larger than 0.3 mm were anastomosed to venules with supermicrosurgical technique. Lymphaticovenous implantation technique was used for thinner lymphatics in a particular incision. Postoperatively, 18 patients used continuous compressive garments, 9 patients used garments but discontinued after 6 months, and no compression was used in 9 patients. The results of surgery were assessed both clinically with volume measurements and by lymphoscintigraphy and were classified as good, moderate, or ineffective. The mean decrease in the volume of the edema was 59.3% at an average follow- up of 11.8 months. Six outcomes were classified as ineffective, eight outcomes as moderate, and 28 outcomes as good. Supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation seems to be highly beneficial, especially in the early stages of peripheral lymphedema and may be offered as the treatment of choice in selected patients. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009. PMID: 19399890 [PubMed - as supplied by publisher] ========================= 21. Psychooncology. 2009 Apr 27. [Epub ahead of print] Related Articles, Links Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Chachaj A, Malyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudelko M, Andrzejak R, Szuba A. Department of Internal Medicine, Wroclaw Medical University, Wroclaw, Poland. Objective: The aim of the study was to identify factors associated with worse physical and emotional functioning of breast cancer survivors with upper extremity lymphedema.Methods: 1250 sets of questionnaires consisting of WHO-DAS II, EORTC QLQ-C30, EORTC QLQ-BR23 and GHQ-30 were mailed to women who underwent a breast cancer surgery at the Lower Silesian Oncology Center in Poland between January 1998 and December 2005.Results and conclusions: The response rate was 33.47%. 117 women were included into a lymphedema group and 211 into a group without this complication. Women with lymphedema were more disabled (overall disability (DAS) score 39.78 versus 34.67; p<0.001), reported symptoms from the upper extremity (shoulder or arm pain and difficulties in arm movement) and from the operated breast (pain and swelling) 2-3 times more often, experienced poorer quality of life (global quality of life (QOL) score 0.50 versus 0.57; p=0.005) and higher psychological distress (GHQ score 10.61 versus 8.01; p=0.007) in comparison to breast cancer survivors without lymphedema. The factors associated with higher DAS score, higher GHQ score and lower QOL score in women with lymphedema were as following: pain in the upper limb (mainly shoulder and arm), pain in operated breast, difficulties with arm movement, localization of lymphedema within the hand or in operated breast, a history of dermatolymphangitis and of receiving chemotherapy. Severity of lymphedema, younger age, BMI and localization of lymphedema within the dominant limb were not considerably related to worse outcomes in these women. Copyright (c) 2009 John Wiley & Sons, Ltd. PMID: 19399782 [PubMed - as supplied by publisher] ========================= 22. J Vasc Surg. 2009 May;49(5):1256-63. Related Articles, Links Compression therapy in breast cancer-related lymphedema: A randomized, controlled comparative study of relation between volume and interface pressure changes. Damstra RJ, Partsch H. Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Drachten, The Netherlands. r.damstra@nijsmellinghe.nl OBJECTIVE: Short stretch bandages are very effective in the initial management of arm lymphedema. However, no studies to date have measured the pressure required to achieve specific amounts of volume reduction. The purpose of this study was to determine whether there is a difference between low and high- pressure bandaging in terms of therapeutically intended volume reduction of the compressed arm. METHODS: Experimental, randomized and comparative study with two study-groups consisting of high and low initial interface pressure bandages. Thirty-six hospitalized patients in Nij Smellinghe hospital suffering from moderate to severe unilateral breast cancer-related lymphedema not responsive to outpatient treatment were included. Bilateral arm volume was measured by inverse water volumetry before, after two hours and after 24 hours of bandaging. The amount of edema was calculated by subtracting the volume of the diseased arm from that of the contralateral side. Sub-bandage pressure was measured after bandage application and two hours later. Bandages were then re-applied and the pressure was measured again. Twenty-four hours later, the pressure measurement was repeated and bandages were removed for final volumetry. Patients were randomized into two groups: group A received low pressure bandages (20-30 mm Hg) and group B received high pressure bandages (44-58 mm Hg). The main outcome measures were reduction of arm volume and edema volume in the affected arm in both study groups. Secondary outcome parameters were changes in sub-bandage pressure and patient comfort. RESULTS: Median arm volume reduction after two and 24 hours was 104.5 mL (95% confidence interval [CI], 51.2-184.2) (-2.5%) (P < .0001) and 217 mL (95% CI, 143.9-280.2) (-5.2%) (P < .01) for group A and 56.5 mL (95% CI, -2.7-123.1) (n.s.) and 167.5 mL (95% CI, 105.2-316.1) (-4.2%) (P < .01) for group B, respectively. There was no statistically significant difference between the volume changes in group A and group B. After 24 hours, edema decreased by median percentage of 9.2% in group A and 4.8% in group B (n.s.). Bandages in group A were better tolerated. The sub-bandage pressure drop in the first two hours was between 41% and 48% in both treatment groups at both measuring sites. After 24 hours, the pressure drop was between 55% and 63%. No proximal swelling above the bandage was observed. CONCLUSIONS: Inelastic, multi-layer, multi-component compression bandages with lower pressure (20-30 mm Hg) are better tolerated and achieve the same amount of arm volume reduction as bandages applied with higher pressure (44-58 mm Hg) in the first 24 hours. Publication Types: Comparative Study Randomized Controlled Trial Research Support, Non-U.S. Gov't PMID: 19394553 [PubMed - indexed for MEDLINE] ==================== 23. J Pediatr. 2009 Apr 23. [Epub ahead of print] Related Articles, Links Sporadic In Utero Generalized Edema Caused by Mutations in the Lymphangiogenic Genes VEGFR3 and FOXC2. Ghalamkarpour A, Debauche C, Haan E, Van Regemorter N, Sznajer Y, Thomas D, Revencu N, Gillerot Y, Boon LM, Vikkula M. Laboratory of Human Molecular Genetics (A.G., N.R., L.B., M.V.), de Duve Institute, Université Catholique de Louvain, Brussels, Belgium; Department of Neonatology (C.D.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Genetic Medicine (E.H.), Women's and Children's Hospital, North Adelaide, Australia, and Department of Paediatrics, University of Adelaide, Adelaide, Australia; Centre de Génétique ULB (N.V., Y.S.), Hôpital Erasme, Brussels, Belgium; Unité de Génétique Clinique Pédiatrique (Y.S.), Université Libre de Bruxelles, Brussels, Belgium; Unité Diagnostic Anténatal, Hôpitaux Iris Sud (D.T.), Brussels, Belgium; Center for Human Genetics (Y.G.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; and Centre for Vascular Anomalies (L.B.), Cliniques Universitaires Saint-Luc, Brussels, Belgium. OBJECTIVES: To investigate the genetic causes of idiopathic sporadic prenatal generalized edema. STUDY DESIGN: In a series of 12 patients, in whom in utero generalized skin edema or hydrops fetalis had been diagnosed, we screened 3 lymphangiogenic genes, VEGFR3, FOXC2, and SOX18. RESULTS: In 3 of the patients, we identified a mutation: 2 in VEGFR3 and 1 in FOXC2. Two of the mutations were de novo and one was either de novo or nonpenetrant inherited. In these patients, the generalized edema resorbed spontaneously, either in utero or after birth. In the 2 individuals with a VEGFR3 mutation, edema remained limited to lower limbs. CONCLUSIONS: Mutations in the VEGFR3 and FOXC2 genes account for a subset of patients with unexplained in utero generalized subcutaneous edema and hydrops fetalis without family history of lymphedema. Lymphangiogenic genes should be screened for mutations in sporadic patients diagnosed with fetal edema. PMID: 19394045 [PubMed - as supplied by publisher] ================== 24. J Pediatr. 2009 Apr 23. [Epub ahead of print] Related Articles, Links Sporadic In Utero Generalized Edema Caused by Mutations in the Lymphangiogenic Genes VEGFR3 and FOXC2. Ghalamkarpour A, Debauche C, Haan E, Van Regemorter N, Sznajer Y, Thomas D, Revencu N, Gillerot Y, Boon LM, Vikkula M. Laboratory of Human Molecular Genetics (A.G., N.R., L.B., M.V.), de Duve Institute, Université Catholique de Louvain, Brussels, Belgium; Department of Neonatology (C.D.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Genetic Medicine (E.H.), Women's and Children's Hospital, North Adelaide, Australia, and Department of Paediatrics, University of Adelaide, Adelaide, Australia; Centre de Génétique ULB (N.V., Y.S.), Hôpital Erasme, Brussels, Belgium; Unité de Génétique Clinique Pédiatrique (Y.S.), Université Libre de Bruxelles, Brussels, Belgium; Unité Diagnostic Anténatal, Hôpitaux Iris Sud (D.T.), Brussels, Belgium; Center for Human Genetics (Y.G.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; and Centre for Vascular Anomalies (L.B.), Cliniques Universitaires Saint-Luc, Brussels, Belgium. OBJECTIVES: To investigate the genetic causes of idiopathic sporadic prenatal generalized edema. STUDY DESIGN: In a series of 12 patients, in whom in utero generalized skin edema or hydrops fetalis had been diagnosed, we screened 3 lymphangiogenic genes, VEGFR3, FOXC2, and SOX18. RESULTS: In 3 of the patients, we identified a mutation: 2 in VEGFR3 and 1 in FOXC2. Two of the mutations were de novo and one was either de novo or nonpenetrant inherited. In these patients, the generalized edema resorbed spontaneously, either in utero or after birth. In the 2 individuals with a VEGFR3 mutation, edema remained limited to lower limbs. CONCLUSIONS: Mutations in the VEGFR3 and FOXC2 genes account for a subset of patients with unexplained in utero generalized subcutaneous edema and hydrops fetalis without family history of lymphedema. Lymphangiogenic genes should be screened for mutations in sporadic patients diagnosed with fetal edema. PMID: 19394045 [PubMed - as supplied by publisher] ===================== 25. Physiother Theory Pract. 2009 Apr;25(3):165-73. Related Articles, Links Pole walking for patients with breast cancer-related arm lymphedema. Jönsson C, Johansson K. Lymphedema Unit, Lund University Hospital, Lund, Sweden. charlotta.jonsson@skane.se Arm lymphedema is a well-known side effect of breast cancer treatment. Studies of the effect of physical exercise on arm lymphedema are very rare. The purpose of this study was to investigate the influence of pole walking on breast cancer-related arm lymphedema when using a compression sleeve. Twenty-six women with unilateral arm lymphedema took part in a clinical study of pole walking on one occasion, 4 kilometers for 1 hour. Measurements were made before, immediately after, and 24 hours later. Results revealed no changes in total arm volume of the swollen arm, measured with water displacement method, or in subjective assessments of heaviness and tightness in the affected arm using visual analogue scale. Immediately after pole walking, a temporary increase in total arm volume of the healthy arm (P=0.037) was found. Twenty-four hours later, no differences were found compared to the measurements before walking. The median for perceived exertion immediately after pole walking, measured with Borg scale, was 11 ("fairly light"). The results suggest that a controlled, short-duration pole-walking program can be performed by patients with arm lymphedema, using a compression sleeve, without deterioration of the arm lymphedema. Publication Types: Research Support, Non-U.S. Gov't PMID: 19384736 [PubMed - in process] ================================= http://www.downeast.com/node/10550 Discover Why More Physicians are Choosing Maine Matchmaking can be stressful work. Will the two parties find each other attractive? How will financial expectations compare? Will the extended family get along? No one understands these stresses better than Jane Ham, director of the Maine Recruitment Center. For the past ten years, Ham’s office, a service of the Maine Hospital Association, has been matching physicians with openings in cities and towns across Maine, and she’s seen everything from the storybook romance to The War of the Roses play out in hospitals and small-town doctors’ offices. “We look at recruitment as you’re recruiting the family,” Ham explains. “We had one physician who was interviewing for an orthopedic position, and her husband was an avid fly fisherman. So we made sure he got out fishing, and that went a long way toward making that situation work.” Across the country, small towns are facing a shortage of physicians, especially in primary care, as medical school graduates are increasingly turning to specialties that allow them to quickly repay huge student loan debts. In Maine, the situation is especially dire: the ninety-one physician openings Ham faced in 1999 have skyrocketed to 272 today. “We’re in a full-blown shortage, and it’s only going to get worse,” she says, as the health-care industry expands to handle the state’s graying population. Since 1980, total employment in Maine has increased 52 percent. That sounds impressive until you contrast it with the 200 percent increase in the state’s health-care industry. So Maine definitely needs doctors. “But the good news is that Maine is still an attractive place for physicians who want four-season recreation and quality of life,” says Ham. Indeed, over the past few years Maine has taken several steps to increase its appeal to both young doctors looking for pleasant, safe communities in which to raise their families and older physicians seeking to finish out their careers. “Maine is sort of out here at the end of the world,” Ham explains. “We have a national reach, but we’re reaching out to docs that we hope have some connection to Maine. Maybe they grew up here and are thinking of returning, or maybe they just have vacation experience in Maine. Then there’s that group of physicians who are on the back side of their career and who think they’re not quite ready to retire and want to work a few more years.” Marian Benner, a physician in the Wound, Lymphedema, and Hyperbaric Medicine Center at St. Joseph Hospital in Bangor, is an example of the vacationer-turned-resident doctor. “I called it my midlife crisis. In 2004, I was in my mid-forties living in northeast Maryland, and I just wanted to do something different,” Benner says. Having been to Boothbay and Bar Harbor on vacation and to Portland for a conference, she decided to take the plunge and contacted the Maine Recruitment Center. “And we’ve had nothing but wonderful experiences ever since. In Maryland I had to become a recluse all summer, since the ninety-degree weather hits in May and June and the windows close up, the air- conditioning goes on. I have a new lease on life here — I’m always outside.” She admits her teenage daughters sometimes complain about the lack of shopping opportunities in Maine compared to elsewhere, a craving that is quickly cured by a weekend in Boston or New York. While Maine’s small towns and outdoor opportunities are often most attractive to physicians’ fly-fishing spouses, the growing trend of doctors becoming employees of hospitals often appeals to the physicians themselves. “We employ close to 80 percent of all the physicians in Lincoln County, and that will go to 100 percent in the not-too-distant future,” says James Donovan, president and CEO of Lincoln County Healthcare, which operates Miles Memorial Hospital in Damariscotta and St. Andrews Hospital and Healthcare Center in Boothbay Harbor. “[The trend] has been evolutionary across the state, but it has rapidly increased in momentum over the last five years or so.” Donovan says doctors, especially in small towns, have discovered that working for the local hospital allows them to pass off bookkeeping and administrative work and instead focus on treating patients. “It’s very difficult to run a physician practice these days,” he says. “It’s a small business, with all the complexities of that, but most physicians want to practice medicine.” Charles Dwyer, director of the Maine Office of Rural Health, agrees that the administrative headaches of running a private practice, including how to deal with low reimbursement rates through MaineCare, can often outweigh the benefits of staying independent. “If I’m struggling to keep the overhead of my back office, and I have one case where I need to rebill something, I’ve basically lost any kind of margin,” he says. Statewide, Maine hospitals now employ 45 percent of the 5,400 licensed doctors, and a whopping 78 percent of all licensed primary care physicians. “For physicians tired of the hassle of paperwork, Maine is very attractive,” Ham says. “We’re so much further along in all of this — we started employing doctors in hospitals in the early nineties, and what I hear from colleagues nationally is that they’ve just started looking at doing this.” But the ability to focus on patient care isn’t always enough when it comes to attracting good doctors to Maine small towns. Pay scales for physicians in Portland are comparable to the national median, but Donovan says rural areas are always hard-pressed to offer the high salaries that doctors need to repay student loans. As the physician shortage in Maine has worsened, hospitals like Donovan’s in Damariscotta and Boothbay Harbor have seen a rapid escalation in salaries required to secure quality doctors. But St. Joseph’s Dr. Benner says the pace of life and work in Maine makes up for the lower pay. “Yes, the pay is a little less, but I don’t work as hard here,” she remarks. “You get paid for how hard you work, and I think if you look across the board, with cost of living and malpractice costs and everything, it all evens out.” The other compensation that doesn’t make it onto a spreadsheet, she says, is the camaraderie that exists among doctors in Maine. “The physician camaraderie is great here — everyone knows each other, as opposed to Maryland, where you came in, worked, and went home, and nobody really knew you.” One program through which Maine has been most successful in attracting new doctors is the J-1 visa waiver program, whereby foreign doctors are allowed to practice in rural areas, including Maine, in exchange for a two-year commitment. Dwyer’s Office of Rural Health surveys these international physicians when their commitment is complete and has found that a surprising majority of them continue practicing in Maine. Of the last group of 116 foreign physicians surveyed, in 2004, 71 percent intended to stay in the state, up from 69 percent the previous year. “I’d be surprised if you did a random sampling of non-foreign physicians if you’d find a higher percentage,” Dwyer declares. “Especially in this labor market, which is fairly fluid.” He says the local community usually deserves as much credit for retaining these doctors as the hospitals that they end up working for. “One of the things that makes a huge difference for whether these physicians stay or go is how well they were integrated into the community. Is there more than a small group of people in your area that has your same religious preference? Are there other people that your family can relate to?” Ham says retaining doctors once they arrive in Maine is especially critical today, when competition for primary care physicians is at an all-time high. “It used to take three to six months to recruit a family practitioner; now it takes a year,” she says. Even if the state is able to entice a doctor from another state to join a Maine practice or hospital, often the sagging real estate situation nationwide will put a cross-country move on hold. “Physicians who are practicing in other parts of the country who might want to move to Maine are hung up in the real estate bust. They have homes, usually expensive homes, that they just can’t sell.” One factor working against Maine’s ability to attract new doctors over the years has been its lack of a traditional medical school (though the University of New England has operated its College of Osteopathic Medicine since 1978). Since building a bricks-and-mortar medical school would be exceptionally expensive, this fall the state will launch a new agreement with Tufts University and the University of Vermont to allow medical students to do some of their clinical rotations in Maine. “We need to grow our own, to let kids see what it’s like to work in Maine,” Ham says. “The more we can expose people in training to physicians in Maine, and to the health-care system in Maine, the more likely they are to stay here.” This period in a medical student’s training is especially critical for states like Maine, Ham says, as this is when young doctors typically marry and choose where they’d like to raise a family. Without doubt, though, the biggest asset Maine can offer its doctors is a quality of life that is the envy of much of the nation. “In my view, spouse and family issues are 51 percent of the decision,” remarks Lincoln County Healthcare’s James Donovan, “Maine is such a great place to practice.” In the end, Maine’s ability to attract new doctors to its small towns will rest not on a single strategy, but rather the multi-faceted approach that has evolved over the past few years: allow doctors to practice more and administrate less by joining hospitals’ payrolls; foster communities that welcome doctors and integrate them into their small town; and create partnerships with out-of-state medical schools to bring physicians in training to Maine and expose them to the quality of life, and of patient care, that the state offers. ===================== From http://blog.diabeticparents.org/ Getting Free Prescriptions When You Make Too Much $$ Let's face it. The majority of our population make well over the federal poverty line to receive any federal aid. In this time of uncertainty in our economy, pinching pennies is something we are all looking to do. As a diabetic parent, we know that the cost of a family and the cost of taking care of ourselves is expensive and never gets any cheaper! That's why a recent television news article caught our attention. Families with insurance and those families who make up to $80,000 a year as a family of four can get free or greatly reduced prescriptions. When my husband and I heard this, we laughed! We've been hearing for years that we don't qualify for anything simply because we make too much. But even if you make well over the federal poverty line, many prescription drug companies will help you--if you ask. If you have a chronic disease like diabetes, or are experiencing financial difficulties paying for your medications there are ways to receive help that won't cost you anything. There are three websites that are available to help. RxAssis allows you to type in the medications you are taking. After typing in your medications, the website pulls coupons, and gives you direct links to the drug manufacturer financial hardship links. While some medications and drug companies list specific income requirements, the article claims that you should still pursue filling out and sending an application. Many families facing financial hardships or who have chronic diseases can qualify for reduced or free medications, whether or not they have insurance, and whether or not you make mo re than the minimum requirement from the drug manufacturer. NeedyMeds.org is another website that can help. The website has an extensive link of coupons available to use at local pharmacies. You can also qualify for financial assistance through the website and even drug discount cards. Montel Williams created a pharmacy program to help assist those who need medications but may not be able to afford them. They cover those who may have reached a gap in their current medical insurance and are now paying for their medications, or those who can't afford the cost of their medications. They state that they will cover those with insurance who take medications not covered by your insurance, and even those with a high deductible co pay. You must earn equal to or less than $41,800 for a single person, $56,000 for couples, or $84,800 for a family of four to be considered for the program. What if you try all these programs, and you still don't qualify for any? Don't despair! Other ideas for saving mo ney include sending a letter directly to the drug manufacturer of your insulin or other diabetic medication or supplies directly and letting them know of your financial hardship. Some companies will send out coupons, savings cards, or will tell you ways to save mo ney on the drugs they sell. Checking with your doctors office or with your local diabetic clinic can also help. They routinely get drug reps in who stock them with samples of some of the medications you may be taking. They also on occasion offer your doctor coupons to give out to patients for free 7, 14, or 30 day supplies. Let your doctor know of your situation and see if they may have any of these things available. Many times doctors get busy and don't think to check the med closet. Sometimes doctors even have new meters and mo re to give out from drug reps! You can check out these websites by going to these links: Rx Assist: www.rxassist.org Needy Meds: www.needymeds.org Montel Williams Pharmacy Program: http://www.freemedicine.com =========== t Large in Ballard: Casting from the curb By Peggy Sturdivant June 1, 2009 updated 6 hours ago Fly fishing entered my life when John Olson parked his City of Seattle Department of Transportation backhoe along the front curb and prepared to eat lunch in the cab. He was the advance team for the crew from the streets division dispatched to lift the concrete at the base of the alley in order to explore the void by a storm water drain (At Large in Ballard: The void). When your vehicle is a four-ton backhoe it isn’t practical to return to the break room at Haller Lake for lunch; besides John prefers the quiet at the job site. Excited at the appearance of equipment that could solve the sidewalk problem I waved up at John in the cab to ask questions. It seemed fitting to learn in our “street talk” that he grew up within a half a mile, back on the street where I lived for the last 21 years. “We played baseball down your way,” he said. “The catch basins were the bases.” It was clear he really knew these streets. Later when the rest of the concrete crew arrived, John climbed into the cab of his machine and donned ear protection while operating a pneumatic hammer drill to break up the sidewalk. While the crew on the ground poked at the revealed drain pipe he gave me a smile. John Olson has a great smile. John was born at Ballard Hospital and went to school at Adams Elementary. He graduated from Ballard High School (1973) as did his father, and his own two children. Three generations of Ballard graduates. In this neighborhood he recalled the phone booth that used to be in front of the Foodtown Grocery on 32nd Avenue Northwest. As a youngster he was intrigued by the hinged doors, but once he got stuck inside. A neighbor finally rescued him, put him under her arm and deposited him at home. Later on when he was learning to drive he got the car underbelly stuck on a bump in the parking lot. He doesn’t miss Foodtown. Like so many kids growing up in Ballard in the 1960s he and his friends would play down at the beach by Ray’s. They’d fish or throw a tennis ball for a dog but then have to swim out for the ball when the dog lost interest. His father had a three stage whistle that he used to call the kids home. With the exception of three weeks working in Idaho soon after high school, John Olson didn’t go far from Ballard. He returned from making orange juice in Idaho (“I cannot stand this”), married a Nathan Hale graduate he’d met while working as a ball field attendant and settled on Northwest 74th. He’s worked for the City of Seattle for 28 years and had the same phone number even longer. He eyed the street where we were standing and recalled that he almost bought a home nearby, but the street condition suggested underlying instability. “I want a house on a street that has curbs and sidewalks because then you have good drainage," he said. He lives in Olympic Manor, but he still owns the house that was next to his on 74th. He paid the back taxes for an elderly neighbor so that she wouldn’t lose her home; then purchased it from her family after her death. He’s had the same tenant for 19 years. When the tenant goes on vacation, John feeds his fish. We talked while John re-attached the bucket to the backhoe and double-checked the fasteners. How did we start discussing fly-fishing? Perhaps anyone who spends time with John hears about tie end casting. John currently teaches fly-tying at the Orvis store in Bellevue, though over the last decades he’s taught classes in Ballard and near by. His classes are geared for adults but he once taught two nine-year old boys, best friends who lived across the street from each other. His oldest student was an 87 year-old widow who had always wanted to learn. He had her come an hour early one week to work with her one-on-one, and, “She really got the hang of it.” Every year John participates in a retreat called “Casting for Recovery,” teaching fly fishing to women recovering from breast cancer. The casting motion is therapeutic, particularly in countering effects of lymphedema that can occur after surgery involving lymph nodes. John demonstrated the motion, a sinew in the air that I couldn’t help but correlate with his controlling the pneumatic drill from 10 feet above the ground. It was the lure of sidewalks and curbs that drew John and his family to Olympic Manor plus a 360 degree view and a veritable boulevard to practice casting. Unless he gets transferred during department changes John works the north division of Seattle, south to Denny and north to 145th. He enjoyed seeing old friends during the sidewalk project on Ballard Avenue. With school boundaries shifting he doesn’t foresee a fourth generation of his family graduating from Ballard High School. “That’s over,” he said, along with getting his chowder fix from Gordo’s on Seaview. He shared a final story before driving back to the Haller Lake facility in his backhoe; which takes much longer returning to the north, than descending to the south. While casting with his fly rod in front of his house he heard a neighbor take a fall. After he’d helped the neighbor and the firemen had patched him up they gathered to ply John with questions about his choice of rod and reel. One of John’s best rods cost more than his $1,000 car - but the rod will last forever. John made another casting motion with his whole arm and then gave a wave. The backhoe took a left at the stop sign; then John and his beaming smile were gone. http://www.ballardnewstribune.com/2009/05/31/features/large-ballard-casting-curb ---- Patients cope with Lymphedema through self-management nächste Meldung 05.06.2009 - 05.06.2009 In Quebec, it is estimated that approximately 70,000 men, women and children have lymphedema, the majority as an unavoidable side effect of cancer treatments. However, less than one percent of them are treated. Many wait years before finding a health professional who can recognize and diagnose their symptoms. Anzeige Living well with Lymphedema: Focus on Self-Management is an important public education event organized by the LAQ, in collaboration with the McGill Lymphedema Research Program. It should be of great interest to health care professionals, people living with lymphedema, as well as the general public. It will include the following bilingual lectures and interactive workshops: ...mehr zu: > Bladder > breast > colon > compression garments > gynecological cancer > LAQ > lymph node > lymphatic system > lymphedema > lymphedema products > melanoma > prostate > self-massage• Dr. Anna Towers, Director, MUHC Lymphedema Clinic: Latest News on Lymphedema Research • Ms. Marjorie McClure, OTR/L, Magee Women’s Research Institute, Pittsburgh, USA.: Exercise for Lymphedema Patients: Why and How the Breast Cancer Recovery Program works • Mr. Marco Raffis, BSc, KT, PT Lymphedema Therapist: Understanding Lymphedema • A choice of interactive workshops providing participants with tools of self-management, including information on compression garments, self-measurement, self-massage and exercise. • An open visit of exhibits of lymphedema products and services WHEN: Friday, June 5, 2009 TIME: From noon to 6pm WHERE: Hotel Maritime, 1155 Guy Street, Montreal Participation fees are from $15.00. RSVP: Registration forms are available on LAQ’s website www. infolympho.ca or at 514-979-2463. Lymphedema is a progressive, debilitating, excessive build-up of fluid in body tissues with no known cure. Fact: Primary lymphedema is caused by a deficiency of the lymphatic system. It can appear at birth or any time in life, usually for reasons unknown. Fact: Secondary lymphedema is caused when the lymphatic system is damaged as a result of trauma, surgery or radiation. It can be a side effect of cancer-related surgeries that require the removal of lymph nodes, including for such cancers as: breast, melanoma, gynecological cancer, prostate, bladder and colon. Lymphedema may occur months or years after surgery. Fait: Treatments can cost thousands of dollars. Quebec’s health care system does not cover the costs involved, and patients are left to cope on their own. Due to the lack of medical professionals with expertise in the lymphatic system, the LYMPHEDEMA ASSOCIATION OF QUEBEC (LAQ) was founded in 1999. The LAQ is a registered charity dedicated to raising awareness and providing education about lymphedema - its causes and treatments, and supporting patients, their families and health professionals as well as encouraging research in this area. For more information, please contact: Rachel Pritzker Tel:514-979-2463 http://www.innovations-report. de/html/berichte/seminare_workshops/patients_cope_lymphedema_management_133304.html ---------------------- Researchers Target Lymphatic System Cause Behind Many Diseases Nevada – Dr. Paul Yanick was born with a systemic lymphatic disease that caused him to go deaf and lose kidney function in his late teens. During his childhood, his parents sought out every renowned specialist and were distraught and overwhelmed to find extremely limited information and treatments available for lymphatic disorders. Today, forty years later, despite being sent home to die at only twenty years old; Yanick tells his story and highlights his research in this neglected medical field in a new e-book entitled “The Forgotten River of Health.” He reviews his hundreds of research studies which started in 1976 in the Journal of the American Audiology Society with a clinical study that linked the swelling of lymph fluids to deafness and brain and nervous system abnormalities. Yanick is not alone citing the medical neglect of the lymphatic system. The 2006 Senate Appropriations Committee Report stated “The lymphatic system is central to the progression of disease and the maintenance of health, yet scientific and medical knowledge of this important system is woefully deficient. According to Michael Detmar, PhD this forgotten river of health provides a “… hot new field. We are in a pioneering phase; there is still so much to discover.” Just as the currents of a river run through the mountains and valleys to cleanse out the landscape, the body’s internal waterways made up of lymphatic fluids function as a “river of health,” cleansing the body by carrying away accumulated wastes and foreign invaders. This powerful cleansing aqueduct is actually twice as large as there are twice as many lymph vessels as there are blood vessels. The lymphatic system is the body’s first line of defense against disease. As the body’s internal cleansing waterway, it plays an indispensible role in immunity and in the body’s immune surveillance against cancer. When immune surveillance fails, cancer grows and spreads (metastasizes), and inflammatory diseases like fibromyalgia, lupus, arthritis, and shingles progress into incapacitating disorders. The lymphatic system is the most forgotten and neglected system of the entire body. It is composed of a network of thin tubes that branch, like blood vessels. These lymphatic capillaries carry lymph fluid into tissues throughout the body. Lymph fluid is loaded with infection- fighting cells called lymphocytes that originate from clusters of bean- shaped organs called lymph nodes, which are found under the arms and in the groin, neck, chest, and abdomen. Lymphatic organs include the spleen, thymus, tonsils, and bone marrow. Designed to function as a cleansing aqueduct, bathing each cell and draining away detritus through the circulatory system, its malfunction causes brain fog, chemical sensitivity, depression, fatigue, headaches and often a feeling of heaviness in the abdomen. Stagnant lymph interferes with the body’s ability to cleanse viruses, bacteria, mutagenic cells, metabolic toxins and cancer, and it inhibits critical self-repair and self-healing mechanisms in the body, causing acne, skin rashes, cysts, tumors, fibrocystic breast lumps, fatty tumors, and in advanced cases spider veins and cellulite. In 2005 Nature (436:28) an article entitled ”Unlocking the Drains” stated, “After centuries of playing second fiddle to the blood system, our lymphatic circulation is coming into its own as a key player in diseases ranging from cancer to asthma. Once dismissed as a mere drainage network, the body’s ‘second circulation’ [lymphatic system] is emerging as a crucial player in numerous diseases….and as a vital part of the normal immune system.” Dr. Robert Smith, director of cancer screening for the American Cancer Society stated, "Lymphatic diseases, including lymphedema are important health problems which until very recently received far too little attention." Wendy Chaite, the Founder and President of the Lymphatic Research Foundation (LRF), states, “It is the lymphatic system, after all, that is the body's first defense against disease. A disorder of the lymphatic system affects virtually every other system in the body. Research into how the lymphatic system works promises preventive and therapeutic benefits for millions of people afflicted with a broad array of diseases. There is tremendous potential for health benefits hidden within the lymphatic system. The power to discover these benefits is in the hands of the researchers and in the will of the patient community and their loved ones.” Does your lymphatic system need attention? If you are overweight around the abdomen, have skin abnormalities, allergies, digestive disorders or have chronic fatigue, anxiety or nervous system issues, your lymphatic system is already moderately compromised. If you’ve been diagnosed with fibromyalgia, cancer, multiple sclerosis, multiple chemical sensitivity, Parkinson’s or Alzheimer’s disease, lupus, arthritis, asthma or have cellulite or varicose veins your lymphatic system is chronically compromised with no traditional medical cure available. Contact Details: Dr. Paul Yanick URL: http://www.quantafood.com/ Address: 1982 State Road 44 #359, New Smyrna Beach, FL 32168 USA http://www.newdesignworld.com/press/story/5749 ----------------------------------------------------- Aqua Lipo ORLANDO, Fla. (Ivanhoe Newswire) -- It helps many slim down, but liposuction isn't easy. It requires anesthesia and often leads to swelling, pain and days of bruising. New technology is helping patients look leaner without the long recovery -- and the secret ingredient is water. Kathryn Nantz is happy to show off all her old clothes. She went from a size 16 to an 8, thanks to diet, exercise and liposuction. "It's just the best thing I ever did for myself," Nantz said. Nantz had aqua lipo. So did Candie Coulter. During the procedure, the surgeon makes two small incisions in the patient's sides and numbs the area -- all while the patient is awake. The surgeon then uses an instrument to spray water into the abdomen. Instead of using harsh motions to dislodge fat, the water gently breaks it up. An instrument then sucks out the fat. With this new procedure, there's less bruising, swelling and trauma to the nerves, muscles and skin. It costs about $3,000, which is less than standard lipo because patients don't require general anesthesia. "The patient's going to drive themselves to the office, get the procedure done, drive themselves home, [and] go back to work that day or the next day," Roger Bassin, M.D., a cosmetic surgeon at the Bassin Center for Facial Plastic Surgery in Orlando, Fla., told Ivanhoe. Both Nantz and Coulter are happy with the results. The procedure helped Nantz accomplish something she couldn't on her own -- results that earned her a whole new wardrobe! Liposuction is only for people who want to sculpt -- not lose weight. Dr. Bassin is only the third doctor in the country to use the new aqua-jet lipo technique. Doctors in Germany have been performing the procedure since 2007. More Information FOR MORE INFORMATION, PLEASE CONTACT: The Bassin Center for Facial Plastic Surgery (407) 851-3888 http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=21579 ------------------------------ NEWS: First study to include LYMF patients published in the New England Journal of Medicine... Read more... Can you say Lymphangiomatosis? Then just say LYMF... The story behind the acronym... From the heart of Sharon J. White, President/Founder October 3, 2007 Over the past 2 months we have lost 4 of our youngest patients. Dyan (10/years), Luca (4 years), Dominick (5 months), and Chelsea (4 years) lost their brief battles with Lymphangiomatosis over the past 2 months. These precious losses give us greater motivation to build the foundation into one that will effect change in the awareness and pulling physicians and researchers to study this devastating disease. Each of these children was born apparently healthy. You can only imagine how devastating it has been for their parents and families. The helplessness they have felt has been tragic as even the doctors treating them had never heard of LYMF before they encountered these children. The thoughts are that there are not enough patients out there to study. If you take a moment to think about science and statistics – when you lose 4 children from the same diagnosis within a 2 month period – the likelihood is that there are at least 24 patients per year that are dying from this disease. The patients I have mentioned are only the few that have found their way to our foundation. The fact is that this disease has not had a registry – and thus – there are so many that are not even known about. My heart breaks every time I hear of a new child and young adult who lose their battle with this disease. I am forever grateful that I have survived over 34 years with this diagnosis. There are very few patients that I know with histories such as mine who survive into their 50’s. The biggest question I have is “Why?”. We need more information in order to build the foundation into one that can successfully attack this tragic disease. We also need funds to build the needed database; and also need funds to attract the scientific community in that we will be able to fund research. Website upgrade From Sharon J. White - President/Founder Our new feature that allows patients to have their own Web Page is now functional. Please Click here to learn how you can have your own page... As of August 14, 2007 - we have our first patient page posted. A new link tab will be added to our menu above in the very near future. To new patients and parents of children with this disease - it is important for you to understand that this is a memorial page for a child that recently lost his battle with this disease. To view this page you may click here. Click Here It is essential that you understand that this is the most feared outcome of this disease - but not the only outcome. The patient's story reinforces the urgency for us to pull together all of our resources (information and fundraising) - so that we can urge researchers to explore this disease to find effective treatments and ultimately a cure... You can read about Luca Zieren at: Luca Zieren - Memorial Web Page We will have two sections for patient pages - one for patients who are still battling this disease... and another for the patients who have lost their battles. Please think about submitting your/your child's information so that we can get to understand the different journeys each of us goes through. It is so important for anyone interested in learning more about this disease to have the stories of our different patients. Please go to: Click here and contact the foundation at: PatientPages@lymphangiomatosis.org -------------------------------------------------------------------------------- Update - Biomarker Study -------------------------------------------------------------------------------- The number of patients responding to this study has been encouraging. This does not mean that there are enough patients (there are never enough with LYMF) - but - there are enough to pique the researchers interest in LYMF and their desire to learn more. If you have not yet contacted me about this study - if you are 18 or older - please contact me and learn how you can participate. This is a start and a big chance for us to gain the recognition from the scientific/medical community that we so need!!! If you are new to this site or have not yet read the information regarding the Biomarker Study - please read previously posted information below: As I posted in March - Dr. Lisa Young at the University of Cincinnati is conducting a study with adult patients diagnosed with LYMF. The study requires a blood sample that can be drawn whenever you have blood drawn. As I mentioned this is an excellent opportunity as it is the first study ever that will include LYMF patients (over the age of 18). Dr. Young has contacted me and informed me that she has heard from 4 "eligible" patients - so far - with 3 having completed the requirements (including myself). She stated that there was one who contacted her but has not completed the requirements - which include sending her a signed consent form. As I mentioned previously, there is a potential to include patients under the age of 18 in the future. She also mentioned to me that several parents of young children expressed interest in having their children participate, but - that their study is only approved for age 18 and over at this time. She stated "Certainly we will consider how to expand to learn more about how this disorder affects chidren in the future." Please take this as a road for us to follow and if you are over the age of 18 and live within the contiguous United States and Canada - I strongly urge you to think about participating. We need at least 18 patients (and of course as many patients as possible - as any patients over the 18 will help demonstrate that this disease does occur in more patients than the literature demonstrates). -------------------------------------------------------------------------------- Patient Registry - A database that will collect information from patients diagnosed with Lymphangiomatosis and/or Gorham's disease is essential in raising the interest of researchers to search for a cure. Without a significant sized "pool" of patients to study - scientists are not able to conduct any reliable studies. When the database is complete (this has been an enormous job) - we need everyone to participate. Most researchers and physicians are under the misconception that there are only 5 or 10 patients out therer with this diagnosis. Clearly there are many more - and we need to provide evidence to prove there are more of us than they imagined. http://www.lymphangiomatosis.org/ ======================================== http://professional.cancerconsultants.com/oncology_main_news.aspx?id=43642 Sentinel Node Micrometastases Indicate Need for Additional Axillary Treatment in Patients with Early Breast Cancer Researchers from the Netherlands have reported that breast cancer patients with micrometastases (pN1mi) in sentinel lymph node biopsy (SLNB) should have an axillary lymph node dissection (ALND) or receive radiation therapy (RT). The details of this study were presented at the 2009 annual meeting of the American Society of Clinical Oncology in Orlando, Florida, on May 30.[1] Axillary lymph node dissection is the traditional method for staging women with clinically localized breast cancer. Unfortunately, the removal of axillary lymph nodes (approximately 25 nodes) is associated with chronic side effects including pain, infection, limited shoulder motion, numbness, and lymphedema. Because these complications can become debilitating, SLNB has emerged as an alternative method of staging and is currently being used in most medical centers treating breast cancer. When performed appropriately, there is a 95% correlation between the results of SLNB and ALND. There is also emerging evidence that women who have a SLNB showing microscopic disease who receive adjuvant chemotherapy and/or adjuvant hormonal therapy may not benefit from an ALND. A randomized trial (American College of Surgeons Oncology Group Z0011 Phase III trial) to address this issue was started but closed after five years due to inadequate accrual. Thus, the question of necessity of ALND in patients who have a positive SLNB remains unanswered. However, researchers from several U.S. medical centers have recently reported that women with localized breast cancer who have a positive SLNB that shows microscopic disease may not benefit from ALND. This study utilized data from the National Cancer Data Base for the years 1998 to 2005. This study included 403,167 women who underwent SLNB for clinically node-negative localized breast cancer. This analysis focused on 97,314 women (24%) with clinically node-negative localized breast cancer who had micrometastases. Twenty-four percent of these women had a SLNB only, and 79% also had an ALND. These authors found no statistically significant differences in outcomes between women treated with SLNB alone and those treated with ALND. For the 5,596 women undergoing SLNB alone, the axillary recurrence rate was 1% compared with 1.1% for 22,591 women undergoing ALND. The five-year survival was 82.1% in patients undergoing SLNB alone compared with 81.8% for women undergoing ALND. These findings were confirmed even when the data was corrected for confounding factors such as clinicalopathologic characteristics, adjuvant treatment, and hospital type. However, for women treated between 1998 and 2000, there was “a nonsignificant trend toward better outcomes for completion of ALND” compared with SLNB alone. These authors concluded: “This study offers evidence that axillary recurrence and survival are comparable for SLNB alone versus SLNB with completion ALND for microscopic nodal disease and in selected patients, for macroscopic nodal metastases.” The Dutch study evaluated the records of about 2,700 women who underwent surgery and sentinel lymph node biopsy for early-stage breast cancer and who had sentinel nodes that were free of cancer or that contained only micrometastases or isolated tumor cells. Some of the women underwent additional axillary lymph node treatment with ALND or RT. The following table summarizes the main findings of this trial: Table 1: Axillary Recurrence in Women Undergoing Surgery and Sentinel Lymph Node Biopsy Number of Patients Axillary Recurrence in Five Years pN0(i-)(sn) cALND 113 1.9% pN0(i-)(sn) SN 722 2.2% pN0(i+)(sn)cALND or axillary RT 459 1.1% pN0(i+)(sn) SN 340 1.7% pN1mi(sn) cALND or axillary RT 828 1.2% pN1mi(sn) SN 130 6.2% P=pathologic, N=node, i=isolated tumor cells, cALND=completed axillary lymph node dissection, SN=sentinel node Based on these results, the researchers recommend ALND or RT to the axilla for women who are found to have sentinel node micrometastases. This additional treatment is important in order to reduce the risk of breast cancer recurrence. Comments: These data are at odds with the much larger study reported from the United States. However, because the United States also found a trend for benefit of ALND for the most recent patients, the prudent course could be to treat patients with microscopic disease. Reference: [1] Tjan-Heijnen VC, Pepels MJ, de Boer M et al. Impact of omission of completion axillary lymph node dissection (cALND) or axillary radiotherapy (ax RT) in breast cancer patients with micrometastases (pN1mi) or isolated tumor cells (pN0[i+] in the sentinel lymph node (SN): Results from the MIRROR study. Presented at the 2009 annual meeting of the American Society of Clinical Oncology, May 29-June 2, 2009, Orlando, FL. Abstract CRA596. --------------------------- Sewickley breast cancer survivor helps craft exercise DVD Strength and courage Joe Appel/Tribune-Review About the writer Deb Erdley can be reached at 412-320-7996. By Debra Erdley TRIBUNE-REVIEW Sunday, June 7, 2009 Sharon Cowden thought she'd make her mark in medicine as a pediatrician. Breast cancer was never part of the plan. But the Sewickley pediatrician's battle to regain her strength after breast cancer was the genesis of an exercise DVD for breast cancer survivors rapidly becoming a part of post-treatment rehabilitation in Western Pennsylvania. Cowden, 59, an avid golfer, has a simple message for survivors. "'You can be better than you were before.' Before, I could hit a golf ball 150 yards, now I can hit it 190 to 200 yards," she said. She'll take that message to Harrisburg this fall. Cowden and Janette Poppenberg, the American College of Sports Medicine-certified health and fitness specialist who helped her regain strength, were invited to give a presentation on the DVD, titled "Strength & Courage," at the Pennsylvania Breast Cancer Conference. Cowden, a mother of two and grandmother who entered medical school at 36, was diagnosed with breast cancer in 2002. Shortly afterward, she underwent a lumpectomy and axillary node dissection, the removal of lymph nodes under the arm. "You think the worst is over when you've had your surgery. ...Then I got a handout with eight pages of things I couldn't do anymore, including lifting more than 10 pounds. ... My physical therapist suggested maybe I should give up golf," Cowden recalled. Cowden was horrified. "I'm a pediatrician. I lift children all day long. Do you know how much babies weigh by the time they come in for the second visit?" She worried about lymphedema, a complication that can result in the swelling and further loss of mobility in the arm on the side where the lymph nodes are removed. A friend who knew about her concerns introduced her to Poppenberg. The 45-year-old trainer worked with Cowden for 18 months, slowly guiding her through stretching exercises, gradually rebuilding her upper body strength through weight training and introducing her to aerobic exercise. Along the way, Cowden learned that researchers believe exercise dramatically improves the prognosis for breast cancer survivors — by reducing reoccurrence of cancer and helping to prevent conditions such as lymphedema. But as Cowden and Poppenberg celebrated their success, it became apparent that many breast cancer survivors lacked access to such assistance. "The more survivors we talked to, the more we realized they needed help. We saw women who were afraid to lift an arm for six months," Cowden said. Poppenberg wanted to help spread the information that research was yielding about the value of exercise. Others, like Kathryn Schmitz, a University of Pennsylvania researcher who has studied links between exercise and breast cancer recovery, and Dr. Adam Brufsky, co-director of the Breast Cancer Program at Magee Womens Hospital of UPMC, encouraged the women to produce an exercise DVD. In 2007, with money from the Park Family Foundation, Cowden and Poppenberg began lining up assistance for the project. Brufsky offers advice in the introduction on the DVD, noting that modest weight- and resistance-training coupled with an aerobic program can combat exhaustion, sleeplessness and swelling many women experience after breast cancer treatment. Foundations and businesses stepped up to make the 60-minute DVD available for free to breast cancer survivors in Western Pennsylvania. More than 5,000 were distributed at breast cancer treatment centers from Pittsburgh to Erie. The DVD is available at Gilda's Club in the Strip District and the Cancer Caring Center in Bloomfield. Those outside the region can buy it for $20 at the Web site strengthandcourage.net. To date, it has filled orders from 26 states and several foreign countries. "As women, mothers, sisters, aunts and daughters, the best thing we can do for our friends is to make time to exercise, to go for a walk with them," Poppenberg said. http://www.pittsburghlive.com/x/pittsburghtrib/news/pittsburgh/s_628459.html ----------------------------------- 1. Ann Plast Surg. 2009 Jun;62(6):703-6. Diffuse lipofibromatosis of the lower extremity masquerading as a vascular anomaly. Greene AK, Karnes J, Padua HM, Schmidt BA, Kasser JR, Labow BI. Vascular Anomalies Center, Department of Plastic Surgery, Children's Hospital Boston, 300 Longwood Ave., Boston, MA 02115, USA. arin.greene@childrens.harvard.edu Lipofibromatosis is a slow-growing, childhood soft-tissue neoplasm that is often confused with other conditions. We report a patient with lipofibromatosis causing extremity enlargement at birth. The lesion initially was thought to be a vascular anomaly or lipedema on clinical and MRI examination. When involving the lower extremity, diffuse lipofibromatosis must be differentiated from more common causes of lower limb enlargement in children: lymphatic malformation, lymphedema, or lipedema. Compared with these more frequent conditions, lipofibromatosis usually causes less morbidity. Management of the tumor includes observation or excision. Because complete extirpation of the lesion is difficult, the recurrence rate is high. PMID: 19461290 [PubMed - in process] ----------------------------- 2. Ann Plast Surg. 2009 Jun;62(6):685-9 Simple, safe, and satisfactory secondary penile enhancement after near-total oncologic amputation Hage JJ. Department of Plastic and Reconstructive Surgery, NCI-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, Amsterdam NL-1066 CX, The Netherlands. j.jorishage@inter.nl.net After oncologic penile amputation, the penile stump may prove of insufficient length, causing poor personal hygiene and scrotal excoriation and an inability to void while standing. In these cases, penile enhancement by uncovering its subcutaneous parts may offer a simple and satisfactory solution.From August 2003 to August 2007, penile enhancement was performed in 6 patients with a mean age of 63 years (range, 51-69 years) and only 1 cm (range, 0-1.5 cm) of remaining penile length when standing up.The skin on the penile stump was used to recreate a neoglans. The subcutaneously covered penile shaft was dissected deep to Buck's fascia up into the deep suspensory ligament. Ventrally, the bulbospongeous muscle was laid bare over 1 to 2 cm. After resection of pubic subcutaneous fat, the pubic and scrotal skin edges were anchored to the suspensory ligament, bulbospongious fascia, and tunica albuginea. The resulting bare surface of the penile shaft was covered by a skin graft.Partial neoglandular skin slough was observed in 2 patients and could be treated conservatively in both. Penile lymphedema was observed in the 1 patient whom had previously undergone radiotherapy. This was treated by secondary subcutaneous resection and skin tightening. At a mean follow-up of 2.5 years (range, 1-5 years), the cosmetic appearance was acceptable in all patients and their penile length ranged from 7.5 to 9 cm. All were able to void while standing without soiling themselves. PMID: 19461286 [PubMed - in process] ---------------------------------------- 3. Ann Plast Surg. 2009 Jun;62(6):669-75. Modified Charles procedure using negative pressure dressings for primary lymphedema: a functional assessment. van der Walt JC, Perks TJ, Zeeman BJ, Bruce-Chwatt AJ, Graewe FR. Department of Plastic and Reconstructive Surgery, Tygerberg Hospital/ University of Stellenbosch, Francie van Zijl Drive, Parow, Private Bag X3, South Africa. chrisenkate@mweb.co.za OBJECTIVE: The Charles procedure is an aggressive operation usually only indicated for severe lymphedema as it often yields an unpredictable outcome. We modified this procedure in order to achieve predictable results. METHODS: The modification entailed the use of a negative-pressure dressing after the initial debulking surgery and then the delay of skin grafting by 5 to 7 days. Patients were graded by means of a lower limb functional scale to assess their functional status pre- and postoperatively. RESULTS: Eight patients with severe primary lymphedema underwent a modified Charles procedure. All patients underwent this procedure without any major complications with an average resection of 8.5 kg of lymphedematous tissue. Minor complications included operative blood loss and additional regrafting (3 patients). The average follow-up was 27.3 months. CONCLUSION: The results show a dramatic functional improvement in quality of life and a high overall satisfaction rate of patients undergoing this procedure. Our modification makes this a relatively simple procedure with a predictable outcome. PMID: 19461283 [PubMed - in process] ------------------------------------------- 4. Clin Exp Dermatol. 2009 May 18. [Epub ahead of print] Localized bilateral lymphoedema of the ear lobes secondary to mesothelioma. Gudi V, Chan SK, Laroche C, Ford HE, Darrah R, Love K. Department of Dermatology, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk, IP33 2QZ, UK. PMID: 19456781 [PubMed - as supplied by publisher] ----------------------------------- Acta Derm Venereol. 2009;89(3):318-9. Fatal lymphangiosarcoma revealed by lymphoedema of the neck. Lalanne N, Ezzedine K, Vergier B, Liferman F, Taïeb A, Jouary T. Skin and Cancer Unit, Dermatology Department, Saint André's Hospital, 1, Rue Jean Burguet. PMID: 19479140 [PubMed - in process] ---------------------------- Histol Histopathol. 2009 Jul;24(7):909-69. Pericytes. Morphofunction, interactions and pathology in a quiescent and activated mesenchymal cell niche. Díaz-Flores L, Gutiérrez R, Madrid JF, Varela H, Valladares F, Acosta E, Martín-Vasallo P, Díaz-Flores L Jr. Department of Anatomy, Pathology, Histology and Radiology, Faculty of Medicine, University of La Laguna, Tenerife, Spain. We review the morphofunctional characteristics of pericytes and report our observations. After a brief historical background, we consider the following aspects of pericytes: A) Origin in embryonic vasculogenesis (mesenchymal stem cells, neurocrest and other possible sources) and in embryonic and postnatal life angiogenesis (pre-existing pericytes, fibroblast/ myofibroblasts and circulating progenitor cells). B) Location in pericytic microvasculature and in the other blood vessels (including transitional cell forms and absence in lymphatic vessels), incidence (differences depending on species, topographical location, and type and stage of vessels) and distribution (specific polarities) in blood vessels. C) Morphology (cell body, and longitudinal and circumferential cytoplasmic processes), structure (nucleus, cytoplasmic organelles and distribution of microtubules, intermediate filaments and microfilaments) and surface (caveolae system). D) Basement membrane disposition, formation, components and functions. E) Contacts with endothelial cells (ECs) (peg and socket arrangements, adherent junctions and gap junctions) and with basal membrane (adhesion plaques). F) Molecular expression (pericyte marker identification). G) Functions, such as vessel stabilization, regulation of vascular tone and maintenance of local and tissue homeostasis (contractile capacity and vessel permeability regulation), matrix protein synthesis, macrophage-like properties, immunological defense, intervention in coagulation, participation in mechanisms that regulate the quiescent and angiogenic stages of blood vessels (including the behaviour of pericytes during sprouting angiogenesis and intussuceptive vascular growth, as well as pericyte interactions with endothelium and other cells, and with extracellular matrix) and plasticity, as progenitor cells with great mesenchymal potential, originating other pericytes, fibroblast/myofibroblasts, preadipocytes, chondroblasts, osteoblasts, odontoblasts, vascular smooth muscle and myointimal cells. This mesenchymal capacity is seen in a broad section on the perivascular mesenchymal cell niche hypothesis and in the concept of pericyte and EC "marriage and divorce". H) Peculiar pericyte types, such as hepatic stellate cells (Ito cells), bone marrow reticular cells and mesangial cells. I) Involvement in pathological processes, such as repair through granulation tissue, pericyte-derived tumors, tumor angiogenesis and tumoral cell metastasis, diabetic microangiopathy, fibrosis, atherosclerosis and calcific vasculopathy, lymphedema distichiasis, chronic venous insufficiency, pulmonary hypertension, Alzheimer disease and multiple sclerosis. J) Clinical and therapeutic implications (de-stabilization of vessels or formation of a stable vasculature). PMID: 19475537 [PubMed - in process] =========================== 1: J Dtsch Dermatol Ges. 2009 May 27. [Epub ahead of print] Links Podoconiosis - non-filarial geochemical elephantiasis - a neglected tropical disease? Nenoff P, Simon JC, Muylowa GK, Davey G. Laboratory for Medical Microbiology, Mölbis, Germany. Summary Podoconiosis or mossy foot is a form of non-filarial lymphedema. This geo-chemical elephantiasis is a disabling condition caused by the passage of microparticles of silica and aluminum silicates through the skin of people walking barefoot in areas with a high content of soil of volcanic origin. Podoconiosis is widespread in tropical Africa, Central America and North India, yet it remains a neglected and under- researched condition. The disabling effects of podoco-niosis cause great hardship to patients. It adversely affects the economic (reduced productivity and absenteeism), social (marriage, education, etc.) and psychological (social stigma) well-being of those affected. Podoconiosis can be prevented; the main primary preventive measure is protective footwear. Secondary measures include a strict hygiene regimen and compression therapy, which can reverse initial lesions. Tertiary approaches include surgical management, such as shaving operations to reduce hyperplastic and verru-cous elephantiasis. PMID: 19486227 [PubMed - as supplied by publisher] ---------------------------------------------------- 2. Support Care Cancer. 2009 May 31. [Epub ahead of print] Links A prospective randomised study of alginate-drenched low stretch bandages as an alternative to conventional lymphologic compression bandaging. Kasseroller RG, Brenner E. Klinik St. Barbara, Medizinisches Zentrum Bad Vigaun GmbH & Co. KG, Karl-Rödhammer-Weg 91, 5424, Bad Vigaun, Austria, rgk@drkasseroller.at. BACKGROUND: Breast-cancer-related lymphoedema, either caused by the tumour itself or its therapy, can be found in approximately 24% of all patients. It results in disabilities, psychological distress and reduced quality of life. Therefore, proper therapy for this entity is very important. Guidelines recommend a therapy in two phases, an intensive phase I for 3 weeks for volume reduction and, between the cycles of phase I, a reduced phase II to maintain the result. During phase I therapy, manual lymphatic drainage often cannot be administered on weekends or holidays; only a reduced therapy, mainly by application of a more or less passive compression by bandaging, is administered. For this, conventional low-stretch bandages are hitherto being used. Several attempts have been made to overcome this disadvantage by either impregnating or covering the bandage with sticky or adhesive substances such as india rubber, elastomeres, polyacrylates, etc. Recently, new bandages are available, which are drenched with alginate that becomes semi-rigid after drying for approximately 6 h. It was the aim of this study to compare alginate bandaging to a conventional lymphologic-multilayered low-stretch bandaging with individual supportive lining as to their effect concerning their congestive capacity in exactly delimited time periods of reduced decongestive therapy as well as the patients' tolerance. MATERIALS AND METHODS: From December 2007 until May 2008, 61 female patients with a one- sided lymphoedema of the axillary tributary region after axillar dissection who underwent a phase I complex decongestive therapy were prospectively selected for our investigation. On weekends, group A got the conventional low-stretch compressive bandaging, whereas group B got an alginate semi-rigid bandage. Arm volumes were measured before and after these bandages were applied. Additionally, the subjective sensations of the skin caused by the compression were measured by means of a five-level Likert scale. RESULTS AND CONCLUSIONS: The initial volumes (V (0)) of the two groups (A, 2,939.0 ml +/- 569.182; B, 3,062.6 ml +/- 539.161) varied within the same magnitude, with somewhat smaller values in group A. The same was true for the final volumes (V (6)), measured at day 22 (A, 2,674.5 ml +/- 480.427; B, 2,740.1 ml +/- 503.593). During the weekends, the arm volumes re-increased (first weekend: A, 16.4 ml vs. B, 4.7 ml; second weekend: A, 14.2 ml vs. B, 2.7 ml; third weekend: A, 7.5 ml vs. B, 1.1 ml). A significantly smaller volume increase appeared in the alginate group during the weekends. There were no serious side effects in both groups. Concerning the patients' comfort, the values of the alginate group were clearly better than those of the conventionally bandaged group. Additionally, the volume changes in the alginate group revealed fewer fluctuations. As a summary, one can state that a good alternative to the conventional bandaging is available with the alginate bandages, bringing distinct advantages for the patients when administered properly. PMID: 19484485 [PubMed - as supplied by publisher] ------------------------------------------ 3. Eur J Surg Oncol. 2009 May 27. [Epub ahead of print] Links Massive localized lymphedema of the thigh in a morbidly obese patient. Berenji M, Kalani A, Kim J, Kelly K, Wallack MK. Department of Surgery, Metropolitan Hospital Center, New York Medical College, New York, NY, USA. PMID: 19481410 [PubMed - as supplied by publisher] --- http://www.fayettefrontpage.com/health-09/4-23-09_hands.htm Piedmont Fayette Hospital Patient Regains Full Use of Hands April is Occupational Therapy Month 4/23/09 While out with her family at the local skating rink, Fayetteville resident Jennifer Smith, tripped over another skater and landed backwards on the edge of her palms. The result: bilateral fractures in both wrists, and shattered bones beneath her thumb and pinky. She was rushed to the emergency room at Piedmont Fayette Hospital (PFH). After X-rays, splints, surgery and a 2-day hospital stay, Smith was sent for occupational therapy. “When I showed up for therapy at Piedmont Fayette Hospital, my hand was straight up and down, I could only move it a quarter of an inch at the very most,” said Smith. “I couldn’t tie my shoes or get dressed, let alone do my job.” Smith underwent 6 weeks of therapy at PFH, with two sessions every week. She participated in flexion, extension and strength building exercises, which included lifting small weights, pushing and pulling objects, circular movements of the wrist to regain rotation, and massages. “The occupational therapy program is designed to help our patients perform day-to-day tasks for themselves, whether that is at home, school, work or play,” said Lisa Caphe, an occupational therapist at Piedmont Fayette Hospital. “But more than boosting motor skills and improving mental acumen, we want them to know they can overcome their injuries or disabilities and lead normal lives.” April is Occupational Therapy (OT) Month and Piedmont Fayette Hospital is recognizing the hospital’s occupational therapy department for its efforts to help individuals, like Smith, lead fulfilling lives. Occupational therapy (OT) is the use of treatments to develop, recover, or maintain the daily living and work skills of patients such as Smith. The therapists help clients not only to improve their basic motor functions and reasoning abilities, but also to compensate for permanent loss of function. The goal is to help clients have independent, productive, and satisfying lives. “Lisa explained everything to my husband so he would know what to do after my sessions were over,” said Smith. “She suggested using things around the house for weights – like canned goods or a hammer to simulate the same exercises.” With continued exercises at home, as suggested by her OT, Smith returned to work and has regained almost full mobility in her left wrist and hand and is 85-90 percent recovered in her right. “You get so much more out of the therapy with a specialist than you can do it at home. Having someone there to tell you when you’re doing it right or wrong, and what exercises to do really helped,” said Smith. “It was a wonderful experience, -- without them I don’t think I’d be back where I am today.” PFH Rehabilitation and Fitness Center offers cardiac rehab, pulmonary rehab, diabetes education, physical therapy, occupational therapy and speech-language pathology. There are also specialty programs including pelvic pain and incontinence therapy, lymphedema therapy, wound care and ostomy management, joint replacement pre-op classes, and Healthy Heart Classes. The fitness center is open to the community and offers a full line of state of the art equipment. Physician referral is required for most rehabilitation services. For more information about PFH's occupational therapy department and other rehabilitation and fitness services, call 770-719-7290. To learn more about Piedmont Fayette Hospital, visit www.fayettehospital. org. ------------------------ http://funjockey.com/help-for-persistent-or-recurring-swelling/ Help For Persistent Or Recurring Swelling Like the arteries, veins and capillaries that transport blood through our bodies, our bodies also contains an extensive drainage system that returns water and proteins from our tissues back to the bloodstream. Called the lymphatic system, it is part of our immune system and works to defend the body from diseases caused by viruses, bacteria, or fungi. The lymphatic system has two major functions. First, it works to regulate the amount of fluids within our bodies. Secondly, it is responsible for “taking out the trash”, that is collecting waste products, such as dead blood cells and pathogens from the interstitial fluid (the fluid that fills the spaces around cells) and filters it before returning it to the bloodstream. The lymphatic system is made up of lymph vessels that carry lymph, a protein-rich fluid that is transported through the lymph vessels, and lymph nodes which filter out germs and toxins. There are over 100 lymph nodes throughout the body, with the majority of them being located in the neck, groin and armpits. Lymphatic vessels contain valves that prevent the lymph from flowing backwards within the system. Within the lymphatic vessels, lymph is transported through the vessels and moves via the squeezing action of their neighboring skeletal muscles. When the movement of lymph through the body becomes impaired, it will leak out of the lymphatic capillaries and cause the surrounding tissues to swell. This condition is called lymphedema. Lymphedema occurs when the amount of lymph fluid in the body exceeds the body’s ability to transport it. This causes the lymph fluid to accumulate in the tissues, where it causes swelling, particularly of the arms and legs. There are two types of lymphedema. Doctors don’t know what causes Primary Lymphedema, but it can be present at birth, or can develop later on in life. Fortunately, this condition is rare. Secondary Lymphedema is a condition that is not often talked about, but often affects individuals who have undergone surgery, such as cancer surgery where lymph nodes are commonly removed. It can also affect individuals who have undergone radiation therapy, which can damage lymph nodes and cause scar tissue to form ultimately interfering with the flow of lymph. It can also be experienced by individuals who have experienced a severe trauma or infection. In the initial stages of this chronic condition, Lymphedema often begins with swelling in a hand or foot, particularly the one closest to where the surgery has occurred or radiation therapy has taken place. If left unchecked, the protein-rich lymph can continue to accumulate, leading to increased swelling and a hardening of the tissues. This increases your risk of developing an infection or may interfere or impair the function of the limb. Lymphedema can develop in any part of the body. If you experience persistent or recurring swelling anywhere in your body, it is important to seek medical advice. Early intervention with this disorder greatly improves the long term outcome of the disease’s progression. Recommendations For Wellness Avoid rigorous, repetitive movements or heavy lifting. Women, if your arm is affected, get rid of extra 50 lbs that you carry over your shoulder and trade it in for a purse that has hand straps. If your arm or leg starts to ache, lie down and elevate it. Wear loose fitting clothes, jewelry, socks and undergarments that may restrict lymphatic flow. Wear a compression sleeve or stocking on the affected limb. Keep your “at risk” limb clean and avoid activities that may irritate or damage the skin. Careful skin care may reduce the risk of lymphedema by helping you to avoid infection. Massage, particularly lymphatic massage has been shown to help increase lymph drainage. You can do this yourself or work with a qualified massage therapist who has been specially trained in how to perform manual lymph drainage techniques. Begin a gentle exercise program. Exercise and muscle movement can help drain lymph fluid. (Consult with your doctor prior to beginning any exercise program). Drink plenty of water. Water is critical for proper lymph drainage. Echinacea has a long history of improving lymph filtration and drainage. Garlic is known for being able to stimulate the lymph system to throw off waste materials. Oregon grape can be used to help reduce the inflammation of the lymphatic system and works to help cleanse the lymph. Poke Root has been known to help stimulate the body and aid its ability to remove waste materials that may be trapped in the tissues. It can also help improve the elasticity of tissues that may have experienced hardening due to congestion. Burdock, red clover and mullein are known to thin lymph fluid and enhance lymphatic drainage. Herbal combinations such as Nature’s Sunshine’s Lymphatic Drainage, Lymphomax or Lymphostim are designed to stimulate the immune system, fight infections and support the lymphatic system. Copyright Body, Mind & SoulHealer 2004. About The Author Dr. Rita Louise, PhD is a Naturopathic Physician and a 20-year veteran in the Human Potential Field, and it is her unique gift as a medical intuitive that enlivens her work. Author of the books “Avoiding the Cosmic 2×4? and “The Power Within: A Psychic Healing Primer”, Dr. Rita Louise, Ph.D. a can help you identify what is really going on and provide you with straightforward guidance and advice. She can be reached by calling 972-475-3393. ------------------------------------------ http://www.integrative-healthcare.org/mt/archives/2009/04/bodywork_after.html Bodywork After Breast Cancer Surgery While more women than ever are able to beat breast cancer, there is still a need to help them recover from breast removal surgery. Despite warnings to avoid bodywork on anyone with a history of cancer, properly prepared massage therapists can help survivors heal from their breast cancer surgery. by Nicole Cutler, L.Ac. Weighing in as one of the diseases women fear most, breast cancer is estimated to affect one in every eight women. Despite breast cancer being the second-leading cause of cancer deaths in American women, its early diagnosis and treatment has drastically improved this illness’ survival rate. When included in a person’s recovery from this illness, massage therapy has the capacity to improve the physical and emotional health of a breast cancer survivor. With compassion, specific training and attention to documentation and legal issues, bodyworkers have the tools to help clients mend the parts of their life fragmented by traditional breast cancer treatment. As one of the leading treatments for breast cancer, the complete or partial surgical removal of breast tissue can make a significant impact on a person’s life. In addition to the side effects from other therapies one may have received, the loss of one or both breasts may congest blood, lymph and energy circulation in the chest and upper extremities. Just as important to an individual’s well-being, breast disfigurement or amputation can take a drastic psychological toll on survivors. Types of Breast Cancer Surgeries Since there are so many variations of type and severity of breast cancer, the treatment approach for this illness is highly individual. Involving a great deal of deliberation between patient and doctor, most women will have surgery and an additional therapy such as radiation, chemotherapy or hormone therapy. In general, breast removal surgeries fall into one of the following four categories: 1. Lumpectomy – A surgical excision of only the palpable tumor mass. 2. Partial Mastectomy – Removes less than the whole breast, such as a quarter of the breast where the tumor resides. 3. Modified Radical Mastectomy – Removes all breast tissue, including the skin, nipple, areola and most of the axillary lymph nodes on the same side while leaving the pectoral muscles intact. As the most common surgery for early stage breast cancer, this is also called a total mastectomy with axillary dissection. 4. Halsted Radical Mastectomy – Removes the breast, skin, both pectoral muscles and all axillary lymph nodes on the same side. Massage Therapy Following Breast Surgery Because of the unknown mechanism for spreading cancerous cells, most massage therapy schools teach that cancer is a contraindication for massage. However, modern research has repeatedly demonstrated that carefully executed bodywork offers measurable benefits to people currently living with or who have survived a bout of cancer. Regardless of the growing acceptance of massage therapy for cancer-related issues, approaching a client with a recent or distant history of breast cancer always mandates the practitioner proceed with caution. · Permission – First and foremost, obtain the permission of your client’s physician prior to administering massage. · Consent – Make certain you have your client’s written informed consent before proceeding with massage therapy. · SOAP notes – Adhere to this conventional form of record keeping, which includes taking subjective, objective and assessment plan notes. · Training – Only proceed with bodywork if you have successfully completed training specific to oncology massage. Following breast cancer surgery, common physical problems may include local pain, swelling and restricted range of motion. If the pectoral muscles have remained intact, the physical effects are likely the result of impaired circulation from removed lymph nodes, scar tissue and adhesions from surgery. Including techniques such as therapeutic touch for acute surgical recovery, lymphatic drainage massage for lymphedema, scapular mobilization for a stiff shoulder, myofascial spreading for tight pectorals and cross- fiber friction to dissolve scar tissue, a therapist trained in oncology massage has many tools to help clients recover from breast cancer surgery. Women who have experienced the trauma of breast cancer surgery can benefit emotionally from touch- centered therapy. When applied with healing intent and compassion, a massage therapist’s touch can function as a bridge to help clients become reconnected to their body. For many breast cancer surgery recipients, the physical contact of massage eases the feeling of being a stranger in their own body, a transition that can help them find comfort in their new physical form. Since a lumpectomy or mastectomy is indicated in a majority of cases, many breast cancer survivors must contend with the consequences of their surgery. Although not outfitted with a medical doctor degree, massage therapists can help clients with a history of breast cancer return to health. By seeking the proper training, taking acceptable notes, getting physician permission and obtaining client written consent, massage therapists can facilitate their clients’ physical and emotional recovery from breast cancer surgery. References: Handley, W. C., Jr., LMT, Massage for Cancer Patients: Indicated or Contraindicated?, Massage Today, January 2007. Manzulli, Sabino L., LMT, Bodywork & Visualization Therapy for People With Cancer, Massage & Bodywork, August/September 2001. Vanderbilt, Shirley, Into the Looking Glass: Massage for Mastectomy Patients, Massage & Bodywork, August/September 2000. Mastectomy Massage, Cheryl Chapman, Eileen Kennedy, American Massage Therapy Association, 2008. About Breast Cancer: Statistics, Causes, Symptoms, Surgery Options, breastcancer.org, 2008. Breast Cancer, Mayo Foundation for Medical Education and Research, 2008. Massage After Mastectomy, Chris E. Barrett, 2008. --------------------------- http://www.newstimes.com/ci_12212807 New Milford mother organizes team for breast cancer charity race By Nanci G. Hutson staff writer Updated: 04/23/2009 08:51:04 PM EDT NEW MILFORD -- Three of Lisa Arasim's best friends -- all seemingly the epitome of good health --were diagnosed with breast cancer last year. Arasim, the 43-year-old mother of three young girls -- Hannah, 8, Emily, 7 and Olivia, 4 -- was daunted by the realities that one out of every seven women is diagnosed with the disease in their lifetime; family history and good health often playing no role one way or another. The one common denominator for her friends was that they were able to even their odds against the disease as it was caught early; each with a strong prognosis for survival after early treatment. Inspired by her friends, Arasim decided this was not their fight alone. She wanted to do something to promote early detection vigilance in other women. So she participated with one of her friends, breast cancer survivor Marianne Colacray, in the Susan G. Komen 5K Race for the Cure in Boston in September. Yet she still longed to do something closer to home. She opted to organize a team, "New Milford Cares,'' for the Susan G. Komen 5K Race for the Cure to be held in Bushnell Park in Hartford on June 6. So far, Arasim said several area businesses have pledged their financial support and she has a few people who have offered to join her team, including a neighbor who was diagnosed with breast cancer last year. "It's personal for me,'' said 44-year-old Colleen Golembeski, Arasim's neighbor and the mother of two children Golembeski praised Arasim for stepping up to show solidarity for all women so that they get the information they need for early screenings and treatment options after diagnosis. She said she is glad she might be able to help "someone like me who is facing this challenge.'' To prepare for the event, Golembeski said she is walking on her treadmill and some other exercise so she will be able to either run or walk the course. Whether someone walks or runs the course matters little, Arasim said. Personally, she said she is training to run, but if more of her team chooses to walk, she'll walk. She jokes that she still has a long way to go to get in shape, "but I will. In truth, Arasim said, this race is far from a competition. It is a support for women with breast cancer even as it promotes education and research to thwart the disease that befalls 3,000 Connecticut women each year, Arasim said. "It really celebrates survivorship,'' Arasim said of the race that engenders thousands to line the streets cheering on the runners and walkers. So far, Arasim said she has been making rounds to local businesses about sponsorships and talking to friends and strangers alike about joining the team. One of her connections was with Denise Mariconda, a registered nurse who is the breast health navigator at New Milford Hospital's Regional Cancer Center. Mariconda has served as something of a cheerleader for Arasim's efforts as the hospital is a long-time recipient of grants from the Susan G. Komen organization. Earlier this month, the cancer center was awarded a $35,255 grant to offer screening mammography and lymphedema care to women 40 and older who are uninsured, underinsured, or medically under served in the hospital's eight-town region. Arasim said she expects the hospital will also field a team for the race. "My goal is saving lives and seeing a cure in our lifetime,'' Arasim said. Contact Nanci Hutson at (860) 354-2274. --------------------------------- http://www.emediawire.com/releases/lymphedema/podiatry/prweb2360324.htm LymphaCare to Exhibit Lymphedema & Wound Care Products at Podiatry Conference LymphaCare will be exhibiting home lymphedema pumps, as well as the new MOBILITY1™ IPC device at the the 60th Annual Region Three Podiatry Meeting in Atlantic City on April 29th-30th. LymphaCare is a leading provider and reimbursement specialist for home compression therapy used in the treatment of lymphedema, chronic venous insufficiency (CVI), wound care, and diabetic foot. New York, NY (PRWEB) April 30, 2009 -- More than 40 million Americans suffer from venous or lymphatic disorders, which represent an annual economic cost of over $8 billion of total expenditure on US healthcare. Other than lymphedema, the bulk of peripheral vascular disorder patients suffer from venous ulcers, CVI, DVT, and varicose veins. None of these chronic disorders is currently curable. LymphaPress PBS Pump Patient Sequential Gradient Compression Pump Therapy for lymphedema and venous insufficiency has been utilized for over 30 years throughout the world. Manufacturer's such as LymphaPress & Bio Compression Systems have helped pioneer and perfect this technology by utilizing a 4-12 chambered pneumatic sleeves to gently move the lymph fluid. These devices are recognized treatments and approved by Medicare and most insurance providers in the USA. Mobility-1™ IPC device is the latest compression technology. The Mobility1™ IPC was designed by a technology company in Israel. It is protected by two patents surrounding the use of kinetic energy to drive the pneumatic action, as well as the sophisticated internal mechanisms that allow for the pneumatic action to also be driven by a very small and portable compressor. The product will be the only one of its kind, allowing mobile patients to receive optimal therapy while maintaining their lifestyle, as opposed to being only home bound for treatment. It has been estimated estimated 4.6 million workdays are lost every year in the U.S. due to symptoms associated with CVI. CVI is a disease that affects the legs and is caused by non-functional valves in the leg veins. The normal venous system in the legs contains a series of valves that assist in returning blood flow to the heart. When the valves cease to function properly, blood may pool in the lower leg, leading to swelling, changes in skin color and, eventually, ulcerations near the ankle. Leg vein valve failure is, in many cases, caused by blood clots or vein enlargement due to hereditary causes. The swelling and ulceration is uncomfortable and often painful, making it difficult to move around. The most common treatments for CVI are palliative such as conservative leg rest and use of compression stockings and pumps. Lymphedema symptoms may consist of swelling, heaviness or tightness of the extremity, feelings of discomfort, or a chronic aching in the upper or lower extremities. Lymphedema of the legs may be present at birth, develop at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda). Some cases of lymphedema may be associated with prostate cancer or from other vascular abnormalities. In the lower extremity it will be unilateral or bilateral. If it is bilateral, one leg may be worse than the other. LymphaCare has been providing home compression pump therapy to patients and the medical community for nearly 15 years, and are a clinically proven and cost effective therapy. Treatment compliance is increased as patients can utilize the compression devices on a daily basis in the comfort of their homes. LymphaCare has seen a significant improvement with many patients, especially if conservative therapy such as compression stockings and elevation has been tried prior to receiving a pump. The discomfort, financial, or time constraints of conservative therapies may preclude a physician prescribing home compression therapy for many patients. LymphaCare has had a great deal of success obtaining the lymphedema pumps for patients for home use through Medicare, Aetna, Blue Cross, and most major medical insurance policies. LymphaCare is a national provider and billing and reimbursement specialist for compression therapy devices such as Bio Compression & Lympha-Press Sequential Gradient Lymphedema Pumps, and MOBILITY1™ IPC. LymphaCare compression therapy products can be found on our websites or by calling LymphaCare at 800-288-1801. ### Trackback URL: http://www.prweb.com/pingpr. php/U3F1YS1FbXB0LVNxdWEtRW1wdC1TcXVhLUNvdXAtWmVybw== See the original story at: http://www.prweb.com/releases/lymphedema/podiatry/prweb2360324.htm ------------------------------ Vest designed to aid mastectomy patients By MONICA GRAHAM Sat. Apr 18 - 5:16 AM Pictou County naturopath Dr. Gabrielle Kropp has designed a compression garment that reduces lymphedema in breast cancer surgey patients, but production depends on finding enough hospitals to buy them. (Monica Graham) A Pictou County naturopathic doctor can’t understand why a compression vest she helped develop to aid post breast cancer surgery patients isn’t being used in more hospitals. Known as a mastectomy vest, it is no more expensive than the bandages it replaces and patients have hailed it as a more comfortable alternative. That’s why Dr. Gabrielle Kropp wonders why no one else seems to be using it. "It works, but it will die because no one in the bureaucracy will buy it," she said, adding that she stands to gain nothing personally from the sale of the vests. "It’s hard enough for these women as it is to go through cancer, but then there is lymphedema," she said. "We only want to help them." Dr. Kropp developed the vest after she and nurse Joanne Cumminger, a cancer patient navigator at Aberdeen Hospital in New Glasgow, noticed an increase in the number of women suffering from edema, or swelling, after having breasts removed. The body produces lymphatic fluid in response to surgery, but breast surgery damages or removes lymph nodes that regulate its flow. Without compression by tight bandaging or some kind of garment, the fluid pools around the surgical site and appears as a fluid-filled sac on the chest, underarm, or arm, the doctor explained. The fluid may become infected and painful and if it is not treated the condition becomes permanent. "It’s manageable, but not curable," she said, adding the bra-like garment she and Ms. Cumminger designed can prevent patients from getting lymphedema. Made of a special, stretchable, breathable, latex-free fabric, the vest is soft and lightweight. It has wide shoulders, is cut high to support the underarm and allows for placement of padding over the surgical site. The shoulders and front hook-and-eye fastenings can be adjusted to suit the wearer. The garment comes in seven sizes. Dr. Kropp and Ms. Cumminger tried several commercial designs that did not work and were far too expensive, so they made several models themselves — fitting them on patients over and over until they got the best result. The effect was immediately noticeable. As well as reducing swelling, the garment made women "feel snug again," Ms. Cumminger said, adding that patients and surgeons received it well. "I did not have a lymphedema patient for a long time," said Dr. Kropp, who trained at a specialized lymphedema hospital in Germany before entering naturopathy 15 years ago. She currently practises in New Glasgow and Caribou. In 2004 they surveyed 35 post-mastectomy patients at the Aberdeen Hospital in New Glasgow in order to substantiate their findings. None of the subjects using the vest developed swelling, lymphedema, or infection. Among the patients using bandaging or dressings, 14 had post surgery swelling, six got infections, and six developed lymphedema. "That is dramatic," Dr. Kropp said. "It’s not just coincidence." She searched for a manufacturer, eventually finding a U.S. specialty company to sew the garments. In order to keep the individual price below $100, Dr. Kropp has to order 1,000 vests but the Aberdeen Hospital only does about 60 breast cancer surgeries per year and not all are complete mastectomies needing compression, Ms. Cumminger said. To meet the manufacturer’s requirements and to keep the price down, other hospitals need to join in, but persuading other health districts to use the garments has been more difficult. Once patients and doctors hear more about the vest’s success, they will demand them, Ms. Cumminger said. "The benefit to patients is all that matters," she added. ( mgraham@herald.ca) http://thechronicleherald.ca/forum/read/21/106258/106258#msg-106258 ------------------------------- CENTRAL TEXAS RUNNING: BROM HOBAN A long and painful journey to Boston ends with smiles Tuesday, April 28, 2009 Paul Carmona ran his 15th marathon a week ago in Boston. What made this one special was the decade- long journey to the finish line. Now 45, Carmona's running dates to his time on the Princeton rowing team in the 1980s. He later attended the University of Texas law school and he now works for the Texas attorney general's office as chief of the consumer protection and public health division. Over the years, career and studies left little time for exercise, and Carmona found himself weighing 215 pounds, up from 158 during his rowing days. An entry form for the Statesman Capitol 10,000 in 1996 caught his attention, and his interest in running was renewed. Soon, Carmona ran the 3M Half-Marathon in 2001 and then set his sights on the San Diego Rock 'N Roll Marathon. He ran San Diego in 3:31 and quickly decided he wanted to qualify for Boston, so he added more training miles. Qualifying for Boston separates the serious runners from the recreational ones, and Carmona, then 38, needed a 3:15:59 at the 2002 Austin Marathon to qualify. He missed it by seconds, with a 3:16:38. He ran more marathons but just couldn't get the Boston qualifier. Then a bout of Achilles' tendonitis turned him toward cross training, and then triathlons. It was during a triathlon that he incurred his most serious injury. It started as a staph infection in September 2003 during the Couples Triathlon, when heavy rains forced competitors to remove their shoes and run barefoot (or not run at all). "The mud would so heavily cake on our shoes that we literally could not run with them on," Carmona recalls. "I cut my foot and it got infected, and I ended up hospitalized." The staph infection responded to a course of antibiotics but returned that December. Carmona was hospitalized for four days and couldn't walk. He had swelling in his leg, and his doctor thought (correctly) that the lymph nodes behind his knee and groin were damaged from the infection. Carmona was told he couldn't run until there was no more fluid in his hip. Carmona thinks he may have started running again too soon. Barely a month after his hospital stay, he ran the Distance Challenge 30K, the 3M Half Marathon and then the Austin Marathon He also decided to start coaching, first at RunTex, then at Rogue Training Systems and now with the Twenty-six two Marathon Club. And he upped his running. In one 14-month span from November 2006 to January 2008, he competed in the Ironman Florida, the Houston Marathon, a 50-mile ultra run, the San Diego Marathon, Park City Marathon, Dallas White Rock Marathon and the Disney Marathon. It proved too much for the lymph nodes in his left leg, which had been compromised by the two infections. "Right after that, I noticed a swelling in my leg around my ankle, and it got to be kind of painful. The doctor knew it was the same leg that had the infection, and suspected lymphedema — a fluid accumulation around the lymph nodes, which was draining down to my lower leg," he said. The lymphedema diagnosis led to compression therapy, in which he had to wrap his entire leg in bandages and then wear a compression sock from foot to thigh and sleep with a foam cushion wrap. For Carmona, that therapy continues today. "It was a shock at first, realizing that my leg would never be the same," he said. But Carmona hadn't forgotten his dream, and he told his wife he was going to come out of it and run the Tucson Marathon and qualify for Boston with a 3:30. He started running again a year ago in May and ran an 11-minute mile. A 3:30 marathon was a long way off. He ran all through the summer, wearing the compression sock. He continued to coach runners and to read about training. He changed his diet, concentrating more on fruits and vegetables, and got his weight back again. And he gave it another shot. "I went to Tucson with a specific plan: break the race into five-mile sections, running each at 40 minutes," he said. "If I did it right, it would come out to 3:29:36. It worked to perfection. I ran 3:29:40 and qualified." Boston last week was a 26-mile victory lap for Carmona, who successfully paced his sister there to run under 3:56, with a 3:55 clocking. "Boston was a fantastic experience. It's everything that people tell you about," he said. But what Carmona will always remember was a guy he saw at the marathon expo at Boston — a double amputee with two spring prosthetics with running shoes on. "I saw a picture of him in the Boston Globe the next day," Carmona said. "His name is Richard Whitehead, and he ran 3:02:44, and I realized I may have a problem with my leg, but look at this guy ... ." Round-Up mixup The new route of the Texas Round-Up 5K on Saturday led to some confusion near the finish area. Although the USATF-certified course was accurately measured and correctly barricaded, several runners, including women's winner Chris Kimbrough, inadvertently cut a short distance off the course by stepping over a median strip dividing the eastbound and westbound lanes on 15th Street, yielding an advantage of 15 to 25 meters, which translates into a 5- to 10-second faster time. Kimbrough acknowledged that she cut the corner because she became confused about which lane to use after making the turn and at one point came to a complete stop. Kimbrough figures her 16:27 winning time would still put her well under 17 minutes, her goal for the race, even with the extra 15-25 meters. She was awarded first place despite taking the wrong side of the road. The next women's finisher was more than two minutes back. http://www.statesman.com/sports/content/sports/stories/other/04/28/0428hoban.html --------------------------------- http://www.philly. com/philly/health_and_science/cancer/20090423_You_ve_survived_cancer__Now_what_.html You've survived cancer. Now what? Facing the long-term side effects By STACEY BURLING Inquirer Staff Writer WHEN GWEN DARIEN was treated for non-Hodgkin's lymphoma 15 years ago, no one gave much thought to how she might feel if she lived. "Everything was focused on treating the disease and getting the cancer out of your body," said Darien, now director of survivor and patient advocacy at the Philadelphia-based American Association for Cancer Research. Long-term survival after cancer treatment was still so unusual that no one considered that the radiation and chemotherapy she received might cause side effects years later. No one talked to her about work or the psychological impact of her treatment. "Nobody talked to me about fertility," Darien said. "Nobody talked to me about potential long-term events." Increasingly, cancer experts are devising ways to warn patients like Darien - there are 12 million cancer survivors in this country - about problems their treatments or the cancer itself can cause later on. The information is crucial because primary-care doctors often do not connect a new heart or nerve problem to cancer treatment that occurred years ago. The "survivorship" phase is a hot topic. The Institute of Medicine pushed for greater attention to post- treatment needs in an influential report called Lost in Transition in 2005. Cancer centers are forming survivor clinics that help patients watch for new cancers and manage treatment-related symptoms. They are studying survivors' needs and improving coordination of care by cancer specialists and other doctors. "It's really a culture change that has to occur in terms of how patients view themselves, how providers view the patients they're following," said Linda Jacobs, director of the University of Pennsylvania's LIVESTRONG Survivorship Center of Excellence. In this region, a computerized survivorship program from Penn's OncoLink, a Web site devoted to cancer, recently got a big boost from the Lance Armstrong Foundation (LAF). The foundation will give $2.3 million over four years to OncoLink, which creates individualized treatment plans for survivors. Andy Miller, LAF's vice president of programs and policy, said OncoLink was ahead of the curve in creating survivorship care plans that many people can use easily. "What we've heard from survivors, this is what they need," he said. "This is what the Institute of Medicine is calling for." LAF is joining with Penn to market the computerized-care plan, which will be called the LIVESTRONG Care Plan Powered by Penn Medicine's OncoLink. "The reach of the Lance Armstrong Foundation is so great that we have an ability to get this out to many more people," said James Metz, a Penn radiation oncologist who is editor in chief of OncoLink. Patients need such reports, Metz said, because cancer care increasingly involves multiple types of drugs, often combined with radiation and surgery. It's saving lives, but patients need to be aware of the long-term consequences. "These treatments we give are the gifts that keep on giving," he said. "Toxicities can happen months, years, decades after treatments were given." At OncoLink, cancer patients can type in information about their cancer and treatments. The program generates a report outlining medical tests they should receive, possible side effects of their treatments, and what they can do to keep cancer at bay. Breast-cancer patients who have taken the chemo drug Adriamycin, for example, can later develop heart problems. People who have had surgery risk lymphedema, which causes tissue swelling, even years later. Many patients are unprepared for sexual and fertility problems that cancer treatment can cause. It doesn't seem fair, but if you have had one cancer, the report will tell you that you are more likely to get another one. Ellen Stovall, acting president and chief executive of the National Coalition for Cancer Survivorship, has been advocating for better care planning since 1994 and is still pushing Medicare to pay for the time- consuming work of producing good treatment summaries and care plans. Stovall's chest was radiated to treat Hodgkin's disease in 1971. In 2007, doctors found cancer in both breasts "along the fault lines" of her radiation treatment. She also has a type of blood-vessel damage often found in people who have received radiation. Stovall said she was "very excited" about the OncoLink project. "It's very easy to use," she said. "I really liked it." Darien checked out her OncoLink care plan earlier this month. She already knew that her chemotherapy could damage the heart. She has had gum problems she traces to her treatment. Much of the OncoLink care plan was old news to her, but she thought many patients who had just finished treatment would find it helpful. She had not previously heard of connections between her treatments and bladder cancer or blood-vessel and swallowing problems. She liked the section on chemo brain, the fuzziness many cancer patients say they experience after treatment. "It's wonderful to see that taken seriously," she said. Denise Shaw urged her husband, Bob, an esophageal-cancer survivor who was treated at Penn, to try the care plan. "I wanted him to see in print what some of these poisons they gave him to kill the cancer could do to him," the Drexel Hill woman said. The information was not a surprise, but she said she thought it was helpful for her husband to see in writing that his fatigue is likely a result of his treatment. About 5,000 people have tried the computerized plan since its debut in May 2007. Only about 12 percent had received any previous survivorship information. Carolyn Vachani, a nurse practitioner who works with OncoLink, spearheaded the project because doctors told her they had too little time and money to produce care plans for their patients. That left patients "out there with no information and experiencing these problems with no knowledge at all that they could be related to the treatment they received." A weakness of the system is that information about the long-term effects of cancer treatment in adults is spotty, said Patricia Ganz, a UCLA oncologist whose work has focused on cancer survivorship. OncoLink also is not precise enough about the treatment patients received to suit her. As a result, she says she finds the resulting care plans too generic, though improving. Ganz has been developing computerized programs that make it easier for doctors to give patients a precise record of all the treatments they have received, another key aspect of survivorship planning. It includes much more detail than OncoLink's care plan currently requires. The two complement each other, she said. OncoLink's program already is in its fourth version, and the Web site's leaders plan regular revisions. Ultimately, patients may have less need to go to places like OncoLink for survivorship advice. Penn, Fox Chase Cancer Center, and Cancer Institute of New Jersey all are developing or expanding nurse-run survivorship clinics that give patients similar information in person. E-mail sburling@phillynews.com or call 215-854-4944. ---------------------------------- http://www.newswise.com/articles/view/551720/ Professor Using Night Vision Technology to Learn More About Lymphatic System Libraries Medical News Keywords LYMPHEDEMA Description The director of the new Center for Molecular Imaging at The University of Texas Health Science Center at Houston is using near-infrared night vision technology made famous by American soldiers in the First Gulf War to shed light on the lymphatic system. Eva Sevick, Ph.D. Newswise — The director of the new Center for Molecular Imaging at The University of Texas Health Science Center at Houston is using near-infrared night vision technology made famous by American soldiers in the First Gulf War to shed light on the lymphatic system. While much is known about the blood system, Eva Sevick, Ph.D., who leads the 20-person research team in the university’s Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases (IMM), said that until recently comparatively little was known about the lymphatic system, which is a network of vessels that act as the body’s sewer system picking up excess debris and fluid from tissues. Unlike blood, lymphatic fluid is clear, which makes it hard to see. In addition, lymphatic vessels are so small that it is difficult to inject the amount of contrast agents needed for traditional Magnetic Resonance Imaging or X-rays. While lymphatic fluid can be seen with nuclear techniques, actual fluid movement is hard to observe because it typically takes several minutes to acquire an image. Sevick’s solution to these medical imaging issues was to inject micro amounts of fluorescent dye below the skin where the lymphatic system would sweep it up. Then with the aid of a small laser and a night vision camera designed to pick up small amounts of light, Sevick’s team was able to observe the dye move through the lymph system below the surface of the skin. This was possible because the night vision camera can acquire images in less than one second. “No one had ever watched this before,” said Caroline Fife, M.D., clinical associate professor of medicine at The University of Texas Medical School at Houston and director of clinical research for the Memorial Hermann - TMC Wound and Lymphedema Center. “This was like Christopher Columbus discovering America. Until now, we’ve never had a good way to study the lymph system. It felt like being a doctor before antibiotics.” When the lymphatic system is functioning properly, it picks up fluids that leak from blood vessels into the spaces between cells. As this fluid passes between cells it gathers cell waste and debris. The fluid is subsequently taken up by tiny lymphatic capillaries and propelled through lymphatic ducts and nodes until it is returned to the blood. The lymphatic system also contains immune cells named lymphocytes, which guard the body against invading viruses and bacteria. The lymphatic system is of particular interest to cancer specialists because malignant cells will often end up in lymphatic filters. “Lymph nodes filter out bacteria and tumor cells,” said Fife, noting that the lymphatic system processes six liters of fluid every day. Much like plumbing when it backs up, lymphatic drainage problems can cause fluid retention or swelling, which results in a condition called lymphedema. About one in 200 are born with lymphedema, according to the Lymphatic Research Foundation (LRF); however, most in the United States acquire it as result of surgery, infection or trauma that interferes with the lymphatic system. About 30 percent of breast cancer survivors develop lymphedema, the LRF states. While there is no cure, lymphedema symptoms can sometimes be treated with massage and compression bandaging. “The Center for Molecular Imaging is poised to develop and translate molecular imaging agents, instruments and computer algorithms for improving patient care in a variety of diseases,” Sevick said. “With our optical technologies, we could image disease before the onset of symptoms. We also investigate the impact of breast cancer therapy on lymphatic function in order to evaluate how long-term treatments impact quality of life for cancer survivors.” Sevick is working to translate her bench discoveries into patient care. With the approval of the U. S. Food & Drug Administration, the researchers in her lab have begun patient trials using this medical imaging technique, which could aid in the diagnosis and treatment of many diseases including those of the lymphatic system. In one trial, Sevick’s team is recruiting 18 subjects for a clinical study to determine the effect of an automated massage device on lymphatic flow in persons with lymphedema of either one arm or one leg. In a second study, her research team is evaluating the effect of genetic makeup in persons with hereditary lymphedema and acquired lymphedema. More information is available at 713.500.3561. Sevick is professor and Cullen Chair in Molecular Medicine at the IMM. Her research is supported in part by the National Institutes of Health and the Longaberger Foundation through the American Cancer Society. Prior to joining the IMM faculty in 2008, Sevick served as a professor of radiology at Baylor College of Medicine and led that department’s division of molecular imaging. Sevick earned her Ph.D. at Carnegie Mellon University and did postdoctoral work at the University of Pennsylvania. Her honors include the American Cancer Society Research Scholar, Sylvia Sorkin Greenfield Award, Fellow of the American Institute of Medical and Biomedical Engineering and DuPont Young Faculty Award. photos are available on request. ------------------------------ Superior Student Raises Money For Disease Research It was an exciting night for Meagan Barnard. She got to see her hard work pay off, and was feeling mostly pain free. "I'm in high heels for probably the first time in a year and a half," she said. Four years ago, the Superior High School senior was diagnosed with primary lymphedema. It's a condition where under developed lymph nodes cause severe swelling in her right leg. After nine months of therapy, she found out it was incurable. "Because of my leg, I've had to quit everything that meant the world to me," said Meagan. "Basketball, dancing--I mean I used to be there on the stage with those girls dancing. But instead of it, I coach basketball and I coach dance." For her senior project, Meagan organized a benefit dinner and silent auction to spread the word about lymphedema, and raise money for research. Her friends say she has gone above and beyond expectations, both with her project and in her daily life. "She's had some adversity, and she's really taken that in and owned it," said Eric Nordrum, another Superior High School senior. "Meagan is by far one of the strongest people I know." "She's a fighter," said Lee Nagorski, also a senior at Superior. "It's a condition that could put you down for the rest of your life as far as how you feel about yourself. And she has pushed past that and found a positive side to it." All proceeds from the event will go to the Lymphatic Research Foundation, a non-profit group seeking a cure for Meagan's condition and other lymphatic diseases. "Trying to make everything work out and find a cure," Meagan said. "That's my whole goal." As part of that same project, Meagan also started a magazine dedicated to people with uncommon conditions. She says she's hoping to make it a semi-annual publication. http://www.wdio.com/article/stories/S896044.shtml?cat=10349 ---------------------------- Wound care: Giving your body's healing powers a helping hand Published: Monday, April 27, 2009 By Dr. Dennis Monteiro, Pottstown Memorial Medical Center Have you ever watched a scar heal and marveled at the power your body has to repair itself? Or worried over a cut or sore that simply won't go away? The body's ability to heal after illness or injury is a complex process. Many chronic diseases or conditions can compromise our body's restorative capabilities. Unhealed wounds can not only diminish quality of life, but also raise the risk of additional infection and complications. For this reason, wound care is a critical part of disease management or surgical recovery - and a growing medical specialty. Approximately 5 million Americans suffer from chronic wounds that will not heal or heal slowly, from accidents, burns, surgery or disease. Chronic wounds are most often found among the senior population, patients who are bed-ridden, and those who suffer from diseases that affect the circulation and skin, such as diabetes or peripheral artery disease (PAD). According to the Centers for Disease Control & Prevention, diabetes affects 23.6 million Americans or 7.8 percent of the population, and one-third of all diabetics suffer from lower extremity wounds or PAD. These wounds increase the likelihood of foot problems and the potential for amputation. Other conditions that can lead to slow-healing wounds include traumatic injury, complications after surgery, congestive heart failure, lymphedema, and compromised immune systems, including HIV or AIDS infection. Many hospitals have a wound care team, center or clinic, with specialists trained in advanced therapies that help to speed the healing process and promote or rebuild skin integrity. Chronic wounds that are treated in this way include diabetic skin sores, pressure sores, persistent skin irritations, peripheral arterial disease, surgery wound breakdown, traumatic wounds, burns, venous insufficiency, radiation injuries, spinal injury wounds and other non-healing wounds. Many of these wounds become problematic due to limited blood flow in the area, which can slow the body's healing process. Some patients may require treatments that differ from the standard. Wound care treatments may include dressing changes, hyperbaric oxygen therapy to invigorate oxygen-starved tissues and promote healing, and wound debridement (removal of dead tissue). These specialized therapies are administered in conjunction with other medical or surgical treatment for the skin condition. A patient's doctor generally refers a patient to a wound care team or treatment center where specialists evaluate the wound and review the patient's health and medical history. Tests may be conducted to learn more about the patient's blood flow and tissue oxygenation, as well as determine if there is any infection. The team then develops a treatment program based on the patient's individual needs and is part of the patient's comprehensive medical treatment with the primary care doctor. Once the wound is healed, follow-up care is important and should be in conjunction with any care the patient may be receiving for the condition that originally caused the wound, such as diabetes or hypertension. For more information about wound care, visit www.pottstownmemorial.com or the American Diabetes Association (http://www.diabetes.org/home.jsp). Dr. Dennis Monteiro is a member of the medical staff at Pottstown Memorial Medical Center and co- medical director of the Wound Care Center at PMMC. He is a graduate of Jefferson Medical College and both his internship and residency programs were completed at Graduate Hospital. He served a fellowship in plastic surgery at the Hospital of the University of Florida. Monteiro is board certified by the American Board of Plastic Surgery. He is in practice with Plastic Surgery Specialists, PC, 420 W. Linfield-Trappe Road, Limerick. http://www.pottsmerc.com/articles/2009/04/27/life/srv0000005184585.txt ------------------------------------- Bethpage's Schessler copes with lymphedemaBY KIMBERLEY A. MARTIN | kimberley. martin@newsday.com 10:53 PM EDT, April 20, 2009 Curious eyes often watch Jordan Schessler. But she doesn't mind. In fact, she welcomes the stares, the puzzled looks at her tan-colored knee-highs. "People have said, 'Look at the girl with the funny socks.' . . . When I go to Six Flags, I count the stares. It's almost like a game between me and my friends," the 17-year-old Bethpage junior said, laughing. "If someone is looking, I'll say, 'Would you like to know what it is?' And often times, people are like, 'Yeah.' " At the age of 9, Schessler's feet began to swell, turning dark shades of red and purple. But doctors couldn't explain why. "It was annoying and upsetting that most doctors don't even know what it is," she said. "There was a lot of confusion. You didn't know where to turn." A year later, Schessler was diagnosed with lymphedema, a condition that often causes swelling in both the arms and legs because blockages in the lymphatic system prevent lymph fluid from draining properly. As a result she must wear compression stockings and toe socks at all times - except when in the shower - to prevent swelling. But the condition hasn't hampered her playing ability. The centerfielder is batting .571 (24-for-42) for the Golden Eagles (4-3 ABC-II), and she also plays for the Long Island Bandits 18-under Gold travel team. "My feet go to sleep sometimes in the outfield. I can be running and moving, but my feet may be asleep," Schessler said. "But I just ignore it. I don't let it stop me. I don't like when people use that excuse." She has to change her garments twice a day and do half-hour elevation exercises, where she lies on her back and flexes her legs in and out, each morning and night to help circulate the fluid in her legs. "I try not to think about being an old woman trying to put these garments on. Now I'm mobile and flexible, so it's no problem. I'm actually more uncomfortable without them because I start swelling immediately," she said. "I would love to be the guinea pig if there was ever some cure treatment because someone has to be it." But rather than feel sorry for herself, Schessler says she prefers to raise awareness about lymphedema. "When I was first diagnosed, it was upsetting," she said. "But I've come to the realization that I am going to have it for the rest of my life. So now I'm just trying to act like an advocate." With the help of Bethpage social worker Christine Kennedy, Schessler organized "Scavenger Hunt for a Cure" in February to raise money for lymphedema research. The one-hour event after school generated $1,000, which she donated to the National Lymphedema Network. The more stares Schessler encounters, the more opportunities she gets to educate. "Everyone knows what the yellow 'Livestrong' bracelets are about," said Schessler, who also plays varsity volleyball. "The rubber bracelets we have say, 'We Are Here' because it's unknown. But at least in my school, it's very well known." http://www.newsday.com/news/health/ny-skcove2112676253apr20,0,7219223.story?track=rss ----------------------------------------------- http://www.cantonrep.com/lifestyle/advice/x1092980194/Family-Doctor-Orthopedic-massage-may-help- frozen-shoulder Family Doctor: Orthopedic massage may help frozen shoulder -------------------------------------------------------------------------------- By Peter Gott, M.D. United Media Posted Apr 25, 2009 @ 12:00 PM -------------------------------------------------------------------------------- Q: With regard to your column about “frozen shoulders,” I would like to recommend an alternative treatment, orthopedic massage. My 49-year-old husband had a frozen shoulder for 24 years. His right shoulder would go no further than 90 degrees laterally from his body. Ten months ago, he volunteered to be a “demo” for my massage class, and his frozen shoulder was completely cured in less than 15 minutes, no cutting, no drugs, no anesthesia and no pain. The instructor said that it sometimes takes two sessions. My husband did follow-up self-care exercises for about a month, but hasn’t done any since and still has full range of motion. My 82-year-old mother-in-law has also benefited from orthopedic massage. She had chronic pain (to the point of tears) despite taking Ultracet twice a day. She could only walk short distances with a walker. She received orthopedic massage once a week from my instructor and three times a week from me, and, in a couple of weeks, her pain was tolerable. Within a few months, she was off all pain medication and no longer needed a walker. It has been eight months, and she still receives massage three times a week, but she’s happy to be off the pills and able to enjoy life again. I have been a registered nurse for 28 years and was a director of nursing at a long-term-care facility for five years. I now work for a health-insurance company. I originally took the 600-hour massage-therapy training class as a fun bonding experience with my youngest daughter, who wanted to be a massage therapist. To be an orthopedic massage therapist, you must undergo special training. What was supposed to be just a bonding experience has turned into something else. I never knew that so many people who have pain issues could be helped with this simple therapy. Please let your readers about this amazing therapy. A: You have provided two positive cases for this therapy. However, as I am sure you already know, there are several instances where this therapy can cause more damage than good. While many orthopedic conditions, such as muscle or ligament strain, can be treated successfully with massage, there are instances where more serious conditions can mimic the benign symptoms. Heart attack and stroke can cause muscle pain in some sufferers, so it is vital that the therapist be trained to tell the difference. Certain cancers can also be caused to spread by massage therapy. It is also vital to have a properly trained masseuse, because improper technique can lead to problems such as lymphedema. In this condition, the lymph fluid accumulates in the extremities (usually the legs). Lymph fluid flows through the body similarly to blood. If damage is done to a blood vessel, bleeding, bruising and more can occur. With the lymphatic system, the fluid often backs up and accumulates in the tissues leading to swelling, pain and more. I believe this is an appropriate option for people who have persistent pain due to muscular or joint problems. I urge anyone interested in pursuing this avenue of treatment to speak first with his or her physician to discuss whether this is a viable option for the specific condition to be treated. If it is, then it’s time to do homework. In order to get the best treatment, pick an orthopedic massage therapist who has documentation of certification, noting where and how long they trained. Also, if possible, ask for references and speak to past or present clients. --------------------------------------- http://professional.cancerconsultants.com/oncology_main_news.aspx?id=43432 Sentinel Axillary Node Biopsy: Results of a Randomized Trial Reported Researchers from Italy have reported the results of a randomized trial that confirms that sentinel lymph node biopsy with axillary lymph node dissection performed only for women with a positive biopsy does not compromise outcome in women with localized breast cancer. The details of this study appeared in an early online publication in the Annals of Oncology on January 27, 2009.[1] Axillary lymph node dissection is the traditional method for staging women with clinically localized breast cancer. Unfortunately, the removal of axillary lymph nodes (approximately 25 nodes) is associated with chronic side effects, including pain, infection, limited shoulder motion, numbness, and lymphedema. Because these complications can become debilitating, sentinel lymph node biopsy has emerged as an alternative method of staging and is currently being used in most medical centers treating breast cancer. When performed appropriately, there is a 95% correlation between the results of sentinel node biopsy and lymph node dissection. There is also emerging evidence that women who have microscopic positive lymph nodes and receive adjuvant chemotherapy and/or adjuvant hormonal therapy may not benefit from removal of affected nodes. Although sentinel lymph node biopsy has become an accepted practice, there have been few randomized trials to confirm this approach to treating localized breast cancer. The Italian study began in 1998 and randomly allocated 115 women with localized breast cancer to have an axillary lymph node dissection and 110 to have a sentinel lymph node biopsy with an axillary lymph node dissection only if positive. A positive sentinel lymph node was found in 27 patients assigned to axillary lymph node dissection and 31 in the sentinel lymph node biopsy arm of the study. Overall accuracy of sentinel lymph node biopsy was 93%. At a median follow-up of 5.5 years, no axillary recurrences occurred in women undergoing sentinel lymph node biopsy. Overall and event-free survivals were not different between women undergoing sentinel lymph node biopsy and women undergoing primary axillary lymph node dissection. Comments: This is one of the few randomized trials with a long enough follow-up to confirm the relative effectiveness of sentinel lymph node biopsy in women with a clinically negative axillary lymph node status. One of the main unresolved issues is whether or not women with microscopic nodal disease receiving adjuvant therapy benefit from an axillary lymph node dissection. Reference: [1] Canavese G, Catturich A, Vecchio C, et al. Sentinal node biopsy compared with complete axillary dissection for staging of early breast cancer with clinically negative lymph nodes: results of a randomized trial. Annals of Oncology [early online publication]. 2009; January 27. ----------------------------------- DEAR STACY: Whatever became of actress Joanne Dru? — C.D., Kearny, NJ DEAR C.D.: Dru, best- known for such films as "She Wore a Yellow Ribbon" and "All the King's Men" died in 1996 at age 74, of lymphedema. She was survived by her son and two daughters from her marriage to Dick Haymes, and by her younger brother, former "Hollywood Squares" host Peter Marshall I also found only one further paragraph anywhere that explained anything else about the reference to lymphedema and her death, though I did find it on a couple of different sites : Biography: Joanne Dru (January 31, 1922 - September 10, 1996) was an American film actress. She also was the sister of actor Peter Marshall, best known for being the host of "Hollywood Squares." She died in Los Angeles, California at the age of 74 from lymphedema, a disease "which is especially common after surgery or radiation therapy were used in combination to treat cancer", which indicates that she probably had undergone these treatments for cancer (likely breast cancer) prior to her death. found at: http://www.mysticgames.com/famouspeople/JoanneDru.htm ---------------------------------- Massage Therapy works for cancer patients, too May 1, 2009 by Bill Eagle photo by Gloria Eagle It is always a pleasure to do stories about people who help others and Jeni Quiriconi makes a living being helpful. Jeni is a licensed massage therapist of over ten years. My wife and I visited Jeni. Her shop is located on 9th Ave in a quiet residential section of Longview; she calls her business “Heartsong Massage.” Jeni greeted us. She was slim and tall, and seemed to radiate energy. I asked Jeni how she became a Massage therapist. “I originally was in the Army Signal Corps,” sparkled Jeni. “I worked with mainframe computers. I was on active duty for 7 years. Thanks to the Army, I earned a BS in Business Administration at the University of Central Texas. At that time I thought I wanted to be a CPA. I even worked a while in Hawaii as an auditor.” Jeni smiled and looked intently at my wife and I. “Ever since I was a small child, I have always liked touching people…I could not keep my hands off of them. I used to give friends massages, and I seemed to be able to help people feel better. I started to think that it might fun for me to make a healthier, happier life change. I thought it might be the right time for me to consider becoming a massage therapist. I moved from Hawaii to Portland and enrolled in the East West College of the Healing Arts. I graduated in December of 1998.” I told Jeni that I heard that she worked with cancer patients. Jeni said: “About 10% of my customers are cancer patients. When I first graduated from school there used to be a prohibition against working with cancer patients.” I asked Jeni. “This prohibition no longer exits?” “That’s true,” replied Jeni. “Science has changed how we view cancers. We have found that massage increases circulation. Increased circulation does not cause cancer to spread. If it did, Lance Armstrong would have died a long time ago.” I nodded in agreement and Jeni continued. “Massage controls pain, controls stress, and replaces noxious stimulation messages that people can get from being treated for cancer. It gives compassionate touch and reduces the sense of isolation that cancer patients often face.” I asked Jeni if she works with the local hospital. Jeni replied: “I used to volunteer at “Our House of Portland” where I worked with AIDS patients. I did that almost immediately after I left school. I made a similar offer to our local hospital, but they seemed reluctant. They seemed to think that if they allowed me to volunteer, they would appear to be endorsing me and/or my business.” I raised my eyebrows. “Could it be that the medical establishment might be afraid of being accused of endorsing ‘Alternative Medicine?’” Jeni looked directly at me. “Alternative Medicine? We were around first.” The origins of massage go back to well before 3000 BC. According to Wikipedia: Writings on massage have been found in many ancient civilizations including Rome, Greece, India, Japan, China, Egypt and Mesopotamia. A biblical reference from C.493 BC documents daily massage with olive oil and myrrh as a part of the beauty regimen of the wives of Xerxes (Esther, 2:9-12). Hippocrates wrote in 460 BC that “The physician must be experienced in many things, but assuredly in massage.” Other writings seem to indicate that both India and China started practicing massage prior to 3000 BC. Tomb paintings in Egypt depict individuals being kneaded by others. Furthermore, Egyptians are credited with creating reflexology as early as 2500 BC. Jeni shares some patients with an acupuncturist and often receives referrals from medical doctors and chiropractors. Jeni will, at times, refer patients back to doctors. “I know where my skills end, and I know that I can’t help everyone.” Jeni is presently working with people who suffer from consequences from cancer therapy such as Lymphedema. Lymphedema is what happens when the transport system for lymph is disrupted by radiation treatment. Jeni has a webpage: “Healthcare that feels good.” http://www.heartsongmassage.biz/ According to her webpage: Jeni has worked with a wide range of clients and patients including infants and people with lupus, cancer, HIV AIDS, Alzheimer’s, and fibromyalgia. Jeni has much experience working with automobile collision injuries and is a Washington State Dept. of Labor and Industries health care provider. Heartsong Massage is also a preferred provider for Blue Cross, Aetna, the Uniform Medical Plan, American Specialty Health and other insurance companies. Jeni is licensed and certified by both the states of Oregon and Washington. As part of the certification process, she was required to pass both written and hands on tests. She is also required to complete 15 hours a year continuing education to maintain her certification. Jeni considers her profession a ‘calling’. She told us: “Massage has given my life a sense of purpose and meaning I never had. I am honored and privileged to be allowed to have such closeness with people. I can’t see anyone not having a massage. We even work on people who are dying, people who have just a few hours left. It is good to help people relax, and give them some comfort. People need a personal touch, a little bit of warmth…Our hands can become marvelous transmitters for loving kindness.” It is always a pleasure to write about people who help others and Jeni Quiriconi is that sort of person. If you are interested in reading more about Massage: Massage therapy foundation: www.massagetherapyfoundtion.org Searchable database National Society of Medicine: www.pubmed.gov America Massage Therapy Association: www.amtamassage.org/ http://www.valleybugler.com/2009/05/massage-therapy-works-for-cancer-patients-too/ ----------------------------------------------------------------- Let me tell you a little about a side effect called lymphedema Published: Sunday, May 10, 2009 By Ann DeMatteo News Let me tell you a little about a side effect called lymphedema Published: Sunday, May 10, 2009 1 comment(s) | Email to a friend | Print version | ShareThis| RSS Feeds By Ann DeMatteo I’ve been lucky, in this breast cancer battle, to have been educated about the side effects because of the women who’ve suffered before me. After I was diagnosed almost a year ago, my friend Mary Hayashida, who had breast cancer 20 years ago, warned me about something called lymphedema, swelling that occurs when you lift something too heavy or get an infection in the arm from which lymph nodes were dissected. I learned a little bit more about lymphedema from Quinnipiac University physical therapy doctoral candidate Ashley Glenn, who helps breast cancer patients keep lymphedema at bay through a gentle exercise program known as the Lebed Method. (Congratulations to Dr. Ashley, Miss Connecticut 2008, as she receives her well-deserved diploma today.) And, I also learned along the way that if one is obese and has lymph nodes removed as part of breast cancer treatment, the risk for lymphedema is higher. So, I automatically expected that the combination of my rotundity and continuing breast-cancer-related bad luck would bring it on. Almost immediately upon getting radiation — which thankfully was completed on Thursday — my underarm flab started to feel heavy, and the right side of NuBoob, where it meets the armpit, felt swollen. I mentioned this to my radiation technologists, Roseann Perito and Shalene Neeman (miss you guys already), and reported my suspicions to Dr. Joseph Cardinale and nurse Vanna Dest, who take care of me at the St. Raphael’s Father Michael J. McGivney Center for Cancer Care. Dr. Joe and Vanna agreed, and off I went to the Therapeia Lymphedema Center in Hamden for an evaluation. Owner Linda M. Hodgkins measured my right arm versus my left arm and determined that I was in the early stages of lymphedema. So, after the compression sleeve and glove Linda ordered for me arrived, I started my wonderful week of water withdrawal with occupational therapist Janice Catrone. Janice, Linda and Kelly Hochstetler are certified lymphedema therapists through the Lymphology Association of North America. They believe that the treatment they give is part of wellness and recovery for cancer patients, and they are proud of the relaxed, spa-like, family atmosphere they provide. Let’s back up a bit. What is lymphedema? The lymphatic system is made up of a network of vessels that remove fluid, protein and waste from the body. When these vessels or the lymph nodes are removed or damaged, waste fluid begins to accumulate, causing swelling known as lymphedema. The condition usually occurs in the arms or legs but can show up anywhere. Besides occurring after radiation therapy or surgery, it can also occur after an injury, infection, or as a result of obesity or a genetic condition. It can occur soon after or many years after cancer surgery. The guesstimate is that 30 percent of women with breast cancer will have lymphedema in their lifetime because the lymph nodes that remain may not be sufficient to drain the fluid daily. The guesstimate is as high as 40 percent if the person gets radiation. So, if you’re feeling tightness, stiffness, heaviness, fullness or discomfort in your chest, upper back or armpit following surgery, then you probably need to get checked out for lymphedema. Linda and Janice had been occupational therapists at Gaylord Hospital who were treating outpatients, some for lymphedema. About 4½ years ago, Linda started her practice because she "wanted to follow the standard of care and create an environment unique from a hospital setting." Lymphedema treatment started in Europe in 1936 and came to America in 1985. Most Connecticut hospitals have trained lymphedema therapists and there are one or two other private practices in the state. I can attest that it works. In the week that I was treated by Janice, I lost fluid in my arm and chest, and now have to wear a compression sleeve and glove daily so that the fluid doesn’t build up. The therapy included gentle skin stretching along the neck, breast area and abdomen, and Janice gave me a daily at-home guide to follow. It was also fun to get to know Janice, a cheerful, caring therapist. And, she now knows more about me than any human would want to. But, as she says, everyone who crosses the threshold at 3074 Whitney Ave., is family. And, you get a free cup of coffee on the way out. What can be better? ‰On another note, I wanted to say happy Mother’s Day to all and to mention a fundraiser and two health- related items. ‰The CUREChief Foundation will be holding a fundraiser at 7 p.m. Saturday at the High Lane Club in North Haven. For more information, call (866) 868-2873 or e-mail founder Sandy Centorino at sandy@curechief.org. ‰The Jewish Community Center of Greater New Haven wants to start a 10-week fitness plan for breast cancer survivors. Group classes will be tailored for different surgeries and fitness levels. "The Pink Program" is the only breast cancer recovery program approved by the American Council on Exercise. For details, call Susan Donovan at (203) 387-2522, ext. 265. ‰"Are Your ‘Fat’ Pants Too Tight?" is the name of a June 9 program presented by my friends at the New Haven Hair and Skin Studio in North Haven. It will benefit the Get in Touch program and will be an informative and interactive presentation about health and nutrition with the Transitions Lifestyle System. It will be hosted by Kristin Huffman, a former Miss Ohio and runner-up to Miss America and Broadway performer, and Nutraceutical consultant Andrew Reimann. More info? Call (203) 776-6447. Ann DeMatteo can be reached at (203) 789-5716. http://nhregister.com/articles/2009/05/10/news/doc4a04dea1d0c86019264220.txt --------------------------------------- MEDICALLY SPEAKING: Lymphedema clinic helps patients cope with cancer treatment side effect By Dr. Anthony Jennings Tuesday, May 12, 2009 3:14 AM CDT You know that your lymph nodes swell when you get an infection, but do you know that they're just part of the lymph system, which is responsible for moving excess fluid and proteins from the tissues to the bloodstream? Usually the lymph system functions well, but it's not infallible. When the lymph system is damaged or blocked, fluid builds up and results in swelling. This is called lymphedema. One of the most common triggers for lymphedema is cancer treatment, and as much as 30 percent of breast cancer patients develop lymphedema of the arm and hand. "Radiation treatments or scar tissue due to surgery can disrupt the lymph system," says Melissa Thess, PT, a lymphedema therapist. Thess works in the new Lymphedema Clinic, developed by SSM Rehab, in the SSM Cancer Care building on the campus of SSM St. Joseph Hospital West. While cancer treatment is one of the main culprits causing lymphedema, it may also occur in the legs if an individual has poor vascular flow because of diabetes, smoking, obesity or genetics. Thess uses a combination of approaches, customized for each patient, to help control lymphedema. "Lymphedema can't be cured, but it can be managed," she says. Thess' tools include exercises, manual lymphatic drainage (a type of massage therapy), range of motion and strength training, and pain management. She also educates patients about how to care for their skin in affected areas, which is important for avoiding infections, and advises them on the use of compression garments or bandages to prevent further fluid buildup. "Lymphedema can cause patients to experience trouble moving their joints, difficulty wearing regular clothing, and uncomfortable sensations of skin tightness, itching or burning that can disrupt sleep," she says. "But by using one or more therapeutic approaches, we can minimize and control the symptoms, which is very important for helping people achieve the best quality of life possible." A report presented at the American Association of Plastic Surgeons annual meeting this month identifies a new microsurgery procedure that can "reduce the fluid buildup in women with lymphedema by 25 percent to 39 percent in a year." The procedure reroutes lymph fluid to open vessels, enabling it to drain. If the procedure continues to show positive results, it could become another type of standard treatment. However, the best approach is prevention, and Thess also works to help cancer patients avoid lymphedema in the first place. Preventive measures include protecting the limb from any type of injury or trauma, avoiding strenuous activity while recovering from surgery or radiation therapy, avoiding heat and tight clothing, and elevating the limb. If you or someone you know has lymphedema and would like to schedule a consultation with Thess at the Lymphedema Clinic, call 636-695-2070 or 636-498-7474. Help is available to ensure you return to health and well-being as soon as possible. Dr. Anthony Jennings is director of the Department of Emergency Medicine at SSM St. Joseph Hospital West in Lake Saint Louis. He is board-certified in emergency medicine and is a fellow of the American College of Emergency Physicians and is president-elect of the American College of Osteopathic Emergency Physicians. http://suburbanjournals.stltoday.com/articles/2009/05/16/stcharles/news//0513stc-jennings0.txt ------------------------ The sky's the limit for Superior teen fighting debilitating disease Wed, 05/06/2009 - 9:10pmCommunity Health Twin Ports By Nicolette Helling, FOX 21 News SUPERIOR - Nearing the end of her freshman year at Superior High School, Meagan Barnard was ready to conquer the world. But one year was all she would get before her ideas about a normal high school experience were turned upside down. "When I was thinking about my high school years I was thinking about, you know, prom queen, homecoming queen," said Meagan. Meagan woke up one morning with swelling in her right leg. It was gone the next day, but then came back. It kept coming back until it stayed and Meagan spent the next five months seeing doctors. She was finally diagnosed with lymphedema in December of her sophomore year. "When they told me, the Mayo Clinic told me, that it was not going away, that was when everything actually came clear to me that I was going to live with this for the rest of my life," said Meagan. Her diagnoses means the lymph nodes in her right leg cannot drain fluid adequately. Fluid goes in, but it doesn't come out. The devastating realization that her illness was chronic and incurable brought Meagan to a new low. "My personality definitely changed from it. Everything about me changed," said Meagan. Meagan says she used to be critical of other students wearing sweatpants to school, but now that her leg was swollen, regular pants caused her pain. "To stay away from the pain it was either, look nice and have pain, or just be underdressed and not have to worry about my leg so much," said Meagan. Dressed in clothes she hated, Meagan went to school everyday feeling different. Family members say she never wanted to talk about her disease. "We didn't realize how sensitive she was to it," said Meagan's sister Kaitlyn Barnard. "So it was hard for everybody." As the months passed, Meagan continued to change. She stopped playing basketball because the running caused her leg to swell. She stopped dancing and twirling baton because the costumes revealed her leg. She even stopped hanging out with friends as much as she used to. "I just kinda felt like, at 15 years old my life was over," said Meagan. As her painful junior year faded into summer and summer into fall, Meagan began preparing for her senior year. Most teenage girls enjoy shopping for back to school clothes, but Meagan was constantly reminded of her condition in every store. "I've never been able to go and look for pants or look for bottoms," Meagan said. "I always buy tons of shirts but I have nothing to wear them with." Beyond frustrated, Meagan stayed up late that night searching the internet for clothes that would fit her. At midnight, Meagan found a website that caught her attention. She read about a company that made clothes for people with broken bones, amputees and for people with lymphedema. But as Meagan continued searching The Cast Clothing Company's website, her heart sank when she noticed there were no clothes for young women. She wrote the company's president and the response she received changed her life. Mike Harding is the president and founder of The Cast Clothing Company in Palm Springs, Florida. When he read Meagan's late-night plea for help, he knew he had to act. "It was all about giving her something that she can feel good about," said Harding. "It was about taking away the self-consciousness that she's went her whole high school career with and giving back the dignity that's important to all of us. We all take clothing for granted. We don't have anything wrong so we take it for granted. Well these people, they need it." Harding asked Meagan what she liked and what she wanted to wear. A few weeks later, she received a pair of custom-made jeans. "They're exactly what I like to wear," said Meagan. "And you can't even notice that I'm wearing cast clothing. So, it's amazing." Meagan was in jeans heaven. "I wanted it to look as much like everybody else is wearing as possible. I didn't want the focus to go to my leg," said Meagan. "When they sent me my first pair of jeans it kinda like made me realize that I can overcome things." A year later, Meagan's life is completely different thanks to that first pair of jeans. "It made me think, well maybe I can do sports again, maybe I can do everything else that I've let go of," said Meagan. "So they kinda gave me that little bit of courage to try harder and to work around things." Meagan started looking forward to the future, instead of being frightened by what her disease had in store for her. Meagan decided to start playing recreational basketball. Then, she started coaching younger dancers at the same studio where she used to dance. But one final hurdle sat in the way of Meagan's graduating and moving on: a senior project. With new found courage and optimism, Meagan decided she wanted to learn more about the disease that had changed her. Working with The Cast Clothing Company, Meagan decided to create a magazine that would provide the same kind of information she had needed so badly. "Right now in the media it's, fit in, look this way, be beautiful, and if you have an abnormality you definitely don't fit that description," said Meagan. "I think that's pretty much why I started it because I was like, I needed this, I needed this tool to help me." But after working on the magazine for five months, Meagan realized it wasn't enough. "Learning about all of the things that I'm going to have to face if there isn't a cure, scared me. So I was like, what if I threw a fundraiser?" The same young woman who had been stalled and side-tracked by lymphedema was now enthusiastic about finding a cure. At her fundraiser last month at Superior Middle School, Meagan, the girl who never wanted to talk about her condition, took the stage to tell others how far she had come. Her benefit for lymphedema was a success. "That night it just clicked, that people actually saw that this was going to help them," said Meagan. The disease that had caused her so much pain is now pushing Meagan to bring healing and hope to others. And in the process, Meagan is healing. "It made her realize that she can make a difference and that's made her feel like she has more of a place in this world," said Meagan's sister Kaitlyn. Meagan says the journey from freshman to senior year has taught her how to look for the positive in the most negative of situations. "I don't have cancer. I don't have something that's going to kill me," said Meagan. "I do have something that has no cure, I don't know how I got it or if it will ever go away, but it could be a lot worse. And so I like to try and think that way, and it makes my problem seem a lot smaller." By the age of 18, Meagan Barnard has learned that no problem is without an answer and no illness is without the possibility of healing. Meagan's fundraiser raised more than $3,000, but she continues to receive donations from people who have heard her story. She hopes to raise a total of five thousand dollars before writing a check to the Lymphadic Research Foundation. If you would like to help Meagan find a cure for lymphedema, email her at Meaganbarnard@ymail.com. -------------------- Moves combat lymphedema Lisa Newman • Special to The Clarion-Ledger • May 12, 2009 Side Tricep Extension with Lateral Leg Lifts ... Purpose: The Steel Magnolia series is designed to raise awareness for breast cancer while providing support and hope for those who have been diagnosed. It is believed that gradual progression of flexibility and resistance exercises can help survivors regain their normal range of shoulder and arm movement. Working out may help prevent lymphedema by pumping lymph fluid out of the arm through the undamaged lymph vessels. Plan: The sixth exercise of the Power and Perseverance combination in the Steel Magnolia fitness series is the alternating side tricep extension with lateral leg lifts. This exercise works the arm and shoulder, helping with lymphedema, and strengthens the hip/buttocks area. Start with your feet shoulder- width apart and dumbbells (1-5 pounds) in the hands. You can use an ankle weight (1-5 pounds) on each ankle for added resistance to better shape the buttocks and thigh muscles. Inhale to start, then exhale while lifting one leg out to the side in combination with extending the same arm or opposite arm for a counter balance. Inhale returning to start, then exhale to rest 3-5 seconds or repeat combination sequence 1-2 set of 10-15 repetitions. PERFIT Trainer's Tip: Try to stay upright through the core (torso and spine) with movement. Think tighten tricep and lift upward with the heel. Variations: Depending on tolerance, use no resistance to ensure that the arms/shoulders are ready and capable of the exercise range of motion. Progression with resistance should be gradual. POWER Points to Ponder: "Never, ever, ever, ever, ever, ever, ever give up!" Lisa Newman is a personal fitness trainer, exercise physiologist and owner of Perfit Inc. E-mail questions to perfitlisanewman@aol.com. http://www.clarionledger. com/article/20090512/HEALTH/905120322/1242/health/Moves+combat+lymphedema ---------------------- Team Tracks Nanotube Cancer Killers in Live Tissue CANCER, NANOTECHNOLOGY, LASERS, IN VIVO. Description Collaboration between scientists at medical school and nearby metropolitan campus in Arkansas detected, tracked and killed cancer cells in real time in living system with carbon nanotubes. Newswise — Nanotechnology scientists at two Arkansas research institutions have developed a method of detecting, tracking, and killing cancer cells in real time with carbon nanotubes. The discovery opens the prospect of a new, major front in the fight to eradicate cancer with promise for a new generation of cancer treatment beyond surgery, radiation, and chemotherapy. Dr. Alex Biris, University of Arkansas at Little Rock (UALR) chief scientist at the Nanotechnology Center and assistant professor of applied science in University's Donaghey College of Engineering and Information Technology, and Dr. Vladimir P. Zharov, professor and director of the Phillips Classic Laser and Nanomedicine Laboratories in the University of Arkansas for Medical Sciences (UAMS) Winthrop P. Rockefeller Cancer Institute, published their findings in the latest issue of the Journal of Biomedical Optics. “Until now, nobody has been able to fully understand and study in vivo and in real time how these nanoparticles travel through a living system,” Biris said. “By using Raman spectroscopy, we showed that it is possible not only to monitor and detect nanomaterials moving through the circulation, but also to detect single cancer cells tagged with carbon nanotubes. In this way, we can measure their clearance rate and their biodistribution kinetics through the lymph and blood systems.” Zharov emphasized that in vivo Raman flow cytometry is promising for the detection and identification of a broad spectrum of various nanoparticles with strong Raman scattering properties, such as cells, bacteria, and even viruses. “Before any clinical application of nanoparticles, it is imperative to determine their pharmacological profiles,” Zharov said. “And this tool will provide this function as a supplement or even an alternative to the existing methods.” In their research, Biris, Zharov, and UAMS colleague Ekaterina Galanzha, M.D., injected a single human cancer cell containing carbon nanotube material in the tail vein of a test rat. They were able to follow the circulation of the carbon nanotubes in the blood vessels to the rat’s ear, tracking the cell through the rat’s blood stream, lymphatic system, and tissue with a Raman spectrometer. In the same issue of the scientific journal, Biris and Zharov published a second paper discussing how nanoparticles can tag cancer cells. A laser then heats the nanoparticles, killing the cancer cell. “If we are able to target cancer cells using these nanomaterials, we can monitor where the cancer cells are specifically located, and then we can kill them,” Biris said. He said the live rat experiment shows how the cancer killing process leaves only a dead cell and nanoparticles that, within a matter of hours, disintegrate and die. Dr. Mary Good, dean of UALR’s Donaghey College of Engineering and Information Technology, said the medical and economic ramifications of the discovery are significant. “The research Dr. Biris and Dr. Zharov have conducted indeed is significant and promising,” said Good, former technology undersecretary of Commerce in the Clinton administration. “It points to a whole new direction for medical applications for nanoparticles. There still is extensive time needed for research into the ultimate utility for these approaches and for human subject experiments. But this early work is exciting and provides long-term hope for more effective cancer treatments.” Biris, 34, said the UALR Nanotechnology Center’s aim is to accelerate the development of commercial applications of nanotechnology and its potential to revolutionize medical advancements and the next generation of manufacturing of other products. “The close location of UALR with its cutting-edge analytical chemistry and nanotechnological tools, along with UAMS and its established biological and medical infrastructures, provides unique opportunities for comprehensive pre-clinical evaluation of nanotechnological products,” Zharov said. “That allows for us to accelerate Nanotechnology advances from bench to bedside, providing breakthroughs in early diagnosis, prevention and effective treatment of cancers, stroke, heart attack, infections, and neurological disorders which remain the leading cause of death in the U.S.” About the scientists Zharov obtained his Ph.D and DSc degrees at Moscow State Technical University and completed a postdoctoral fellowship at Lawrence National Laboratory of the University of California. He served as professor and chairman of the Biomedical Engineering Department at Moscow University. Since 2000, he is a professor and director of the Phillips Classic Laser and Nanomedicine Laboratories at the UAMS Winthrop P. Rockefeller Cancer Institute. Zharov has authored and co-authored five books, 40 patents, and published close to 200 papers. He is the principle investigator in 12 grants from the NIH, NSF, and DoD. He has unique interdisciplinary skills in physics, biology and medicine. Zharov’s research interests include the development and medical application of advanced laser, nanotechnology and imaging and he was the first recipient of the United States Maiman Award, named after the inventor of the first laser. His laboratories have pioneered laser-ultrasound microsurgery, phototherapy of post-mastectomy lymphedema, photoacoustic tweezers, multiplex imaging of cancer cells, laser-gene therapy, laser-based chemosensitivity and radiosensitivity tests, in vivo noninvasive photoacoustic cytometry and blood and lymph cancer tests. In particular, Zharov invented one of the first applications of nanotechnology for treating cancer and infections using laser-activated gold nanoparticles (U.S. Patent, 2000). Recently, he was awarded by the $1.5 million five-year grant from the National Cancer Institute supporting one of the first clinical application of nanomedicine technology for early cancer diagnosis. Biris earned his Ph.D. at UALR and joined the faculty in 2006. He and his team have filed 11 patent applications in nanotechnology, bio-nanotechnology, space exploration, and materials science areas. He is fully involved in studying the interaction of nanomaterials with biological systems and using use such novel nanostructures for targeting and killing cancer cells. He has more than 160 papers published in peer reviewed journals or presented at international conferences. He was part of the team that designed and developed a newly patented electrodynamic screen for space exploration in collaboration with NASA. Patent applications are pending on his new method and technology for producing large quantities of carbon nanotubes with high purity. He led the design and development of carbon nanostructures-based filters to efficiently remove bio-chemical contaminants from air and water. Biris also developed a unique tissue regeneration system that has been used successfully in 33 clinical studies to grow bone tissue. The work has been licensed to a spin-off company, Orlumet LLC, in which Biris serves as Chief Technical Officer.The co-founder is Peder Jensen. Biris is honorary president and co-founder of the Romanian Nanomedicine Institute in his native country. In addition to his groundbreaking research and work with graduate and undergraguate students, Biris works one-on-one with gifted middle- and high school students in Arkansas. He said the key to the Nanotechnology Center at UALR is its aggressive outreach program to train and educate young people and other world-class scientists who will serve and attract business and industry to Arkansas from the region and the nation. http://www.newswise.com/articles/view/552591/ ----------------------------- Breast Cancer Patients May be Spared Additional Surgery NorthShore University HealthSystem Researcher reports in the Journal of Clinical Oncology. The surgical community now has confirmed evidence to demonstrate there is no need for aggressive surgery if limited microscopic breast cancers are detected Evanston, IL (Vocus) May 20, 2009 -- A recent study in the Journal of Clinical Oncology, authored by David J. Winchester, FACS, M.D., Chief of General Surgery and Surgical Oncology, NorthShore University HealthSystem, concludes that women whose breast cancer has spread to the lymph nodes may not need a radical lymph node surgery. The observational study of more than 97,000 women whose breast cancer spread to the lymph nodes indicates that women with microscopic lymph node metastases detected on sentinel lymph node (SLN) biopsy, shared the same benefit and survival rate as those who underwent a SLN biopsy with a more invasive completion axillary lymph node dissection (ALND). The analysis was conducted using the National Cancer Database of the American College of Surgeons and was published in the Journal of Clinical Oncology, May 2009. Dr. Winchester, along with the other study authors, analyzed data from approximately 1,400 hospitals. The women whose breast cancer cases were analyzed underwent SLN biopsy for clinically node-negative breast cancer from 1998 to 2005 and were found to have nodal metastases. The authors report that some patients with lymph node metastases identified on sentinel node biopsy may not need to have the rest of their lymph nodes removed. "The surgical community now has confirmed evidence to demonstrate there is no need for aggressive surgery if limited microscopic breast cancers are detected," said Dr. Winchester. "Treating cancer is as much about improving quality of life for our patients as it is about long-term survival." We have relied upon that operation too much, and this paper points out we may not need to do it in terms of a survival difference or a regional recurrence difference, Winchester explained. This is an operation associated with significant morbidity. Among the morbidities linked to ALND are a lifetime risk of lymphedema, problematic cosmetic outcomes, longer recovery times and more postoperative pain than SLN biopsy alone. The National Cancer Data Base, which is a joint program supported by the American College of Surgeons Commission on Cancer and the American Cancer Society, is recognized as the largest clinical registry in the world. It is a nationwide oncology outcomes database for more than 1,460 Commission on Cancer accredited cancer programs in the United States and Puerto Rico, and captures approximately 70 percent of all new invasive cancers diagnosed annually. About NorthShore University HealthSystem Headquartered in Evanston, Ill., NorthShore University HealthSystem (NorthShore) is a comprehensive, fully integrated, healthcare delivery system that serves the greater North Shore and northern Illinois communities. The system includes four Hospitals - Evanston Hospital, Glenbrook Hospital, Highland Park Hospital and Skokie Hospital. In addition, the health system has more than 2,400 affiliated physicians, including a 600-physician, multispecialty physician group practice with over 70 office locations - NorthShore University HealthSystem Medical Group. Further, NorthShore is committed to excellence in its academic mission and supports teaching and research as the principal teaching affiliate for the University of Chicago Pritzker School of Medicine. The NorthShore University HealthSystem Research Institute focuses on clinical and translational research, including leadership in outcomes research and clinical trials. The NorthShore University HealthSystem Foundation is a leading philanthropic entity of NorthShore. It raises charitable contributions, engages volunteer friends and invests in community partnerships. NorthShore has annual revenues of $1.5 billion and a staff of more than 8,000. The HealthSystem has significant capabilities in a wide spectrum of clinical programs, including cancer, heart, orthopaedics, high- risk maternity and pediatrics. NorthShore is a national leader in the implementation of innovative technologies, including electronic medical records, (EMR ). In 2003, the HealthSystem was among the first in the country to successfully launch a systemwide EMR with demonstrable benefits in quality, safety, efficiency and service to patients. NorthShore has been recognized by multiple national organizations for this notable achievement. ### Trackback URL: http://www.prweb.com/pingpr. php/U3VtbS1GYWx1LUNvdXAtSGFsZi1IYWxmLUNvdXAtWmVybw== See the original story at: http://www.prweb.com/releases/2009/05/prweb2446044.htm ============================== BraveHearts Dragon Boat Team Courier-IslanderMay 27, 2009 The BraveHearts Dragon Boat Team was formed in 2006 under the North Island Dragon Boat Society, a registered non-profit Society. In the beginning, the team was little more than just an idea of the founding members, who were all Breast Cancer survivors. Traditionally, Dragon Boats have been embraced by women who have survived Breast Cancer, and what started in Vancouver as a medical experiment has become an international phenomenon and today, there are Breast Cancer teams all over the world. These founding members, having experienced the sport themselves, began to think that anyone who had experienced any type of cancer could benefit from the supportive and healthy lifestyle derived from these ancient Chinese boats, because the long term emotional and physical effects of any cancer can be the same. Dragon Boats were initially used as a medical research project on Lymphedema, a side effect on Breast Cancer survivors who had their lymph nodes removed. Besides reaffirming the obvious physical benefits, particularly in increasing upper body strength, researchers also found that the sport could provide a much needed positive attitude in these patients, get them to exercise, and certainly uplift their spirit. These are crucial elements in the treatment for these individuals and empowers them to face their illness with greater confidence. Most importantly, it provided them with a supportive and healthy environment. Since that initial study, research has confirmed that patients with other cancers can derive the same benefits as those Breast Cancer patients had realized. Thus, the idea became a reality as a few members became many as the word spread. The BraveHearts Dragon Boat Team would become Canada's first co-ed Dragon Boat team for survivors of ALL cancers! Together, the BraveHearts fundraised for their paddles, their life vests, and most importantly, their very own Dragon Boat, complete with the beautiful dragon head and tail and the scales along the boat in green, the chosen colour to represent themselves with. Soon, a custom trailer was added that could take them and their 48 foot, 800 pound vessel to a number of Dragon Boat festivals and racing events all over the west coast. The BraveHearts invite all cancer survivors to join them and experience this life changing and positive activity. This is one that just about anyone can do. There are no limits as to your age, gender, or physical strength. We are also now accepting applications from "supporter" Associate members who wish to participate with us while helping us to bring a kinder experience to cancer survivors. For membership or for more information about sponsoring our team please call Marianne at 287-2327 The BraveHearts are very grateful to the people and businesses in their community of Campbell River for having believed in their idea, and for their generosity in giving this team the means to make this idea a reality. We proudly display their business logos on our boat. We are immensely proud to represent our community at the events we participate in. Our hope is that other communities will follow our lead and form similar teams in their own towns. Most importantly, these cancer survivors are grateful for the means with which we can enrich our lives and prove to ourselves and to others that there can be LIFE after cancer. Together, we all can win the battle against cancer. As we say... "Paddles Up!" http://www.canada.com/BraveHearts+Dragon+Boat+Team/1633561/story.html ============================== http://www.stamfordplus.com/stm/information/nws1/publish/health/New-cancer-survivor-clinic-created-by- the-Connecticut-Challenge-and-St-Vincent-s-Medical-Center5084.shtml New cancer survivor clinic created by the Connecticut Challenge and St. Vincent’s Medical Center By St. Vincent’s Medical Center Chuck Mattes, St. Vincent’s Medical Center Foundation board member and capital campaign co-chair, and Bob Mazzone, executive director of the CT Connecticut Challenge discuss plans for the future cancer survivor clinic at St. Vincent’s Medical Center St. Vincent’s Medical Center of Bridgeport, Connecticut has formed a new partnership with the Connecticut Challenge of Fairfield. The partnership will result in the formation of a survivor clinic at the new Elizabeth M. Pfriem SWIM Center for Cancer Care due to open January 2010. The new survivor clinic will include wellness and fitness education, free lectures, nutritional counseling, psychosocial support, and complimentary spa therapies such as massage, yoga and reiki. St. Vincent’s has begun recruiting physicians who are interested in the needs of survivors. St. Vincent’s Medical Center Foundation Board Member and Co-chair of St. Vincent’s Capital Campaign, Chuck Mattes of Redding helped create the partnership. “It seemed only natural for these two organizations to partner together. In addition to providing cancer screening and education programs, St. Vincent’s SWIM Across the Sound’s mission is also to help cancer patients and their families both in the form of financial assistance while they are in treatment, and also in the form of support programs throughout both treatment and recovery. With the help of the Connecticut Challenge that commitment will continue long after they’ve completed treatment. Many survivors experience recurrences of cancer and this clinic will direct them to change behaviors and reduce their risks,” said Mattes. Founded by Jeffrey Keith, a cancer survivor of Fairfield, John Ragland of Westport and Matthew Vossler of Darien, the Connecticut Challenge is a non-competitive bike ride that raises money for cancer survivors. The relationship between Keith, Vossler and St. Vincent’s dates back to 1987 with St. Vincent’s first SWIM Across the Sound. Corporate Senior Vice President of St. Vincent’s Medical Center and President of the St. Vincent’s Medical Center Foundation Ronald J. Bianchi had worked closely with Jeff Keith in the early days of the SWIM Across the Sound. “It is very rewarding to be working with Jeff again and sharing a commitment to help cancer survivors in Connecticut. Both the SWIM and the Connecticut Challenge share a vision of helping those at risk and making a difference in their lives,” he said. “The Connecticut Challenge is honored to support St. Vincent’s. They have a vision for caring for cancer survivors that is unique and far-reaching,” said Keith. “Their exceptional work will improve the lives of cancer survivors and that is the mission of our organization. This will also mean a lot to our thousands of cyclists, volunteers and donors from the greater Bridgeport community. We are excited to move forward,” he added. There are an estimated 120,000 cancer survivors living in Connecticut today. Many of them will battle long- term medical problems as a result of their chemotherapy and radiation treatments, including lymphedema, heart disease, nerve damage, sexual dysfunction and early menopause in women. By screening for long-term health and psychosocial effects from the disease and treatments, the goal of the CT Challenge survivor clinic at St. Vincent’s will be to educate and empower survivors to optimize their health, quality of life and longevity. Connecticut is among the very few states with a comprehensive program dedicated to meeting the needs of cancer survivors. About St. Vincent’s Medical Center St. Vincent’s Medical Center in Bridgeport, CT is a 473-bed community teaching and referral hospital with a Level II trauma center and a 76-bed inpatient psychiatric facility in Westport. St. Vincent’s provides a full range of inpatient and outpatient services with regional centers of excellence in cardiology, surgery, cancer care, orthopedics, diagnostics, women’s and family services, behavioral health, senior health and an array of specialized services. St. Vincent’s Medical Center is a subsidiary of St. Vincent’s Health Services, which include St. Vincent’s Behavioral Health Services, Westport Campus, St. Vincent’s College, St. Vincent’s Special Needs Services, St. Vincent’s Medical Center Foundation and St. Vincent’s Immediate Health Care Centers. It is a member of Ascension Health, the nation's largest Catholic healthcare system. St. Vincent's is a teaching affiliate of the University of Connecticut’s School of Medicine and of New York Medical College. The Medical Center is also sponsor of SWIM Across the Sound, one of the nation’s largest hospital-based cancer prevention and patient support programs. For referral to a St. Vincent’s physician or about programs and services, call the toll-free Care Line at 1-877-255-SVHS (7847) About the Connecticut Challenge The Connecticut Challenge is a non-competitive bike ride based in Fairfield, CT that raises money for the cancer survivorship programs of the Connecticut Challenge, including survivorship clinics, research grants, symposiums and survivor education and awareness events. Riders of all ages and skill levels can register for a 12, 25, 50, 75 or 100-mile ride and raise funds from personal sponsors to support their efforts. The 2009 Connecticut Challenge will take place on Saturday, July 25th, starting and finishing in Fairfield, CT. To register to ride, volunteer or make a contribution to the 2009 event, please visit www.ctchallenge.org. ====================== Program offers camaraderie for breast cancer survivors May 20, 2009 - by Karen Longwell A program offering fellowship, fitness and education for women who have had breast cancer surgery came to Bracebridge this spring. A pilot of YWCA’s Encore program, the eight-week, specifically designed program of gentle land and water exercises for women who have had breast cancer surgery, ran at the sportsplex. The final class for this first session took place on May 12. Program facilitator Silvia Smith said the 12 women in the class are remarkable. “I just think they are very brave women who have to deal with the reality of a compromised health scenario. They wake up every day and realize that life is never going to be the same, but sometimes it can be better,” said Smith. “It (breast cancer) has really helped them focus on what is important.” The program is offered free of charge. It aims to improve upper body mobility and flexibility, boost self- esteem and help prevent or manage lymphedema. Lymphedema, which can occur after breast cancer surgery, is a condition of localized fluid retention caused by a compromised lymphatic system. The lymphatic system is often referred to as the body’s second circulatory system. Participants, some of whom were not comfortable giving their name, enjoyed hearing from informative guest speakers and learning exercises geared toward regaining mobility after surgery. In surgery, nerves and muscles are cut. Encore participant Marilyn said she lost the use of her right arm. “The exercises stretch the muscles and ligaments — everything that went to sleep (after surgery),” said Marilyn. Recovery is different for everyone, depending on the extent of the surgery, said Nancy, another participant. “The exercises have been helpful. They help us get back into shape,” said another participant. Smith teaches therapy pool classes at the sportsplex, but the exercises for breast cancer recovery are different. They focus on the lymphatic system. “This is a unique course because the lymphatic system is so different from the circulatory system,” said Smith. “The lymphatic moves a lot slower … so the exercises are much slower. It would be more like yoga or tai chi.” Participants also learned land-based exercises, which they can take home with them. Any woman who has had breast cancer surgery at any time in their lives can join an Encore program. Women in this first group in Bracebridge ranged from less than one year after diagnosis up to 30 years, said Smith. While the women enjoyed learning exercises and hearing from speakers every two or three weeks, they also learned a lot from each other. The camaraderie in the group was wonderful, said one participant. “We have learned that we are not alone,” said Marilyn. Smith found the women enjoyed swapping stories. “They love to share information,” said Smith. “Other people just don’t understand what they have gone through.” Encore facilitators Smith and Sarah Hill took training for the program in the fall. They are hoping to continue with more sessions. This session was partially funded through the Canadian Cancer Society and YWCA Muskoka, said Hannah Lin, youth programs facilitator for the YWCA. The program was held in partnership with the Town of Bracebridge. http://www.gravenhurstbanner.com/article/136355 --------------------------------- http://suburbanjournals.stltoday.com/articles/2009/05/20/stcharles/news//0513stc-jennings0.txt MEDICALLY SPEAKING: Lymphedema clinic helps patients cope with cancer treatment side effect By Dr. Anthony Jennings Tuesday, May 12, 2009 3:14 AM CDT You know that your lymph nodes swell when you get an infection, but do you know that they're just part of the lymph system, which is responsible for moving excess fluid and proteins from the tissues to the bloodstream? Usually the lymph system functions well, but it's not infallible. When the lymph system is damaged or blocked, fluid builds up and results in swelling. This is called lymphedema. One of the most common triggers for lymphedema is cancer treatment, and as much as 30 percent of breast cancer patients develop lymphedema of the arm and hand. "Radiation treatments or scar tissue due to surgery can disrupt the lymph system," says Melissa Thess, PT, a lymphedema therapist. Thess works in the new Lymphedema Clinic, developed by SSM Rehab, in the SSM Cancer Care building on the campus of SSM St. Joseph Hospital West. While cancer treatment is one of the main culprits causing lymphedema, it may also occur in the legs if an individual has poor vascular flow because of diabetes, smoking, obesity or genetics. Thess uses a combination of approaches, customized for each patient, to help control lymphedema. "Lymphedema can't be cured, but it can be managed," she says. Thess' tools include exercises, manual lymphatic drainage (a type of massage therapy), range of motion and strength training, and pain management. She also educates patients about how to care for their skin in affected areas, which is important for avoiding infections, and advises them on the use of compression garments or bandages to prevent further fluid buildup. "Lymphedema can cause patients to experience trouble moving their joints, difficulty wearing regular clothing, and uncomfortable sensations of skin tightness, itching or burning that can disrupt sleep," she says. "But by using one or more therapeutic approaches, we can minimize and control the symptoms, which is very important for helping people achieve the best quality of life possible." A report presented at the American Association of Plastic Surgeons annual meeting this month identifies a new microsurgery procedure that can "reduce the fluid buildup in women with lymphedema by 25 percent to 39 percent in a year." The procedure reroutes lymph fluid to open vessels, enabling it to drain. If the procedure continues to show positive results, it could become another type of standard treatment. However, the best approach is prevention, and Thess also works to help cancer patients avoid lymphedema in the first place. Preventive measures include protecting the limb from any type of injury or trauma, avoiding strenuous activity while recovering from surgery or radiation therapy, avoiding heat and tight clothing, and elevating the limb. If you or someone you know has lymphedema and would like to schedule a consultation with Thess at the Lymphedema Clinic, call 636-695-2070 or 636-498-7474. Help is available to ensure you return to health and well-being as soon as possible. Dr. Anthony Jennings is director of the Department of Emergency Medicine at SSM St. Joseph Hospital West in Lake Saint Louis. He is board-certified in emergency medicine and is a fellow of the American College of Emergency Physicians and is president-elect of the American College of Osteopathic Emergency Physicians. ------------------------------ http://www.ecancermedicalscience.com/news-insider-news.asp?itemId=580 Sentinel node biopsy is an effective option for early-stage cervical cancer Published: 31/05/2009 A prospective multicenter study conducted by researchers in France suggests that the majority of women with early-stage cervical cancer can safely undergo sentinel node (SN) biopsy – a technique in which only one to three lymph nodes are removed to determine whether cancer has spread – in lieu of the traditional, more invasive pelvic lymph node removal. This study, presented at the American Society of Clinical Oncology 2009 meeting, showed that SN biopsy was just as useful as full pelvic lymph node removal for identifying even small amounts of cancer cells that spread to lymph nodes in atypical areas of the pelvis. "Sentinel node biopsy is a good option for women with cervical cancer because it enables us to remove fewer lymph nodes to get information about cancer spread, and could decrease the risk of complications from surgery, such as lymphedema," said Dr. Fabrice Lecuru, professor at George Pompidou European Hospital in Paris, and the study’s lead author. "Previous studies have shown that sentinel node biopsy can be used to assess cancer spread in usual areas of the pelvis, but our findings add to this growing body of research by showing that this approach is also effective for identifying cancer spread in less common areas of the pelvis and the abdomen. This approach may become a new standard of care for early-stage cervical cancer." Ten to 15 per cent of patients with early-stage cervical cancer experience recurrence. Some are due to lymph nodes that were missed during surgery or because of undetected cancer spread to other lymph nodes. During standard surgery, several pelvic lymph nodes are removed and examined for the presence of cancer cells. During SN biopsy, however, a blue dye and radioactive substance that can be traced with imaging techniques are used to locate the first lymph node (the sentinel node) where cancer cells would travel after leaving the cervix. If this node is free of cancer cells, no other lymph nodes should be removed. Since the removal of lymph nodes may impair lymphatic drainage and cause uncomfortable swelling in the legs called lymphedema, doctors have been assessing SN biopsy (which is routinely used for breast cancer and melanoma patients) to see if it can be used to gauge cervical cancer spread. Prior studies have shown that SN biopsy can be used in cervical cancer patients to predict cancer spread to lymph nodes in the pelvis most likely to contain cancer cells. But in this study, Dr. Lecuru and his colleagues also evaluated the biopsy of sentinel nodes in atypical areas of the pelvis in 128 women with early-stage cervical cancer who also had full pelvic lymph node removal for comparison. They then analysed sentinel nodes for micrometastastic cancer (0.2 to 2 mm in size) and isolated tumour cells as well as areas of cancer greater than 2 mm (macrometastases). After analysing these nodes, researchers demonstrated that full pelvic lymph node removal and its associated complications could have been avoided in 81.2 per cent of women. Researchers also found that in nearly 40 per cent of women, SN biopsy alone would have provided additional, important information about patients’ disease; for example, SN biopsy was more useful than routine techniques for showing that lymphatic drainage occurred via unusual pathways to less commonly explored areas of the pelvis or of the abdomen, and for detecting micrometastases or isolated tumour cells. ---------------------- 1. Clin Exp Dermatol. 2009 May 18. [Epub ahead of print] Localized bilateral lymphoedema of the ear lobes secondary to mesothelioma. Gudi V, Chan SK, Laroche C, Ford HE, Darrah R, Love K. Department of Dermatology, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk, IP33 2QZ, UK. PMID: 19456781 [PubMed - as supplied by publisher] ================ 2. Int J STD AIDS. 2009 Jun;20(6):437-9. Vulval lymphoedema following pulmonary tuberculosis. Talwar A, Puri N, Sandhu HP. Department of Surgery & Dermatology, GGS Medical College & Hospital, Faridkot 151203, Punjab, India. Acquired lymphoedema of the vulva is induced by impaired lymph flow. We present the case of a 35-year- old woman having lymphoedema of the vulva following pulmonary tuberculosis, which she had developed four years back for which she had taken a full course of antitubercular treatment for nine months from the Chest and Tuberculosis department. The biopsy taken from the perianal swellings showed hyperkeratosis and acanthosis with multiple dilated lymph specs. PMID: 19451336 [PubMed - in process] ====================== 3. Dermatol Online J. 2009 Apr 15;15(4):13. Lympangiectasia of the vulva accompanying congenital lymphedema. Okur MI, Köse R, Yildirim AM, Cobanoglu B. Lymphangiectasia is a benign condition with multiple dilated lymph vessels in the dermis. Vulvar localization is rare and mostly depends on disturbing the lymphatic flow. We present a patient with vulvar lesions and ipsilateral congenital lower extremity lymphedema. Surgical excision eliminated the lymphangiectasia and improved the appearance of the edematous vulva. Publication Types: Letter PMID: 19450406 [PubMed - in process] ============================ 4. Circ Res. 2009 May 14. [Epub ahead of print] Activated Forms of VEGF-C and VEGF-D Provide Improved Vascular Function in Skeletal Muscle. Anisimov A, Alitalo A, Korpisalo P, Soronen J, Kaijalainen S, Leppänen VM, Jeltsch M, Ylä-Herttuala S, Alitalo K. Molecular/Cancer Biology Laboratory, Biomedicum Helsinki, Department of Pathology, Haartman Institute and Helsinki University Central Hospital, University of Helsinki, Finland; and Department of Biotechnology and Molecular Medicine, A. I. Virtanen Institute for Molecular Sciences, University of Kuopio, Finland. The therapeutic potential of vascular endothelial growth factor (VEGF)-C and VEGF-D in skeletal muscle has been of considerable interest as these factors have both angiogenic and lymphangiogenic activities. Previous studies have mainly used adenoviral gene delivery for short-term expression of VEGF-C and VEGF-D in pig, rabbit, and mouse skeletal muscles. Here we have used the activated mature forms of VEGF-C and VEGF-D expressed via recombinant adeno-associated virus (rAAV), which provides stable, long-lasting transgene expression in various tissues including skeletal muscle. Mouse tibialis anterior muscle was transduced with rAAV encoding human or mouse VEGF-C or VEGF-D. Two weeks later, immunohistochemical analysis showed increased numbers of both blood and lymph vessels, and Doppler ultrasound analysis indicated increased blood vessel perfusion. The lymphatic vessels further increased at the 4-week time point were functional, as shown by FITC-lectin uptake and transport. Furthermore, receptor activation and arteriogenic activity were increased by an alanine substitution mutant of human VEGF-C (C137A) having an increased dimer stability and by a chimeric CAC growth factor that contained the VEGF receptor-binding domain flanked by VEGF-C propeptides, but only the latter promoted significantly more blood vessel perfusion when compared to the other growth factors studied. We conclude that long-term expression of VEGF-C and VEGF-D in skeletal muscle results in the generation of new functional blood and lymphatic vessels. The therapeutic value of intramuscular lymph vessels in draining tissue edema and lymphedema can now be evaluated using this model system. PMID: 19443835 [PubMed - as supplied by publisher] ========================= 5. Indian J Dermatol Venereol Leprol. 2009 May-Jun;75(3):290-2. Kaposi's sarcoma in an HIV-positive person successfully treated with paclitaxel. Dongre A, Montaldo C. Medicines sans Frontieres Belgique, HIV/AIDS Khar Clinic, Mumbai, India. atul507@yahoo.co.in Epidemic Kaposi's sarcoma is one of the malignant neoplasms, which can develop in HIV-infected patients. Although the prevalence of HIV infection is reported to be high in Asian countries, Kaposi's sarcoma is rarely reported. We report a case of Kaposi's sarcoma involving the skin and oral mucosa along with extensive bilateral lymphedema of lower extremities, treated successfully with paclitaxel and antiretrovirals. PMID: 19439884 [PubMed - in process] ============================== 6. J Pak Med Assoc. 2009 May;59(5):282-7. Post mastectomy adjuvant radiotherapy in breast cancer: a comparision of three hypofractionated protocols. Shahid A, Athar MA, Asghar S, Zubairi T, Murad S, Yunas N. Institute of Nuclear Medicine & Oncology (INMOL), Wahdat Road, Lahore, Pakistan. OBJECTIVES: To compare three hypofractionated protocols in postmastectomy cancinoma breast in terms of local control, toxicity and work load. METHODS: A total of three hundred patients suffering from cancer breast stage T2-4, N any were randomized into three arms after mastectomy. All the patients were treated with four fields on Co60 i.e. two tangential portals for chest wall, one anterior supraclavicular and axillary field and a posterior axillary boost and were randomized into three arms i.e. 2700 CGy in 5 fractions (one week) arm A, 3500 CGy in 10 fractions (2 weeks) arm B and 4000 CGy in 15 fractions (3 weeks) arm C. Skin, cardiac, pulmonary and haematological toxicities and lymphoedema were compared in addition to local control and work load. RESULTS: The locoregional relapses were 11%, 12% and 10% in arms A, B and C respectively. 26%, 24% and 28% patients developed metastatic disease and 17%, 18% and 20% died in the three arms. G3 and G4 skin toxicities were 37%, 28% and 14%. G2 and G3 lymphedoema was 21%, 22% and 27%. Cardiac toxicity was 5%, 6% and 5% while pulmonary toxicity was 4%, 5% and 5% respectively. All the differences except skin toxicity were statistically insignificant. There were no cases of haematological depression or rib fractures. CONCLUSION: All the three short protocols were equally effective in locoregional disease control and toxicity was also comparable. They were helpful in reducing the work load and can be safely recommended for routine clinical use. PMID: 19438129 [PubMed - in process] ============================= 7. Zhong Xi Yi Jie He Xue Bao. 2009 May;7(5):418-21. [Relationship between ultrasound imaging and traditional Chinese medicine syndrome in limb lymphedema.] [Article in Chinese] Liu M, Zhang Y, Song FC, Cheng ZX. Department of Peripheral Vascular Surgery, Affiliated Hospital, Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China; E-mail: liuming404@sina.com. Objective: To study the correlation between traditional Chinese medicine (TCM) syndrome type and the ultrasound imaging changes in patients with limb lymphedema, and to provide evidence for TCM syndrome differentiation. Methods: Syndrome typing was done and ultrasonography was performed in 107 patients with limb lymphedema. The thickenings of derma, hypodermis and deep-fascia were measured. The ultrasound echo intensity and the morphology of the hypodermis were classified into five degrees according to the ultrasonogram. The ultrasound indexes in the limb lymphedema patients with different syndromes were compared, and the relationship between TCM syndromes and the ultrasound indexes was analyzed. Results: There were specific ultrasound image features in different TCM syndromes of limb lymphedema. The thickenings of derma, hypodermis and deep-fascia in the limb lymphedema patients with downward migration of damp-heat or phlegm stagnation and blood stasis were more significant than those in the patients with collateral obstruction due to cold-dampness (P<0.05, P<0.01). The thickenings of derma and hypodermis in the patients with phlegm stagnation and blood stasis were obviously more severe than those in the patients with downward migration of damp-heat (P<0.01). The maximum and minimum ultrasound echo intensities of hypodermis were in phlegm stagnation and blood stasis and downward migration of damp-heat respectively (P<0.05), and there was a significant difference in the hypodermal morphology among the three syndrome types (P<0.05). The most obvious structure disturbance was observed in the patients with phlegm stagnation and blood stasis syndrome. Conclusion: TCM syndrome type of limb lymphedema is related to ultrasound image changes. The imaging data can be regarded as new objective indexes for TCM syndrome defferentiation, and it has an important value for diagnosis and treatment of limb lymphedema. Publication Types: English Abstract PMID: 19435554 [PubMed - in process] ================================ 8. Aesthetic Plast Surg. 2009 May 12. [Epub ahead of print] Suction-Assisted Lipectomy for Treatment of Lower-Extremity Lymphedema. Eryilmaz T, Kaya B, Ozmen S, Kandal S. Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University School of Medicine, Ankara, Turkey, mdtolgaer@yahoo.com. Lymphedema typically occurs on the extremities and affects millions of people throughout the world. Although currently there is no single treatment proven effective for lymphedema in every patient, suction- assisted lipectomy has been shown to be effective in some patients. Suction-assisted lipectomy offers patients with lower-extremity lymphedema a less invasive, less morbid surgical option compared with traditional excisional techniques. In this article we present a case of lymphedema reduction with suction- assisted lipectomy in a patient with bilateral lower-extremity lymphedema. PMID: 19434444 [PubMed - as supplied by publisher] ==================================== 9. Ann Diagn Pathol. 2009 Jun;13(3):147-50. Epub 2009 Apr 1. Angiosarcoma of the breast: a clinicopathologic analysis of cases from the last 10 years. Wang XY, Jakowski J, Tawfik OW, Thomas PA, Fan F. Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA. Breast angiosarcoma may occur de novo, or as a complication of radiation therapy, or chronic lymphedema secondary to axillary lymph node dissection for mammary carcinoma. In our effort to characterize the clinicopathologic features of breast angiosarcoma, we reviewed all breast angiosarcoma cases in the University of Kansas Medical Center and Ohio State University Medical Center archives from 1997 to 2007. Clinical histories and follow-up data for identified patients were reviewed. The tumors were graded histologically according to Rosen's method. Only 11 angiosarcomas were identified among more than 5000 malignant breast neoplasms (0.1%-0.2% incidence) for the last 10 years. Eight cases (6 high grade, 1 intermediate grade, 1 low grade) were identified as postradiation angiosarcoma (postradiation time interval, 4-12 years), and 3 cases were identified as primary angiosarcomas (1 high grade, 2 low grade). Follow-up (median, 36 months) revealed that 3 cases of postradiation angiosarcoma recurred as skin and/or chest wall lesions and 1 case of primary angiosarcoma developed liver metastases (all high-grade). In conclusion, breast angiosarcoma remains a rare disease. Rosen's method for grading breast angiosarcoma is easy to implement and correlates well with clinical outcome. There are no distinct clinical or histologic differences between primary and postradiation breast angiosarcomas. PMID: 19433291 [PubMed - in process] ============================================ 10. Int J Palliat Nurs. 2009 Apr;15(4):162, 164, 166-9. Understanding the management of lymphoedema for patients with advanced disease. Honnor A. Loros Hospice, Leicester, England. AmandaHonnor@loros.co.uk The problems associated with lymphoedema can be devastating, particularly for patients with lymphoedema and advanced disease. All lymphoedema treatment is palliative in nature as the underlying condition is incurable; however, much can be done to relieve the symptoms associated with the oedema. It is important to remember that the burden of treatment on the patient should not exceed the benefit gained and, therefore, treatment may have to be adapted and modified to suit patients individual needs. This article describes the classification, aetiology and nursing management of lymphoedema with an emphasis on the management of lymphoedema in the patient with advanced disease. PMID: 19430411 [PubMed - in process] ================================== 11. Hum Mol Genet. 2009 May 9. [Epub ahead of print] Vascular defects in a mouse model of hypotrichosis-lymphedema-telangiectasia syndrome indicate a role for SOX18 in blood vessel maturation. Downes M, François M, Ferguson C, Parton RG, Koopman P. Institute for Molecular Bioscience, Brisbane, QLD 4072, Australia. Mutations in the transcription factor gene SOX18 cause vascular, lymphatic and hair follicle defects in humans with dominant and recessive forms of hypotrichosis-lymphedema-telangiectasia (HLT) syndrome. Here, we clarify the role of SOX18 in the vascular dysfunction in HLT by ultrastructural, immunofluorescence, molecular and functional analysis of vascular anomalies in embryos of the naturally occurring Sox18-mutant mouse strain ragged-opossum (Ra(Op)). Early genesis and patterning of vasculature was unimpaired in Ra(Op) embryos, but surface capillaries became enlarged from 12.5 dpc and embryos developed massive surface haemorrhage by 14.5 dpc. Large focal breaches in the endothelial barrier were observed, in addition to endothelial hyperplasia associated with impaired pericyte recruitment to the microvasculature. Expression of the genes encoding the endothelial factors MMP7, IL7R and N- cadherin was reduced in Ra(Op) embryos, suggesting these are downstream targets of SOX18. Together our results indicate that vascular anomalies in HLT arise from defects in regulation of genes required for the acquisition of structural integrity during microvascular maturation. PMID: 19429912 [PubMed - as supplied by publisher] =================================== 11. Hum Mol Genet. 2009 May 9. [Epub ahead of print] Related Articles, Links Vascular defects in a mouse model of hypotrichosis-lymphedema-telangiectasia syndrome indicate a role for SOX18 in blood vessel maturation. Downes M, François M, Ferguson C, Parton RG, Koopman P. Institute for Molecular Bioscience, Brisbane, QLD 4072, Australia. Mutations in the transcription factor gene SOX18 cause vascular, lymphatic and hair follicle defects in humans with dominant and recessive forms of hypotrichosis-lymphedema-telangiectasia (HLT) syndrome. Here, we clarify the role of SOX18 in the vascular dysfunction in HLT by ultrastructural, immunofluorescence, molecular and functional analysis of vascular anomalies in embryos of the naturally occurring Sox18-mutant mouse strain ragged-opossum (Ra(Op)). Early genesis and patterning of vasculature was unimpaired in Ra(Op) embryos, but surface capillaries became enlarged from 12.5 dpc and embryos developed massive surface haemorrhage by 14.5 dpc. Large focal breaches in the endothelial barrier were observed, in addition to endothelial hyperplasia associated with impaired pericyte recruitment to the microvasculature. Expression of the genes encoding the endothelial factors MMP7, IL7R and N- cadherin was reduced in Ra(Op) embryos, suggesting these are downstream targets of SOX18. Together our results indicate that vascular anomalies in HLT arise from defects in regulation of genes required for the acquisition of structural integrity during microvascular maturation. PMID: 19429912 [PubMed - as supplied by publisher] =========================== 12. Int J Radiat Oncol Biol Phys. 2009 May 8. [Epub ahead of print] Related Articles, Links Time Course of Mild Arm Lymphedema After Breast Conservation Treatment for Early-Stage Breast Cancer. Bar Ad V, Cheville A, Solin LJ, Dutta P, Both S, Harris EE. Departmentof Radiation Oncology, University of Pennsylvania, Philadelphia, PA. PURPOSE: Arm lymphedema is a potential consequence of the treatment for breast carcinoma. The objective of this retrospective study was to characterize the progression of mild arm lymphedema after breast conservation treatment for breast cancer. METHODS AND MATERIALS: The study cohort was drawn from 1,713 consecutive Stage I or II breast cancer patients who underwent breast conservation therapy, including axillary staging followed by radiation. Arm lymphedema was documented in 266 (16%) of 1,713 patients. One hundred nine patients, 6% of the overall group and 40% of the patients with arm lymphedema, presented with mild arm lymphedema, defined as a difference of 2 cm or less between the measured circumferences of the affected and unaffected arms. RESULTS: Among the 109 patients with mild arm lymphedema at the time of arm lymphedema diagnosis, the rate of freedom from progression to more severe lymphedema was 79% at 1 year, 66% at 3 years, and 52% at 5 years. The patients who were morbidly obese, had positive axillary lymph nodes, or received supraclavicular irradiation at the time of breast cancer treatment were at higher risk of progression from mild arm lymphedema to more severe edema. CONCLUSIONS: Mild arm lymphedema, generally considered to be a minor complication after breast conservation treatment for breast cancer, was associated with a risk of progression to a more severe grade of arm lymphedema in a substantial fraction of patients. PMID: 19427748 [PubMed - as supplied by publisher] ================================ 13. Int J Radiat Oncol Biol Phys. 2009 Jun 1;74(2):349-54. Related Articles, Links Extrapulmonary soft-tissue fibrosis resulting from hypofractionated stereotactic body radiotherapy for pulmonary nodular lesions. Kawase T, Takeda A, Kunieda E, Kokubo M, Kamikubo Y, Ishibashi R, Nagaoka T, Shigematsu N, Kubo A. Department of Radiology, Keio University School of Medicine, Tokyo, Japan. PURPOSE: To clarify the incidence, symptoms, and timing of extrapulmonary fibrosis developing after hypofractionated stereotactic body radiotherapy. PATIENTS AND METHODS: We analyzed 379 consecutive patients who underwent stereotactic body radiotherapy for lung tumors at four institutions between February 2001 and March 2007. The median follow-up time was 29 months (range, 1-72). We investigated the subjective and objective characteristics of the extrapulmonary masses, redelineated the origin tissue of each on the treatment planning computed tomography scan, and generated dose-volume histograms. RESULTS: In 9 patients (2.4%), extrapulmonary masses were found 3-36 months (median, 14) after irradiation. Coexisting swelling occurred in 3 patients, chest pain in 2, thumb numbness in 1, and arm edema in 1 patient. Extrapulmonary masses occurred in 5 (5.4%) of 92 and 4 (1.4%) of 287 patients irradiated with a 62.5-Gy and 48.0-Gy isocenter dose, respectively. The mean and maximal dose to the origin tissue was 25.8-53.9 Gy (median, 43.7) and 47.5-62.5 Gy (median, 50.2), respectively. In 5 of 9 patients, the standardized uptake values on 18F-fluorodeoxyglucose-positron emission tomography was 1.8- 2.8 (median, 2.2). Percutaneous needle biopsy was performed in 3 patients, and all the specimens showed benign fibrotic changes without malignant cells. CONCLUSION: All patients should be carefully followed after stereotactic body radiotherapy. The findings of any new lesion should prompt an assessment for radiation-induced extrapulmonary fibrosis before an immediate diagnosis of recurrence is made. Careful beam-shape modification and dose prescription near the thoracic outlet are required to prevent forearm neuropathy and lymphedema. Publication Types: Multicenter Study PMID: 19427551 [PubMed - indexed for MEDLINE] ===================================== 14 Gynecol Oncol. 2009 Jun;113(3):299-300. Related Articles, Links Comment on: Gynecol Oncol. 2009 Jun;113(3):301-5. Patient-reported outcomes in sentinel lymph node procedure versus inguinofemoral lymphadenectomy: what is the next step? Wenzel L. Publication Types: Comment Editorial PMID: 19426884 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- 14. J Helminthol. 2009 May 8:1-10. [Epub ahead of print] Related Articles, Links A cohort study on anti-filarial IgG4 and its assessment in good and uncertain MDA-compliant subjects in brugian filariasis endemic areas in southern Thailand. Jiraamonnimit C, Wongkamchai S, Boitano J, Nochot H, Loymek S, Chujun S, Yodmek S. Filaria Division, Ministry of Public Health, Nonthaburi Province, Thailand. The prevalence of Brugia malayi was surveyed in three highly endemic provinces in southern Thailand as part of an ongoing evaluation of the effectiveness of two rounds of mass drug administration (MDA). Prior to MDA IV, and thereafter every 6 months up to 18 months, including MDA V at 12 months, nocturnal blood sampling was assayed for microfilaria (mf) and IgG4 antibodies in 200 subjects from Nakorn Srithammarat and Surathani provinces. From an additional 300 subjects from Narathiwatt province, daytime blood was also examined for IgG4 antibodies for 1 year. Subjects who tested positive, with reciprocal IgG4 titres above 100, were dichotomized in the 'good compliant' or 'uncertain compliant' groups. Stool samples were examined for intestinal parasites from all 500 subjects simultaneously. Only two subjects (1%) tested positive for mf, while 98 subjects (19.6% of 500) tested positive for IgG4. In general, the good drug- compliant subjects were less likely to exhibit the IgG4 response than subjects in the uncertain compliant group. Only six subjects (1.2%) exhibited lymphoedema while 68 subjects (13.6%) had a total of 105 parasitic infections, with female instances of protozoan infections exceeding male instances of helminth infections. It was concluded that the two MDA rounds were highly successful in not only in reducing mf to negligible levels but also in lowering antifilarial IgG4 titres in the good compliant subjects. The IgG4 assay is a sensitive and cost-effective surveillance tool for the early detection of brugian infections that is not contingent on nocturnal blood collections. PMID: 19422729 [PubMed - as supplied by publisher] =================================== Forsch Komplementmed. 2009 Apr;16(2):117-22. Epub 2009 Apr 9. Related Articles, Links [Inpatient treatment for CRPS I by use of complementary medicine] [Article in German] Schencking M, Bohmhammel J, Keller C. Kneipp'sche Kliniken, Kneippstrasse 8, Bad Wörishofen, Germany. dr.schencking@barmherzige-bad- woerishofen.de INTRODUCTION: Complex regional pain syndromes (CRPS) are mainly characterized by a burning, intense spontaneous pain,mechanical allodynia of the affected limb, disorders of the skin,local hyperhidrosis, lymphedema as well as trophic disorders of the skin, bones and joints. The overall clinical appearance is dominated by a dysfunction of the sympathetic nervous system. One dominant etiological hypothesis is that major mechanisms for CRPS symptoms, which might be present during the course of CRPS, are trauma- related cytokine release, exaggerated neurogenic inflammation, sympathetically maintained pain, and cortical reorganization in response to chronic pain. CASE REPORT: We report the case of a 33-year-old female patient who suffered from a CRPS type I (cold type) of the left foot which had been traumatically induced 9 months before. The patient presented with a severe pain syndrome, an allodynia of the dermatomes L5 and S1 left with significant trophic skin disturbances, followed by a lymphedema and a malposition (pronation) of the left dorsum pedis. METHODS: In the course of a 10-week in-house treatment the patient received a multidisciplinary therapy-management based on complementary medicine with intensive use of hydrotherapy according to Kneipp, and physiotherapy. RESULTS: Pain intensity over treatment decreased from 8 (initial) to 2 (after 8 weeks) ona 10-point numeric rating scale. Furthermore, local symptoms of the left foot, i.e. hyperhidrosis, trophic skin disorders and lymphedema decreased significantly. CONCLUSIONS: Therapeutic strategies derived from complementary medicine may be an effective approach to the complex treatment of CRPS. Their effects should be further investigated in controlled clinical trials. Copyright (c) 2009 S. Karger AG, Basel. Publication Types: English Abstract PMID: 19420958 [PubMed - in process] ==================== 15. J Helminthol. 2009 May 8:1-10. [Epub ahead of print] Related Articles, Links A cohort study on anti-filarial IgG4 and its assessment in good and uncertain MDA-compliant subjects in brugian filariasis endemic areas in southern Thailand. Jiraamonnimit C, Wongkamchai S, Boitano J, Nochot H, Loymek S, Chujun S, Yodmek S. Filaria Division, Ministry of Public Health, Nonthaburi Province, Thailand. The prevalence of Brugia malayi was surveyed in three highly endemic provinces in southern Thailand as part of an ongoing evaluation of the effectiveness of two rounds of mass drug administration (MDA). Prior to MDA IV, and thereafter every 6 months up to 18 months, including MDA V at 12 months, nocturnal blood sampling was assayed for microfilaria (mf) and IgG4 antibodies in 200 subjects from Nakorn Srithammarat and Surathani provinces. From an additional 300 subjects from Narathiwatt province, daytime blood was also examined for IgG4 antibodies for 1 year. Subjects who tested positive, with reciprocal IgG4 titres above 100, were dichotomized in the 'good compliant' or 'uncertain compliant' groups. Stool samples were examined for intestinal parasites from all 500 subjects simultaneously. Only two subjects (1%) tested positive for mf, while 98 subjects (19.6% of 500) tested positive for IgG4. In general, the good drug- compliant subjects were less likely to exhibit the IgG4 response than subjects in the uncertain compliant group. Only six subjects (1.2%) exhibited lymphoedema while 68 subjects (13.6%) had a total of 105 parasitic infections, with female instances of protozoan infections exceeding male instances of helminth infections. It was concluded that the two MDA rounds were highly successful in not only in reducing mf to negligible levels but also in lowering antifilarial IgG4 titres in the good compliant subjects. The IgG4 assay is a sensitive and cost-effective surveillance tool for the early detection of brugian infections that is not contingent on nocturnal blood collections. PMID: 19422729 [PubMed - as supplied by publisher] ============================ 17. Forsch Komplementmed. 2009 Apr;16(2):117-22. Epub 2009 Apr 9. Related Articles, Links [Inpatient treatment for CRPS I by use of complementary medicine] [Article in German] Schencking M, Bohmhammel J, Keller C. Kneipp'sche Kliniken, Kneippstrasse 8, Bad Wörishofen, Germany. dr.schencking@barmherzige-bad- woerishofen.de INTRODUCTION: Complex regional pain syndromes (CRPS) are mainly characterized by a burning, intense spontaneous pain,mechanical allodynia of the affected limb, disorders of the skin,local hyperhidrosis, lymphedema as well as trophic disorders of the skin, bones and joints. The overall clinical appearance is dominated by a dysfunction of the sympathetic nervous system. One dominant etiological hypothesis is that major mechanisms for CRPS symptoms, which might be present during the course of CRPS, are trauma- related cytokine release, exaggerated neurogenic inflammation, sympathetically maintained pain, and cortical reorganization in response to chronic pain. CASE REPORT: We report the case of a 33-year-old female patient who suffered from a CRPS type I (cold type) of the left foot which had been traumatically induced 9 months before. The patient presented with a severe pain syndrome, an allodynia of the dermatomes L5 and S1 left with significant trophic skin disturbances, followed by a lymphedema and a malposition (pronation) of the left dorsum pedis. METHODS: In the course of a 10-week in-house treatment the patient received a multidisciplinary therapy-management based on complementary medicine with intensive use of hydrotherapy according to Kneipp, and physiotherapy. RESULTS: Pain intensity over treatment decreased from 8 (initial) to 2 (after 8 weeks) ona 10-point numeric rating scale. Furthermore, local symptoms of the left foot, i.e. hyperhidrosis, trophic skin disorders and lymphedema decreased significantly. CONCLUSIONS: Therapeutic strategies derived from complementary medicine may be an effective approach to the complex treatment of CRPS. Their effects should be further investigated in controlled clinical trials. Copyright (c) 2009 S. Karger AG, Basel. Publication Types: English Abstract PMID: 19420958 [PubMed - in process] ================================= 18. Arch Phys Med Rehabil. 2009 May;90(5):803-9. Related Articles, Links Validity for the simplified water displacement instrument to measure arm lymphedema as a result of breast cancer surgery. Sagen A, Kåresen R, Skaane P, Risberg MA. Cancer and Surgical Division, Department of Breast and Endocrine Surgery, Ullevaal University Hospital, Oslo, Norway. aase.sagen@uus.no OBJECTIVES: To evaluate concurrent and construct validity for the Simplified Water Displacement Instrument (SWDI), an instrument for measuring arm volumes and arm lymphedema as a result of breast cancer surgery. DESIGN: Validity design. SETTING: Hospital setting. PARTICIPANTS: Women (N=23; mean age, 64+/-11y) were examined 6 years after breast cancer surgery with axillary node dissection. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The SWDI was included for measuring arm volumes to estimate arm lymphedema as a result of breast cancer surgery. A computed tomography (CT) scan was included to examine the cross-sectional areas (CSAs) in square millimeters for the subcutaneous tissue, for the muscle tissue, and for measuring tissue density in Hounsfield units. Magnetic resonance imaging (MRI) with T2-weighted sequences was included to show increased signal intensity in subcutaneous and muscle tissue areas. RESULTS: The affected arm volume measured by the SWDI was significantly correlated to the total CSA of the affected upper limb (R=.904) and also to the CSA of the subcutaneous tissue and muscles tissue (R=.867 and R=.725), respectively (P<.001). The CSA of the subcutaneous tissue for the upper limb was significantly larger compared with the control limb (11%). Tissue density measured in Hounsfield units did not correlate significantly with arm volume (P>.05). The affected arm volume was significantly larger (5%) than the control arm volume (P<.05). Five (22%) women had arm lymphedema defined as a 10% increase in the affected arm volume compared with the control arm volume, and an increased signal intensity was identified in all 5 women on MRI (T2-weighted, kappa=.777, P<. 001). CONCLUSIONS: The SWDI showed high concurrent and construct validity as shown with significant correlations between the CSA (CT) of the subcutaneous and muscle areas of the affected limb and the affected arm volume (P>.001). There was a high agreement between those subjects who were diagnosed with arm lymphedema by using the SWDI and the increased signal intensity on MRI, with a kappa value of .777 (P<.001). High construct validity for the SWDI was confirmed for arm lymphedema as a volume increase, but it was not confirmed for lymphedema without an increase in arm volume (swelling). The SWDI is a simple and valid tool for estimating arm volume and arm lymphedema after breast cancer surgery. Publication Types: Research Support, Non-U.S. Gov't PMID: 19406300 [PubMed - in process] =================================== 19. Microsurgery. 2009 Apr 27. [Epub ahead of print] Related Articles, Links Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Demirtas Y, Ozturk N, Yapici O, Topalan M. Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey. Recent supermicrosurgical techniques have developed the possibility for vascular anastomosis of smaller vessels and it is now safe and sound to perform precise anastomoses between lymphatics and venules. Reported here is the 2 years experience on supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation combined with a nonoperative physical therapy for treatment of lower extremity lymphedema. Microlymphatic surgery was performed in 42 patients with unilateral lower extremity lymphedema. Thirty patients were women and 12 were men with a mean age of 34. Lymphaticovenular anastomoses were performed in 37 patients with an average of 2.5 anastomoses per patient, and lymphaticovenous implantations were made in 36 patients with an average of 2.4 implantations per patient. The lymphatics that were larger than 0.3 mm were anastomosed to venules with supermicrosurgical technique. Lymphaticovenous implantation technique was used for thinner lymphatics in a particular incision. Postoperatively, 18 patients used continuous compressive garments, 9 patients used garments but discontinued after 6 months, and no compression was used in 9 patients. The results of surgery were assessed both clinically with volume measurements and by lymphoscintigraphy and were classified as good, moderate, or ineffective. The mean decrease in the volume of the edema was 59.3% at an average follow- up of 11.8 months. Six outcomes were classified as ineffective, eight outcomes as moderate, and 28 outcomes as good. Supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation seems to be highly beneficial, especially in the early stages of peripheral lymphedema and may be offered as the treatment of choice in selected patients. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009. PMID: 19399890 [PubMed - as supplied by publisher] =========================== 20. Microsurgery. 2009 Apr 27. [Epub ahead of print] Related Articles, Links Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Demirtas Y, Ozturk N, Yapici O, Topalan M. Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey. Recent supermicrosurgical techniques have developed the possibility for vascular anastomosis of smaller vessels and it is now safe and sound to perform precise anastomoses between lymphatics and venules. Reported here is the 2 years experience on supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation combined with a nonoperative physical therapy for treatment of lower extremity lymphedema. Microlymphatic surgery was performed in 42 patients with unilateral lower extremity lymphedema. Thirty patients were women and 12 were men with a mean age of 34. Lymphaticovenular anastomoses were performed in 37 patients with an average of 2.5 anastomoses per patient, and lymphaticovenous implantations were made in 36 patients with an average of 2.4 implantations per patient. The lymphatics that were larger than 0.3 mm were anastomosed to venules with supermicrosurgical technique. Lymphaticovenous implantation technique was used for thinner lymphatics in a particular incision. Postoperatively, 18 patients used continuous compressive garments, 9 patients used garments but discontinued after 6 months, and no compression was used in 9 patients. The results of surgery were assessed both clinically with volume measurements and by lymphoscintigraphy and were classified as good, moderate, or ineffective. The mean decrease in the volume of the edema was 59.3% at an average follow- up of 11.8 months. Six outcomes were classified as ineffective, eight outcomes as moderate, and 28 outcomes as good. Supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation seems to be highly beneficial, especially in the early stages of peripheral lymphedema and may be offered as the treatment of choice in selected patients. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009. PMID: 19399890 [PubMed - as supplied by publisher] ========================= 21. Psychooncology. 2009 Apr 27. [Epub ahead of print] Related Articles, Links Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Chachaj A, Malyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudelko M, Andrzejak R, Szuba A. Department of Internal Medicine, Wroclaw Medical University, Wroclaw, Poland. Objective: The aim of the study was to identify factors associated with worse physical and emotional functioning of breast cancer survivors with upper extremity lymphedema.Methods: 1250 sets of questionnaires consisting of WHO-DAS II, EORTC QLQ-C30, EORTC QLQ-BR23 and GHQ-30 were mailed to women who underwent a breast cancer surgery at the Lower Silesian Oncology Center in Poland between January 1998 and December 2005.Results and conclusions: The response rate was 33.47%. 117 women were included into a lymphedema group and 211 into a group without this complication. Women with lymphedema were more disabled (overall disability (DAS) score 39.78 versus 34.67; p<0.001), reported symptoms from the upper extremity (shoulder or arm pain and difficulties in arm movement) and from the operated breast (pain and swelling) 2-3 times more often, experienced poorer quality of life (global quality of life (QOL) score 0.50 versus 0.57; p=0.005) and higher psychological distress (GHQ score 10.61 versus 8.01; p=0.007) in comparison to breast cancer survivors without lymphedema. The factors associated with higher DAS score, higher GHQ score and lower QOL score in women with lymphedema were as following: pain in the upper limb (mainly shoulder and arm), pain in operated breast, difficulties with arm movement, localization of lymphedema within the hand or in operated breast, a history of dermatolymphangitis and of receiving chemotherapy. Severity of lymphedema, younger age, BMI and localization of lymphedema within the dominant limb were not considerably related to worse outcomes in these women. Copyright (c) 2009 John Wiley & Sons, Ltd. PMID: 19399782 [PubMed - as supplied by publisher] ========================= 22. J Vasc Surg. 2009 May;49(5):1256-63. Related Articles, Links Compression therapy in breast cancer-related lymphedema: A randomized, controlled comparative study of relation between volume and interface pressure changes. Damstra RJ, Partsch H. Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Drachten, The Netherlands. r.damstra@nijsmellinghe.nl OBJECTIVE: Short stretch bandages are very effective in the initial management of arm lymphedema. However, no studies to date have measured the pressure required to achieve specific amounts of volume reduction. The purpose of this study was to determine whether there is a difference between low and high- pressure bandaging in terms of therapeutically intended volume reduction of the compressed arm. METHODS: Experimental, randomized and comparative study with two study-groups consisting of high and low initial interface pressure bandages. Thirty-six hospitalized patients in Nij Smellinghe hospital suffering from moderate to severe unilateral breast cancer-related lymphedema not responsive to outpatient treatment were included. Bilateral arm volume was measured by inverse water volumetry before, after two hours and after 24 hours of bandaging. The amount of edema was calculated by subtracting the volume of the diseased arm from that of the contralateral side. Sub-bandage pressure was measured after bandage application and two hours later. Bandages were then re-applied and the pressure was measured again. Twenty-four hours later, the pressure measurement was repeated and bandages were removed for final volumetry. Patients were randomized into two groups: group A received low pressure bandages (20-30 mm Hg) and group B received high pressure bandages (44-58 mm Hg). The main outcome measures were reduction of arm volume and edema volume in the affected arm in both study groups. Secondary outcome parameters were changes in sub-bandage pressure and patient comfort. RESULTS: Median arm volume reduction after two and 24 hours was 104.5 mL (95% confidence interval [CI], 51.2-184.2) (-2.5%) (P < .0001) and 217 mL (95% CI, 143.9-280.2) (-5.2%) (P < .01) for group A and 56.5 mL (95% CI, -2.7-123.1) (n.s.) and 167.5 mL (95% CI, 105.2-316.1) (-4.2%) (P < .01) for group B, respectively. There was no statistically significant difference between the volume changes in group A and group B. After 24 hours, edema decreased by median percentage of 9.2% in group A and 4.8% in group B (n.s.). Bandages in group A were better tolerated. The sub-bandage pressure drop in the first two hours was between 41% and 48% in both treatment groups at both measuring sites. After 24 hours, the pressure drop was between 55% and 63%. No proximal swelling above the bandage was observed. CONCLUSIONS: Inelastic, multi-layer, multi-component compression bandages with lower pressure (20-30 mm Hg) are better tolerated and achieve the same amount of arm volume reduction as bandages applied with higher pressure (44-58 mm Hg) in the first 24 hours. Publication Types: Comparative Study Randomized Controlled Trial Research Support, Non-U.S. Gov't PMID: 19394553 [PubMed - indexed for MEDLINE] ==================== 23. J Pediatr. 2009 Apr 23. [Epub ahead of print] Related Articles, Links Sporadic In Utero Generalized Edema Caused by Mutations in the Lymphangiogenic Genes VEGFR3 and FOXC2. Ghalamkarpour A, Debauche C, Haan E, Van Regemorter N, Sznajer Y, Thomas D, Revencu N, Gillerot Y, Boon LM, Vikkula M. Laboratory of Human Molecular Genetics (A.G., N.R., L.B., M.V.), de Duve Institute, Université Catholique de Louvain, Brussels, Belgium; Department of Neonatology (C.D.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Genetic Medicine (E.H.), Women's and Children's Hospital, North Adelaide, Australia, and Department of Paediatrics, University of Adelaide, Adelaide, Australia; Centre de Génétique ULB (N.V., Y.S.), Hôpital Erasme, Brussels, Belgium; Unité de Génétique Clinique Pédiatrique (Y.S.), Université Libre de Bruxelles, Brussels, Belgium; Unité Diagnostic Anténatal, Hôpitaux Iris Sud (D.T.), Brussels, Belgium; Center for Human Genetics (Y.G.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; and Centre for Vascular Anomalies (L.B.), Cliniques Universitaires Saint-Luc, Brussels, Belgium. OBJECTIVES: To investigate the genetic causes of idiopathic sporadic prenatal generalized edema. STUDY DESIGN: In a series of 12 patients, in whom in utero generalized skin edema or hydrops fetalis had been diagnosed, we screened 3 lymphangiogenic genes, VEGFR3, FOXC2, and SOX18. RESULTS: In 3 of the patients, we identified a mutation: 2 in VEGFR3 and 1 in FOXC2. Two of the mutations were de novo and one was either de novo or nonpenetrant inherited. In these patients, the generalized edema resorbed spontaneously, either in utero or after birth. In the 2 individuals with a VEGFR3 mutation, edema remained limited to lower limbs. CONCLUSIONS: Mutations in the VEGFR3 and FOXC2 genes account for a subset of patients with unexplained in utero generalized subcutaneous edema and hydrops fetalis without family history of lymphedema. Lymphangiogenic genes should be screened for mutations in sporadic patients diagnosed with fetal edema. PMID: 19394045 [PubMed - as supplied by publisher] ================== 24. J Pediatr. 2009 Apr 23. [Epub ahead of print] Related Articles, Links Sporadic In Utero Generalized Edema Caused by Mutations in the Lymphangiogenic Genes VEGFR3 and FOXC2. Ghalamkarpour A, Debauche C, Haan E, Van Regemorter N, Sznajer Y, Thomas D, Revencu N, Gillerot Y, Boon LM, Vikkula M. Laboratory of Human Molecular Genetics (A.G., N.R., L.B., M.V.), de Duve Institute, Université Catholique de Louvain, Brussels, Belgium; Department of Neonatology (C.D.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Genetic Medicine (E.H.), Women's and Children's Hospital, North Adelaide, Australia, and Department of Paediatrics, University of Adelaide, Adelaide, Australia; Centre de Génétique ULB (N.V., Y.S.), Hôpital Erasme, Brussels, Belgium; Unité de Génétique Clinique Pédiatrique (Y.S.), Université Libre de Bruxelles, Brussels, Belgium; Unité Diagnostic Anténatal, Hôpitaux Iris Sud (D.T.), Brussels, Belgium; Center for Human Genetics (Y.G.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; and Centre for Vascular Anomalies (L.B.), Cliniques Universitaires Saint-Luc, Brussels, Belgium. OBJECTIVES: To investigate the genetic causes of idiopathic sporadic prenatal generalized edema. STUDY DESIGN: In a series of 12 patients, in whom in utero generalized skin edema or hydrops fetalis had been diagnosed, we screened 3 lymphangiogenic genes, VEGFR3, FOXC2, and SOX18. RESULTS: In 3 of the patients, we identified a mutation: 2 in VEGFR3 and 1 in FOXC2. Two of the mutations were de novo and one was either de novo or nonpenetrant inherited. In these patients, the generalized edema resorbed spontaneously, either in utero or after birth. In the 2 individuals with a VEGFR3 mutation, edema remained limited to lower limbs. CONCLUSIONS: Mutations in the VEGFR3 and FOXC2 genes account for a subset of patients with unexplained in utero generalized subcutaneous edema and hydrops fetalis without family history of lymphedema. Lymphangiogenic genes should be screened for mutations in sporadic patients diagnosed with fetal edema. PMID: 19394045 [PubMed - as supplied by publisher] ===================== 25. Physiother Theory Pract. 2009 Apr;25(3):165-73. Related Articles, Links Pole walking for patients with breast cancer-related arm lymphedema. Jönsson C, Johansson K. Lymphedema Unit, Lund University Hospital, Lund, Sweden. charlotta.jonsson@skane.se Arm lymphedema is a well-known side effect of breast cancer treatment. Studies of the effect of physical exercise on arm lymphedema are very rare. The purpose of this study was to investigate the influence of pole walking on breast cancer-related arm lymphedema when using a compression sleeve. Twenty-six women with unilateral arm lymphedema took part in a clinical study of pole walking on one occasion, 4 kilometers for 1 hour. Measurements were made before, immediately after, and 24 hours later. Results revealed no changes in total arm volume of the swollen arm, measured with water displacement method, or in subjective assessments of heaviness and tightness in the affected arm using visual analogue scale. Immediately after pole walking, a temporary increase in total arm volume of the healthy arm (P=0.037) was found. Twenty-four hours later, no differences were found compared to the measurements before walking. The median for perceived exertion immediately after pole walking, measured with Borg scale, was 11 ("fairly light"). The results suggest that a controlled, short-duration pole-walking program can be performed by patients with arm lymphedema, using a compression sleeve, without deterioration of the arm lymphedema. Publication Types: Research Support, Non-U.S. Gov't PMID: 19384736 [PubMed - in process] ================================= http://www.downeast.com/node/10550 Discover Why More Physicians are Choosing Maine Matchmaking can be stressful work. Will the two parties find each other attractive? How will financial expectations compare? Will the extended family get along? No one understands these stresses better than Jane Ham, director of the Maine Recruitment Center. For the past ten years, Ham’s office, a service of the Maine Hospital Association, has been matching physicians with openings in cities and towns across Maine, and she’s seen everything from the storybook romance to The War of the Roses play out in hospitals and small-town doctors’ offices. “We look at recruitment as you’re recruiting the family,” Ham explains. “We had one physician who was interviewing for an orthopedic position, and her husband was an avid fly fisherman. So we made sure he got out fishing, and that went a long way toward making that situation work.” Across the country, small towns are facing a shortage of physicians, especially in primary care, as medical school graduates are increasingly turning to specialties that allow them to quickly repay huge student loan debts. In Maine, the situation is especially dire: the ninety-one physician openings Ham faced in 1999 have skyrocketed to 272 today. “We’re in a full-blown shortage, and it’s only going to get worse,” she says, as the health-care industry expands to handle the state’s graying population. Since 1980, total employment in Maine has increased 52 percent. That sounds impressive until you contrast it with the 200 percent increase in the state’s health-care industry. So Maine definitely needs doctors. “But the good news is that Maine is still an attractive place for physicians who want four-season recreation and quality of life,” says Ham. Indeed, over the past few years Maine has taken several steps to increase its appeal to both young doctors looking for pleasant, safe communities in which to raise their families and older physicians seeking to finish out their careers. “Maine is sort of out here at the end of the world,” Ham explains. “We have a national reach, but we’re reaching out to docs that we hope have some connection to Maine. Maybe they grew up here and are thinking of returning, or maybe they just have vacation experience in Maine. Then there’s that group of physicians who are on the back side of their career and who think they’re not quite ready to retire and want to work a few more years.” Marian Benner, a physician in the Wound, Lymphedema, and Hyperbaric Medicine Center at St. Joseph Hospital in Bangor, is an example of the vacationer-turned-resident doctor. “I called it my midlife crisis. In 2004, I was in my mid-forties living in northeast Maryland, and I just wanted to do something different,” Benner says. Having been to Boothbay and Bar Harbor on vacation and to Portland for a conference, she decided to take the plunge and contacted the Maine Recruitment Center. “And we’ve had nothing but wonderful experiences ever since. In Maryland I had to become a recluse all summer, since the ninety-degree weather hits in May and June and the windows close up, the air- conditioning goes on. I have a new lease on life here — I’m always outside.” She admits her teenage daughters sometimes complain about the lack of shopping opportunities in Maine compared to elsewhere, a craving that is quickly cured by a weekend in Boston or New York. While Maine’s small towns and outdoor opportunities are often most attractive to physicians’ fly-fishing spouses, the growing trend of doctors becoming employees of hospitals often appeals to the physicians themselves. “We employ close to 80 percent of all the physicians in Lincoln County, and that will go to 100 percent in the not-too-distant future,” says James Donovan, president and CEO of Lincoln County Healthcare, which operates Miles Memorial Hospital in Damariscotta and St. Andrews Hospital and Healthcare Center in Boothbay Harbor. “[The trend] has been evolutionary across the state, but it has rapidly increased in momentum over the last five years or so.” Donovan says doctors, especially in small towns, have discovered that working for the local hospital allows them to pass off bookkeeping and administrative work and instead focus on treating patients. “It’s very difficult to run a physician practice these days,” he says. “It’s a small business, with all the complexities of that, but most physicians want to practice medicine.” Charles Dwyer, director of the Maine Office of Rural Health, agrees that the administrative headaches of running a private practice, including how to deal with low reimbursement rates through MaineCare, can often outweigh the benefits of staying independent. “If I’m struggling to keep the overhead of my back office, and I have one case where I need to rebill something, I’ve basically lost any kind of margin,” he says. Statewide, Maine hospitals now employ 45 percent of the 5,400 licensed doctors, and a whopping 78 percent of all licensed primary care physicians. “For physicians tired of the hassle of paperwork, Maine is very attractive,” Ham says. “We’re so much further along in all of this — we started employing doctors in hospitals in the early nineties, and what I hear from colleagues nationally is that they’ve just started looking at doing this.” But the ability to focus on patient care isn’t always enough when it comes to attracting good doctors to Maine small towns. Pay scales for physicians in Portland are comparable to the national median, but Donovan says rural areas are always hard-pressed to offer the high salaries that doctors need to repay student loans. As the physician shortage in Maine has worsened, hospitals like Donovan’s in Damariscotta and Boothbay Harbor have seen a rapid escalation in salaries required to secure quality doctors. But St. Joseph’s Dr. Benner says the pace of life and work in Maine makes up for the lower pay. “Yes, the pay is a little less, but I don’t work as hard here,” she remarks. “You get paid for how hard you work, and I think if you look across the board, with cost of living and malpractice costs and everything, it all evens out.” The other compensation that doesn’t make it onto a spreadsheet, she says, is the camaraderie that exists among doctors in Maine. “The physician camaraderie is great here — everyone knows each other, as opposed to Maryland, where you came in, worked, and went home, and nobody really knew you.” One program through which Maine has been most successful in attracting new doctors is the J-1 visa waiver program, whereby foreign doctors are allowed to practice in rural areas, including Maine, in exchange for a two-year commitment. Dwyer’s Office of Rural Health surveys these international physicians when their commitment is complete and has found that a surprising majority of them continue practicing in Maine. Of the last group of 116 foreign physicians surveyed, in 2004, 71 percent intended to stay in the state, up from 69 percent the previous year. “I’d be surprised if you did a random sampling of non-foreign physicians if you’d find a higher percentage,” Dwyer declares. “Especially in this labor market, which is fairly fluid.” He says the local community usually deserves as much credit for retaining these doctors as the hospitals that they end up working for. “One of the things that makes a huge difference for whether these physicians stay or go is how well they were integrated into the community. Is there more than a small group of people in your area that has your same religious preference? Are there other people that your family can relate to?” Ham says retaining doctors once they arrive in Maine is especially critical today, when competition for primary care physicians is at an all-time high. “It used to take three to six months to recruit a family practitioner; now it takes a year,” she says. Even if the state is able to entice a doctor from another state to join a Maine practice or hospital, often the sagging real estate situation nationwide will put a cross-country move on hold. “Physicians who are practicing in other parts of the country who might want to move to Maine are hung up in the real estate bust. They have homes, usually expensive homes, that they just can’t sell.” One factor working against Maine’s ability to attract new doctors over the years has been its lack of a traditional medical school (though the University of New England has operated its College of Osteopathic Medicine since 1978). Since building a bricks-and-mortar medical school would be exceptionally expensive, this fall the state will launch a new agreement with Tufts University and the University of Vermont to allow medical students to do some of their clinical rotations in Maine. “We need to grow our own, to let kids see what it’s like to work in Maine,” Ham says. “The more we can expose people in training to physicians in Maine, and to the health-care system in Maine, the more likely they are to stay here.” This period in a medical student’s training is especially critical for states like Maine, Ham says, as this is when young doctors typically marry and choose where they’d like to raise a family. Without doubt, though, the biggest asset Maine can offer its doctors is a quality of life that is the envy of much of the nation. “In my view, spouse and family issues are 51 percent of the decision,” remarks Lincoln County Healthcare’s James Donovan, “Maine is such a great place to practice.” In the end, Maine’s ability to attract new doctors to its small towns will rest not on a single strategy, but rather the multi-faceted approach that has evolved over the past few years: allow doctors to practice more and administrate less by joining hospitals’ payrolls; foster communities that welcome doctors and integrate them into their small town; and create partnerships with out-of-state medical schools to bring physicians in training to Maine and expose them to the quality of life, and of patient care, that the state offers. ===================== From http://blog.diabeticparents.org/ Getting Free Prescriptions When You Make Too Much $$ Let's face it. The majority of our population make well over the federal poverty line to receive any federal aid. In this time of uncertainty in our economy, pinching pennies is something we are all looking to do. As a diabetic parent, we know that the cost of a family and the cost of taking care of ourselves is expensive and never gets any cheaper! That's why a recent television news article caught our attention. Families with insurance and those families who make up to $80,000 a year as a family of four can get free or greatly reduced prescriptions. When my husband and I heard this, we laughed! We've been hearing for years that we don't qualify for anything simply because we make too much. But even if you make well over the federal poverty line, many prescription drug companies will help you--if you ask. If you have a chronic disease like diabetes, or are experiencing financial difficulties paying for your medications there are ways to receive help that won't cost you anything. There are three websites that are available to help. RxAssis allows you to type in the medications you are taking. After typing in your medications, the website pulls coupons, and gives you direct links to the drug manufacturer financial hardship links. While some medications and drug companies list specific income requirements, the article claims that you should still pursue filling out and sending an application. Many families facing financial hardships or who have chronic diseases can qualify for reduced or free medications, whether or not they have insurance, and whether or not you make mo re than the minimum requirement from the drug manufacturer. NeedyMeds.org is another website that can help. The website has an extensive link of coupons available to use at local pharmacies. You can also qualify for financial assistance through the website and even drug discount cards. Montel Williams created a pharmacy program to help assist those who need medications but may not be able to afford them. They cover those who may have reached a gap in their current medical insurance and are now paying for their medications, or those who can't afford the cost of their medications. They state that they will cover those with insurance who take medications not covered by your insurance, and even those with a high deductible co pay. You must earn equal to or less than $41,800 for a single person, $56,000 for couples, or $84,800 for a family of four to be considered for the program. What if you try all these programs, and you still don't qualify for any? Don't despair! Other ideas for saving mo ney include sending a letter directly to the drug manufacturer of your insulin or other diabetic medication or supplies directly and letting them know of your financial hardship. Some companies will send out coupons, savings cards, or will tell you ways to save mo ney on the drugs they sell. Checking with your doctors office or with your local diabetic clinic can also help. They routinely get drug reps in who stock them with samples of some of the medications you may be taking. They also on occasion offer your doctor coupons to give out to patients for free 7, 14, or 30 day supplies. Let your doctor know of your situation and see if they may have any of these things available. Many times doctors get busy and don't think to check the med closet. Sometimes doctors even have new meters and mo re to give out from drug reps! You can check out these websites by going to these links: Rx Assist: www.rxassist.org Needy Meds: www.needymeds.org Montel Williams Pharmacy Program: http://www.freemedicine.com =========== Large in Ballard: Casting from the curb By Peggy Sturdivant June 1, 2009 updated 6 hours ago Fly fishing entered my life when John Olson parked his City of Seattle Department of Transportation backhoe along the front curb and prepared to eat lunch in the cab. He was the advance team for the crew from the streets division dispatched to lift the concrete at the base of the alley in order to explore the void by a storm water drain (At Large in Ballard: The void). When your vehicle is a four-ton backhoe it isn’t practical to return to the break room at Haller Lake for lunch; besides John prefers the quiet at the job site. Excited at the appearance of equipment that could solve the sidewalk problem I waved up at John in the cab to ask questions. It seemed fitting to learn in our “street talk” that he grew up within a half a mile, back on the street where I lived for the last 21 years. “We played baseball down your way,” he said. “The catch basins were the bases.” It was clear he really knew these streets. Later when the rest of the concrete crew arrived, John climbed into the cab of his machine and donned ear protection while operating a pneumatic hammer drill to break up the sidewalk. While the crew on the ground poked at the revealed drain pipe he gave me a smile. John Olson has a great smile. John was born at Ballard Hospital and went to school at Adams Elementary. He graduated from Ballard High School (1973) as did his father, and his own two children. Three generations of Ballard graduates. In this neighborhood he recalled the phone booth that used to be in front of the Foodtown Grocery on 32nd Avenue Northwest. As a youngster he was intrigued by the hinged doors, but once he got stuck inside. A neighbor finally rescued him, put him under her arm and deposited him at home. Later on when he was learning to drive he got the car underbelly stuck on a bump in the parking lot. He doesn’t miss Foodtown. Like so many kids growing up in Ballard in the 1960s he and his friends would play down at the beach by Ray’s. They’d fish or throw a tennis ball for a dog but then have to swim out for the ball when the dog lost interest. His father had a three stage whistle that he used to call the kids home. With the exception of three weeks working in Idaho soon after high school, John Olson didn’t go far from Ballard. He returned from making orange juice in Idaho (“I cannot stand this”), married a Nathan Hale graduate he’d met while working as a ball field attendant and settled on Northwest 74th. He’s worked for the City of Seattle for 28 years and had the same phone number even longer. He eyed the street where we were standing and recalled that he almost bought a home nearby, but the street condition suggested underlying instability. “I want a house on a street that has curbs and sidewalks because then you have good drainage," he said. He lives in Olympic Manor, but he still owns the house that was next to his on 74th. He paid the back taxes for an elderly neighbor so that she wouldn’t lose her home; then purchased it from her family after her death. He’s had the same tenant for 19 years. When the tenant goes on vacation, John feeds his fish. We talked while John re-attached the bucket to the backhoe and double-checked the fasteners. How did we start discussing fly-fishing? Perhaps anyone who spends time with John hears about tie end casting. John currently teaches fly-tying at the Orvis store in Bellevue, though over the last decades he’s taught classes in Ballard and near by. His classes are geared for adults but he once taught two nine-year old boys, best friends who lived across the street from each other. His oldest student was an 87 year-old widow who had always wanted to learn. He had her come an hour early one week to work with her one-on-one, and, “She really got the hang of it.” Every year John participates in a retreat called “Casting for Recovery,” teaching fly fishing to women recovering from breast cancer. The casting motion is therapeutic, particularly in countering effects of lymphedema that can occur after surgery involving lymph nodes. John demonstrated the motion, a sinew in the air that I couldn’t help but correlate with his controlling the pneumatic drill from 10 feet above the ground. It was the lure of sidewalks and curbs that drew John and his family to Olympic Manor plus a 360 degree view and a veritable boulevard to practice casting. Unless he gets transferred during department changes John works the north division of Seattle, south to Denny and north to 145th. He enjoyed seeing old friends during the sidewalk project on Ballard Avenue. With school boundaries shifting he doesn’t foresee a fourth generation of his family graduating from Ballard High School. “That’s over,” he said, along with getting his chowder fix from Gordo’s on Seaview. He shared a final story before driving back to the Haller Lake facility in his backhoe; which takes much longer returning to the north, than descending to the south. While casting with his fly rod in front of his house he heard a neighbor take a fall. After he’d helped the neighbor and the firemen had patched him up they gathered to ply John with questions about his choice of rod and reel. One of John’s best rods cost more than his $1,000 car - but the rod will last forever. John made another casting motion with his whole arm and then gave a wave. The backhoe took a left at the stop sign; then John and his beaming smile were gone. http://www.ballardnewstribune.com/2009/05/31/features/large-ballard-casting-curb ---- 1. Ann Surg Oncol. 2009 Jul 29. [Epub ahead of print] Quality of Life After Axillary or Groin Sentinel Lymph Node Biopsy, With or Without Completion Lymph Node Dissection, in Patients With Cutaneous Melanoma. de Vries M, Hoekstra HJ, Hoekstra-Weebers JE. Department of Surgical Oncology, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands. BACKGROUND: The aim of this study was to asses quality of life (QoL) after axillary or inguinal sentinel lymph node biopsy (SLNB) with or without completion lymph node dissection (CLND) in patients with cutaneous melanoma by comparing patients to a norm group of the general population and by comparing QoL between four patient groups depending on surgical procedure and location, i.e., patients receiving an axillary or groin SLNB, or an axillary or groin CLND. METHODS: Between 1995 and 2003, a total of 242 axillary and inguinal SLNBs were performed. Of the 127 patients eligible for the study, 116 patients participated (91%). QoL was measured by the 30-item European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the McGill Pain Questionnaire and the Groningen Activity Restriction Scale. RESULTS: Median age at diagnosis was 50 (range, 18-77) years; median Breslow thickness 2.0 (range, 1- 13) mm; median follow-up 56 (range, 4-94) months. SLNB only was performed in 89 patients (77%): 48 in the groin and 41 in the axilla. CLND was performed in 27 patients (23%): 13 in the axilla and 14 in the groin. More postoperative complications (13 vs. 5; P < 0.001) and lymphedema (10 vs. 8; P < 0.001) occurred in the CLND group than in the SLNB group. The total group of patients reported better physical (P < 0.001), role (P < 0.001), emotional (P < 0.001), and social functioning (P = 0.049), global QoL (P < 0.001), and less fatigue (P < 0.001) and pain (P < 0.001) than a German norm group. Analysis of variance revealed significant differences in role functioning (P = 0.02) and tendencies toward physical problems (P = 0.051) and fatigue (P = 0.051) between the four groups. Post hoc Bonferroni tests showed that the axillary CLND group had more problems than the axillary and inguinal SLNB groups. Kruskal-Wallis tests showed that the axillary CLND group reported most pain. CONCLUSIONS: QoL in melanoma survivors after axillary or inguinal SLNB with or without CLND was better than that in a norm group. Patients who underwent CLND in the axilla after SLNB reported most problems. PMID: 19639366 [PubMed - as supplied by publisher ---------------------------------- 1. Rev Assoc Med Bras. 2009 May-Jun;55(3):355-62. [Paradigm shift in bancroftian filariasis.][Article in Portuguese] Dreyer G, Mattos D, Figueredo-Silva J, Norões J. Organização Não-Governamental Amaury Coutinho para Doenças Endêmicas Tropicais, Recife, PE. The way a particular subject is understood changes over time as a result of scientific research. In most cases, these changes are minor, with limited effect on the overall knowledge on the subject. Sometimes, however, revolutionary changes occur and not only modify the understanding of the subject but open perspectives that can trigger new interpretations and new ways for expansion of scientific knowledge. The studies of Gregor Johann Mendel were a good example. They led to discovery of the laws of inheritance which, in turn, have revolutionized biology and provided the foundation for genetics. In certain situations, changes not only alter ways of thinking, but have practical implications, also improving the quality of life for many people. In his book The Structure of Scientific Revolutions, Thomas Kuhn refers to discontinuities in scientific development as a 'change of paradigm', a term now used in a generic manner to describe a profound changes in our reference points. For lymphatic filariasis the old paradigm stated that Wuchereria bancrofti at the adult stage causes lymphatic vessel obstruction, triggering an inevitable immune response in predisposed individuals and leading to elephantiasis. This has been replaced by a new paradigm, which offers hope that W. bancrofti infection does not necessarily predispose to the disfiguring outward manifestation of lymphatic dysfunction. Repeated secondary bacterial infections (erysipela-like) are now recognized as the most important factor for initiation and progression of chronic lymphedema in individuals living in filariasis-endemic areas. Most inhabitants of endemic communities can prevent and minimize the acute bacterial episodes by regular use of soap and water, the simplest form of hygiene already well known to human beings. PMID: 19629359 [PubMed - in process --------------------------------------- 2. S Afr J Surg. 2009 May;47(2):62-3. Kaposi's sarcoma, lymphoedema and gangrene in AIDS--a therapeutic challenge. Ebrahim S, Singh B, Moodley J, Ramdial PK. Department of General Surgery, Nelson R. Mandela School of Medicine, Faculty of Health Sciences, University of KwaZulu-Natal, Durban. PMID: 19626783 [PubMed - in process ------------------------------------- 3. Eur J Dermatol. 2009 Jul 22. [Epub ahead of print] Neutrophilic dermatosis on postmastectomy lymphoedema: a localized and less severe variant of Sweet syndrome. Lee CH, Lee HC, Lu CF, Hsiao CH, Jee SH, Tjiu JW. PMID: 19625233 [PubMed - as supplied by publisher --------- 1. Eur J Dermatol. 2009 Jul 21. [Epub ahead of print] LinksPurpura-associated congenital lymphedema Berti S, Pieri A, Lotti T, Duranti A, Panelos J, Martino MD, Moretti S. An 8-year-old girl referred to our Department for a two-month worsening of congenital primary lymphedema of the lower limb and for the appearance of several purpuric lesions on the right thigh and knee. We diagnosed a lichenoid pigmented purpura of Gougerot and Blum in a patient with Milroy disease, complicated by an insufficiency of anterior saphena. We treated the patient with topical steroids and compression stockings, until surgical intervention of phlebectomy. We report this case for the rarity of the disease, for the even more rare association with lichenoid pigmented purpura and for cutaneous immunopathological findings. PMID: 19620038 [PubMed - as supplied by publisher] ----------------------------------- 2. Int J Radiat Oncol Biol Phys. 2008 Dec 1;72(5):1449-55. Comment in: Int J Radiat Oncol Biol Phys. 2009 Aug 1;74(5):1627. Does axillary boost increase lymphedema compared with supraclavicular radiation alone after breast conservation? Hayes SB, Freedman GM, Li T, Anderson PR, Ross E. Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA. PURPOSE: To determine independent predictors of lymphedema (LE) after breast radiotherapy and to quantify added risks of LE from regional node irradiation (RNI). MATERIALS AND METHODS: A total of 2,579 women with T1-2, N 0-3, M0 breast cancer treated with breast conservation between 1970 and 2005 were studied. A total of 2,169 patients (84%) received radiation to the breast (B), 226 (8.8%) to the breast and supraclavicular LNs (B+SC), and 184 (7.1%) to the breast, supraclavicular LNs, and a posterior axillary boost (B+SC+PAB). Median follow-up was 81 months (range, 3-271). RESULTS: Eighteen percent of patients developed LE. LE risks were as follows: 16% (B), 23% (B+SC), and 31% (B+SC+PAB) (p < 0.0001). LE severity was greater in patients who had RNI (p = 0.0002). On multivariate analysis, RT field (p < 0.0001), obesity index (p = 0.0157), systemic therapy (p = 0.0013), and number of LNs dissected (p < 0.0001) independently predicted for LE. In N1 patients, the addition of a SC to tangents (p < 0.0001) and the addition of a PAB to tangents (p = 0.0017) conferred greater risks of LE, but adding a PAB to B+SC RT did not (p = 0.8002). In the N2 patients, adding a PAB increased the risk of LE 4.5-fold over B+SC RT (p = 0.0011). CONCLUSIONS: LE predictors included number of LNs dissected, RNI, obesity index, and systemic therapy. LE risk increased when a SC or PAB were added in the N1 subgroup. In the N2 patients, a PAB increased the risk over B+SC. The decision to boost the axilla must be weighed against the increased risk of LE that it imposes. PMID: 19028274 [PubMed - indexed for MEDLINE] ---- http://www.fayettefrontpage.com/health-09/4-23-09_hands.htm Piedmont Fayette Hospital Patient Regains Full Use of Hands April is Occupational Therapy Month 4/23/09 While out with her family at the local skating rink, Fayetteville resident Jennifer Smith, tripped over another skater and landed backwards on the edge of her palms. The result: bilateral fractures in both wrists, and shattered bones beneath her thumb and pinky. She was rushed to the emergency room at Piedmont Fayette Hospital (PFH). After X-rays, splints, surgery and a 2-day hospital stay, Smith was sent for occupational therapy. “When I showed up for therapy at Piedmont Fayette Hospital, my hand was straight up and down, I could only move it a quarter of an inch at the very most,” said Smith. “I couldn’t tie my shoes or get dressed, let alone do my job.” Smith underwent 6 weeks of therapy at PFH, with two sessions every week. She participated in flexion, extension and strength building exercises, which included lifting small weights, pushing and pulling objects, circular movements of the wrist to regain rotation, and massages. “The occupational therapy program is designed to help our patients perform day-to-day tasks for themselves, whether that is at home, school, work or play,” said Lisa Caphe, an occupational therapist at Piedmont Fayette Hospital. “But more than boosting motor skills and improving mental acumen, we want them to know they can overcome their injuries or disabilities and lead normal lives.” April is Occupational Therapy (OT) Month and Piedmont Fayette Hospital is recognizing the hospital’s occupational therapy department for its efforts to help individuals, like Smith, lead fulfilling lives. Occupational therapy (OT) is the use of treatments to develop, recover, or maintain the daily living and work skills of patients such as Smith. The therapists help clients not only to improve their basic motor functions and reasoning abilities, but also to compensate for permanent loss of function. The goal is to help clients have independent, productive, and satisfying lives. “Lisa explained everything to my husband so he would know what to do after my sessions were over,” said Smith. “She suggested using things around the house for weights – like canned goods or a hammer to simulate the same exercises.” With continued exercises at home, as suggested by her OT, Smith returned to work and has regained almost full mobility in her left wrist and hand and is 85-90 percent recovered in her right. “You get so much more out of the therapy with a specialist than you can do it at home. Having someone there to tell you when you’re doing it right or wrong, and what exercises to do really helped,” said Smith. “It was a wonderful experience, -- without them I don’t think I’d be back where I am today.” PFH Rehabilitation and Fitness Center offers cardiac rehab, pulmonary rehab, diabetes education, physical therapy, occupational therapy and speech-language pathology. There are also specialty programs including pelvic pain and incontinence therapy, lymphedema therapy, wound care and ostomy management, joint replacement pre-op classes, and Healthy Heart Classes. The fitness center is open to the community and offers a full line of state of the art equipment. Physician referral is required for most rehabilitation services. For more information about PFH's occupational therapy department and other rehabilitation and fitness services, call 770-719-7290. To learn more about Piedmont Fayette Hospital, visit www.fayettehospital. org. ------------------------ http://funjockey.com/help-for-persistent-or-recurring-swelling/ Help For Persistent Or Recurring Swelling Like the arteries, veins and capillaries that transport blood through our bodies, our bodies also contains an extensive drainage system that returns water and proteins from our tissues back to the bloodstream. Called the lymphatic system, it is part of our immune system and works to defend the body from diseases caused by viruses, bacteria, or fungi. The lymphatic system has two major functions. First, it works to regulate the amount of fluids within our bodies. Secondly, it is responsible for “taking out the trash”, that is collecting waste products, such as dead blood cells and pathogens from the interstitial fluid (the fluid that fills the spaces around cells) and filters it before returning it to the bloodstream. The lymphatic system is made up of lymph vessels that carry lymph, a protein-rich fluid that is transported through the lymph vessels, and lymph nodes which filter out germs and toxins. There are over 100 lymph nodes throughout the body, with the majority of them being located in the neck, groin and armpits. Lymphatic vessels contain valves that prevent the lymph from flowing backwards within the system. Within the lymphatic vessels, lymph is transported through the vessels and moves via the squeezing action of their neighboring skeletal muscles. When the movement of lymph through the body becomes impaired, it will leak out of the lymphatic capillaries and cause the surrounding tissues to swell. This condition is called lymphedema. Lymphedema occurs when the amount of lymph fluid in the body exceeds the body’s ability to transport it. This causes the lymph fluid to accumulate in the tissues, where it causes swelling, particularly of the arms and legs. There are two types of lymphedema. Doctors don’t know what causes Primary Lymphedema, but it can be present at birth, or can develop later on in life. Fortunately, this condition is rare. Secondary Lymphedema is a condition that is not often talked about, but often affects individuals who have undergone surgery, such as cancer surgery where lymph nodes are commonly removed. It can also affect individuals who have undergone radiation therapy, which can damage lymph nodes and cause scar tissue to form ultimately interfering with the flow of lymph. It can also be experienced by individuals who have experienced a severe trauma or infection. In the initial stages of this chronic condition, Lymphedema often begins with swelling in a hand or foot, particularly the one closest to where the surgery has occurred or radiation therapy has taken place. If left unchecked, the protein-rich lymph can continue to accumulate, leading to increased swelling and a hardening of the tissues. This increases your risk of developing an infection or may interfere or impair the function of the limb. Lymphedema can develop in any part of the body. If you experience persistent or recurring swelling anywhere in your body, it is important to seek medical advice. Early intervention with this disorder greatly improves the long term outcome of the disease’s progression. Recommendations For Wellness Avoid rigorous, repetitive movements or heavy lifting. Women, if your arm is affected, get rid of extra 50 lbs that you carry over your shoulder and trade it in for a purse that has hand straps. If your arm or leg starts to ache, lie down and elevate it. Wear loose fitting clothes, jewelry, socks and undergarments that may restrict lymphatic flow. Wear a compression sleeve or stocking on the affected limb. Keep your “at risk” limb clean and avoid activities that may irritate or damage the skin. Careful skin care may reduce the risk of lymphedema by helping you to avoid infection. Massage, particularly lymphatic massage has been shown to help increase lymph drainage. You can do this yourself or work with a qualified massage therapist who has been specially trained in how to perform manual lymph drainage techniques. Begin a gentle exercise program. Exercise and muscle movement can help drain lymph fluid. (Consult with your doctor prior to beginning any exercise program). Drink plenty of water. Water is critical for proper lymph drainage. Echinacea has a long history of improving lymph filtration and drainage. Garlic is known for being able to stimulate the lymph system to throw off waste materials. Oregon grape can be used to help reduce the inflammation of the lymphatic system and works to help cleanse the lymph. Poke Root has been known to help stimulate the body and aid its ability to remove waste materials that may be trapped in the tissues. It can also help improve the elasticity of tissues that may have experienced hardening due to congestion. Burdock, red clover and mullein are known to thin lymph fluid and enhance lymphatic drainage. Herbal combinations such as Nature’s Sunshine’s Lymphatic Drainage, Lymphomax or Lymphostim are designed to stimulate the immune system, fight infections and support the lymphatic system. Copyright Body, Mind & SoulHealer 2004. About The Author Dr. Rita Louise, PhD is a Naturopathic Physician and a 20-year veteran in the Human Potential Field, and it is her unique gift as a medical intuitive that enlivens her work. Author of the books “Avoiding the Cosmic 2×4? and “The Power Within: A Psychic Healing Primer”, Dr. Rita Louise, Ph.D. a can help you identify what is really going on and provide you with straightforward guidance and advice. She can be reached by calling 972-475-3393. ------------------------------------------ http://www.integrative-healthcare.org/mt/archives/2009/04/bodywork_after.html Bodywork After Breast Cancer Surgery While more women than ever are able to beat breast cancer, there is still a need to help them recover from breast removal surgery. Despite warnings to avoid bodywork on anyone with a history of cancer, properly prepared massage therapists can help survivors heal from their breast cancer surgery. by Nicole Cutler, L.Ac. Weighing in as one of the diseases women fear most, breast cancer is estimated to affect one in every eight women. Despite breast cancer being the second-leading cause of cancer deaths in American women, its early diagnosis and treatment has drastically improved this illness’ survival rate. When included in a person’s recovery from this illness, massage therapy has the capacity to improve the physical and emotional health of a breast cancer survivor. With compassion, specific training and attention to documentation and legal issues, bodyworkers have the tools to help clients mend the parts of their life fragmented by traditional breast cancer treatment. As one of the leading treatments for breast cancer, the complete or partial surgical removal of breast tissue can make a significant impact on a person’s life. In addition to the side effects from other therapies one may have received, the loss of one or both breasts may congest blood, lymph and energy circulation in the chest and upper extremities. Just as important to an individual’s well-being, breast disfigurement or amputation can take a drastic psychological toll on survivors. Types of Breast Cancer Surgeries Since there are so many variations of type and severity of breast cancer, the treatment approach for this illness is highly individual. Involving a great deal of deliberation between patient and doctor, most women will have surgery and an additional therapy such as radiation, chemotherapy or hormone therapy. In general, breast removal surgeries fall into one of the following four categories: 1. Lumpectomy – A surgical excision of only the palpable tumor mass. 2. Partial Mastectomy – Removes less than the whole breast, such as a quarter of the breast where the tumor resides. 3. Modified Radical Mastectomy – Removes all breast tissue, including the skin, nipple, areola and most of the axillary lymph nodes on the same side while leaving the pectoral muscles intact. As the most common surgery for early stage breast cancer, this is also called a total mastectomy with axillary dissection. 4. Halsted Radical Mastectomy – Removes the breast, skin, both pectoral muscles and all axillary lymph nodes on the same side. Massage Therapy Following Breast Surgery Because of the unknown mechanism for spreading cancerous cells, most massage therapy schools teach that cancer is a contraindication for massage. However, modern research has repeatedly demonstrated that carefully executed bodywork offers measurable benefits to people currently living with or who have survived a bout of cancer. Regardless of the growing acceptance of massage therapy for cancer-related issues, approaching a client with a recent or distant history of breast cancer always mandates the practitioner proceed with caution. · Permission – First and foremost, obtain the permission of your client’s physician prior to administering massage. · Consent – Make certain you have your client’s written informed consent before proceeding with massage therapy. · SOAP notes – Adhere to this conventional form of record keeping, which includes taking subjective, objective and assessment plan notes. · Training – Only proceed with bodywork if you have successfully completed training specific to oncology massage. Following breast cancer surgery, common physical problems may include local pain, swelling and restricted range of motion. If the pectoral muscles have remained intact, the physical effects are likely the result of impaired circulation from removed lymph nodes, scar tissue and adhesions from surgery. Including techniques such as therapeutic touch for acute surgical recovery, lymphatic drainage massage for lymphedema, scapular mobilization for a stiff shoulder, myofascial spreading for tight pectorals and cross- fiber friction to dissolve scar tissue, a therapist trained in oncology massage has many tools to help clients recover from breast cancer surgery. Women who have experienced the trauma of breast cancer surgery can benefit emotionally from touch- centered therapy. When applied with healing intent and compassion, a massage therapist’s touch can function as a bridge to help clients become reconnected to their body. For many breast cancer surgery recipients, the physical contact of massage eases the feeling of being a stranger in their own body, a transition that can help them find comfort in their new physical form. Since a lumpectomy or mastectomy is indicated in a majority of cases, many breast cancer survivors must contend with the consequences of their surgery. Although not outfitted with a medical doctor degree, massage therapists can help clients with a history of breast cancer return to health. By seeking the proper training, taking acceptable notes, getting physician permission and obtaining client written consent, massage therapists can facilitate their clients’ physical and emotional recovery from breast cancer surgery. References: Handley, W. C., Jr., LMT, Massage for Cancer Patients: Indicated or Contraindicated?, Massage Today, January 2007. Manzulli, Sabino L., LMT, Bodywork & Visualization Therapy for People With Cancer, Massage & Bodywork, August/September 2001. Vanderbilt, Shirley, Into the Looking Glass: Massage for Mastectomy Patients, Massage & Bodywork, August/September 2000. Mastectomy Massage, Cheryl Chapman, Eileen Kennedy, American Massage Therapy Association, 2008. About Breast Cancer: Statistics, Causes, Symptoms, Surgery Options, breastcancer.org, 2008. Breast Cancer, Mayo Foundation for Medical Education and Research, 2008. Massage After Mastectomy, Chris E. Barrett, 2008. --------------------------- http://www.newstimes.com/ci_12212807 New Milford mother organizes team for breast cancer charity race By Nanci G. Hutson staff writer Updated: 04/23/2009 08:51:04 PM EDT NEW MILFORD -- Three of Lisa Arasim's best friends -- all seemingly the epitome of good health --were diagnosed with breast cancer last year. Arasim, the 43-year-old mother of three young girls -- Hannah, 8, Emily, 7 and Olivia, 4 -- was daunted by the realities that one out of every seven women is diagnosed with the disease in their lifetime; family history and good health often playing no role one way or another. The one common denominator for her friends was that they were able to even their odds against the disease as it was caught early; each with a strong prognosis for survival after early treatment. Inspired by her friends, Arasim decided this was not their fight alone. She wanted to do something to promote early detection vigilance in other women. So she participated with one of her friends, breast cancer survivor Marianne Colacray, in the Susan G. Komen 5K Race for the Cure in Boston in September. Yet she still longed to do something closer to home. She opted to organize a team, "New Milford Cares,'' for the Susan G. Komen 5K Race for the Cure to be held in Bushnell Park in Hartford on June 6. So far, Arasim said several area businesses have pledged their financial support and she has a few people who have offered to join her team, including a neighbor who was diagnosed with breast cancer last year. "It's personal for me,'' said 44-year-old Colleen Golembeski, Arasim's neighbor and the mother of two children Golembeski praised Arasim for stepping up to show solidarity for all women so that they get the information they need for early screenings and treatment options after diagnosis. She said she is glad she might be able to help "someone like me who is facing this challenge.'' To prepare for the event, Golembeski said she is walking on her treadmill and some other exercise so she will be able to either run or walk the course. Whether someone walks or runs the course matters little, Arasim said. Personally, she said she is training to run, but if more of her team chooses to walk, she'll walk. She jokes that she still has a long way to go to get in shape, "but I will. In truth, Arasim said, this race is far from a competition. It is a support for women with breast cancer even as it promotes education and research to thwart the disease that befalls 3,000 Connecticut women each year, Arasim said. "It really celebrates survivorship,'' Arasim said of the race that engenders thousands to line the streets cheering on the runners and walkers. So far, Arasim said she has been making rounds to local businesses about sponsorships and talking to friends and strangers alike about joining the team. One of her connections was with Denise Mariconda, a registered nurse who is the breast health navigator at New Milford Hospital's Regional Cancer Center. Mariconda has served as something of a cheerleader for Arasim's efforts as the hospital is a long-time recipient of grants from the Susan G. Komen organization. Earlier this month, the cancer center was awarded a $35,255 grant to offer screening mammography and lymphedema care to women 40 and older who are uninsured, underinsured, or medically under served in the hospital's eight-town region. Arasim said she expects the hospital will also field a team for the race. "My goal is saving lives and seeing a cure in our lifetime,'' Arasim said. Contact Nanci Hutson at (860) 354-2274. --------------------------------- http://www.emediawire.com/releases/lymphedema/podiatry/prweb2360324.htm LymphaCare to Exhibit Lymphedema & Wound Care Products at Podiatry Conference LymphaCare will be exhibiting home lymphedema pumps, as well as the new MOBILITY1™ IPC device at the the 60th Annual Region Three Podiatry Meeting in Atlantic City on April 29th-30th. LymphaCare is a leading provider and reimbursement specialist for home compression therapy used in the treatment of lymphedema, chronic venous insufficiency (CVI), wound care, and diabetic foot. New York, NY (PRWEB) April 30, 2009 -- More than 40 million Americans suffer from venous or lymphatic disorders, which represent an annual economic cost of over $8 billion of total expenditure on US healthcare. Other than lymphedema, the bulk of peripheral vascular disorder patients suffer from venous ulcers, CVI, DVT, and varicose veins. None of these chronic disorders is currently curable. LymphaPress PBS Pump Patient Sequential Gradient Compression Pump Therapy for lymphedema and venous insufficiency has been utilized for over 30 years throughout the world. Manufacturer's such as LymphaPress & Bio Compression Systems have helped pioneer and perfect this technology by utilizing a 4-12 chambered pneumatic sleeves to gently move the lymph fluid. These devices are recognized treatments and approved by Medicare and most insurance providers in the USA. Mobility-1™ IPC device is the latest compression technology. The Mobility1™ IPC was designed by a technology company in Israel. It is protected by two patents surrounding the use of kinetic energy to drive the pneumatic action, as well as the sophisticated internal mechanisms that allow for the pneumatic action to also be driven by a very small and portable compressor. The product will be the only one of its kind, allowing mobile patients to receive optimal therapy while maintaining their lifestyle, as opposed to being only home bound for treatment. It has been estimated estimated 4.6 million workdays are lost every year in the U.S. due to symptoms associated with CVI. CVI is a disease that affects the legs and is caused by non-functional valves in the leg veins. The normal venous system in the legs contains a series of valves that assist in returning blood flow to the heart. When the valves cease to function properly, blood may pool in the lower leg, leading to swelling, changes in skin color and, eventually, ulcerations near the ankle. Leg vein valve failure is, in many cases, caused by blood clots or vein enlargement due to hereditary causes. The swelling and ulceration is uncomfortable and often painful, making it difficult to move around. The most common treatments for CVI are palliative such as conservative leg rest and use of compression stockings and pumps. Lymphedema symptoms may consist of swelling, heaviness or tightness of the extremity, feelings of discomfort, or a chronic aching in the upper or lower extremities. Lymphedema of the legs may be present at birth, develop at the onset of puberty (praecox), or not become apparent for many years into adulthood (tarda). Some cases of lymphedema may be associated with prostate cancer or from other vascular abnormalities. In the lower extremity it will be unilateral or bilateral. If it is bilateral, one leg may be worse than the other. LymphaCare has been providing home compression pump therapy to patients and the medical community for nearly 15 years, and are a clinically proven and cost effective therapy. Treatment compliance is increased as patients can utilize the compression devices on a daily basis in the comfort of their homes. LymphaCare has seen a significant improvement with many patients, especially if conservative therapy such as compression stockings and elevation has been tried prior to receiving a pump. The discomfort, financial, or time constraints of conservative therapies may preclude a physician prescribing home compression therapy for many patients. LymphaCare has had a great deal of success obtaining the lymphedema pumps for patients for home use through Medicare, Aetna, Blue Cross, and most major medical insurance policies. LymphaCare is a national provider and billing and reimbursement specialist for compression therapy devices such as Bio Compression & Lympha-Press Sequential Gradient Lymphedema Pumps, and MOBILITY1™ IPC. LymphaCare compression therapy products can be found on our websites or by calling LymphaCare at 800-288-1801. ### Trackback URL: http://www.prweb.com/pingpr. php/U3F1YS1FbXB0LVNxdWEtRW1wdC1TcXVhLUNvdXAtWmVybw== See the original story at: http://www.prweb.com/releases/lymphedema/podiatry/prweb2360324.htm ------------------------------ Vest designed to aid mastectomy patients By MONICA GRAHAM Sat. Apr 18 - 5:16 AM Pictou County naturopath Dr. Gabrielle Kropp has designed a compression garment that reduces lymphedema in breast cancer surgey patients, but production depends on finding enough hospitals to buy them. (Monica Graham) A Pictou County naturopathic doctor can’t understand why a compression vest she helped develop to aid post breast cancer surgery patients isn’t being used in more hospitals. Known as a mastectomy vest, it is no more expensive than the bandages it replaces and patients have hailed it as a more comfortable alternative. That’s why Dr. Gabrielle Kropp wonders why no one else seems to be using it. "It works, but it will die because no one in the bureaucracy will buy it," she said, adding that she stands to gain nothing personally from the sale of the vests. "It’s hard enough for these women as it is to go through cancer, but then there is lymphedema," she said. "We only want to help them." Dr. Kropp developed the vest after she and nurse Joanne Cumminger, a cancer patient navigator at Aberdeen Hospital in New Glasgow, noticed an increase in the number of women suffering from edema, or swelling, after having breasts removed. The body produces lymphatic fluid in response to surgery, but breast surgery damages or removes lymph nodes that regulate its flow. Without compression by tight bandaging or some kind of garment, the fluid pools around the surgical site and appears as a fluid-filled sac on the chest, underarm, or arm, the doctor explained. The fluid may become infected and painful and if it is not treated the condition becomes permanent. "It’s manageable, but not curable," she said, adding the bra-like garment she and Ms. Cumminger designed can prevent patients from getting lymphedema. Made of a special, stretchable, breathable, latex-free fabric, the vest is soft and lightweight. It has wide shoulders, is cut high to support the underarm and allows for placement of padding over the surgical site. The shoulders and front hook-and-eye fastenings can be adjusted to suit the wearer. The garment comes in seven sizes. Dr. Kropp and Ms. Cumminger tried several commercial designs that did not work and were far too expensive, so they made several models themselves — fitting them on patients over and over until they got the best result. The effect was immediately noticeable. As well as reducing swelling, the garment made women "feel snug again," Ms. Cumminger said, adding that patients and surgeons received it well. "I did not have a lymphedema patient for a long time," said Dr. Kropp, who trained at a specialized lymphedema hospital in Germany before entering naturopathy 15 years ago. She currently practises in New Glasgow and Caribou. In 2004 they surveyed 35 post-mastectomy patients at the Aberdeen Hospital in New Glasgow in order to substantiate their findings. None of the subjects using the vest developed swelling, lymphedema, or infection. Among the patients using bandaging or dressings, 14 had post surgery swelling, six got infections, and six developed lymphedema. "That is dramatic," Dr. Kropp said. "It’s not just coincidence." She searched for a manufacturer, eventually finding a U.S. specialty company to sew the garments. In order to keep the individual price below $100, Dr. Kropp has to order 1,000 vests but the Aberdeen Hospital only does about 60 breast cancer surgeries per year and not all are complete mastectomies needing compression, Ms. Cumminger said. To meet the manufacturer’s requirements and to keep the price down, other hospitals need to join in, but persuading other health districts to use the garments has been more difficult. Once patients and doctors hear more about the vest’s success, they will demand them, Ms. Cumminger said. "The benefit to patients is all that matters," she added. ( mgraham@herald.ca) http://thechronicleherald.ca/forum/read/21/106258/106258#msg-106258 ------------------------------- CENTRAL TEXAS RUNNING: BROM HOBAN A long and painful journey to Boston ends with smiles Tuesday, April 28, 2009 Paul Carmona ran his 15th marathon a week ago in Boston. What made this one special was the decade- long journey to the finish line. Now 45, Carmona's running dates to his time on the Princeton rowing team in the 1980s. He later attended the University of Texas law school and he now works for the Texas attorney general's office as chief of the consumer protection and public health division. Over the years, career and studies left little time for exercise, and Carmona found himself weighing 215 pounds, up from 158 during his rowing days. An entry form for the Statesman Capitol 10,000 in 1996 caught his attention, and his interest in running was renewed. Soon, Carmona ran the 3M Half-Marathon in 2001 and then set his sights on the San Diego Rock 'N Roll Marathon. He ran San Diego in 3:31 and quickly decided he wanted to qualify for Boston, so he added more training miles. Qualifying for Boston separates the serious runners from the recreational ones, and Carmona, then 38, needed a 3:15:59 at the 2002 Austin Marathon to qualify. He missed it by seconds, with a 3:16:38. He ran more marathons but just couldn't get the Boston qualifier. Then a bout of Achilles' tendonitis turned him toward cross training, and then triathlons. It was during a triathlon that he incurred his most serious injury. It started as a staph infection in September 2003 during the Couples Triathlon, when heavy rains forced competitors to remove their shoes and run barefoot (or not run at all). "The mud would so heavily cake on our shoes that we literally could not run with them on," Carmona recalls. "I cut my foot and it got infected, and I ended up hospitalized." The staph infection responded to a course of antibiotics but returned that December. Carmona was hospitalized for four days and couldn't walk. He had swelling in his leg, and his doctor thought (correctly) that the lymph nodes behind his knee and groin were damaged from the infection. Carmona was told he couldn't run until there was no more fluid in his hip. Carmona thinks he may have started running again too soon. Barely a month after his hospital stay, he ran the Distance Challenge 30K, the 3M Half Marathon and then the Austin Marathon He also decided to start coaching, first at RunTex, then at Rogue Training Systems and now with the Twenty-six two Marathon Club. And he upped his running. In one 14-month span from November 2006 to January 2008, he competed in the Ironman Florida, the Houston Marathon, a 50-mile ultra run, the San Diego Marathon, Park City Marathon, Dallas White Rock Marathon and the Disney Marathon. It proved too much for the lymph nodes in his left leg, which had been compromised by the two infections. "Right after that, I noticed a swelling in my leg around my ankle, and it got to be kind of painful. The doctor knew it was the same leg that had the infection, and suspected lymphedema — a fluid accumulation around the lymph nodes, which was draining down to my lower leg," he said. The lymphedema diagnosis led to compression therapy, in which he had to wrap his entire leg in bandages and then wear a compression sock from foot to thigh and sleep with a foam cushion wrap. For Carmona, that therapy continues today. "It was a shock at first, realizing that my leg would never be the same," he said. But Carmona hadn't forgotten his dream, and he told his wife he was going to come out of it and run the Tucson Marathon and qualify for Boston with a 3:30. He started running again a year ago in May and ran an 11-minute mile. A 3:30 marathon was a long way off. He ran all through the summer, wearing the compression sock. He continued to coach runners and to read about training. He changed his diet, concentrating more on fruits and vegetables, and got his weight back again. And he gave it another shot. "I went to Tucson with a specific plan: break the race into five-mile sections, running each at 40 minutes," he said. "If I did it right, it would come out to 3:29:36. It worked to perfection. I ran 3:29:40 and qualified." Boston last week was a 26-mile victory lap for Carmona, who successfully paced his sister there to run under 3:56, with a 3:55 clocking. "Boston was a fantastic experience. It's everything that people tell you about," he said. But what Carmona will always remember was a guy he saw at the marathon expo at Boston — a double amputee with two spring prosthetics with running shoes on. "I saw a picture of him in the Boston Globe the next day," Carmona said. "His name is Richard Whitehead, and he ran 3:02:44, and I realized I may have a problem with my leg, but look at this guy ... ." Round-Up mixup The new route of the Texas Round-Up 5K on Saturday led to some confusion near the finish area. Although the USATF-certified course was accurately measured and correctly barricaded, several runners, including women's winner Chris Kimbrough, inadvertently cut a short distance off the course by stepping over a median strip dividing the eastbound and westbound lanes on 15th Street, yielding an advantage of 15 to 25 meters, which translates into a 5- to 10-second faster time. Kimbrough acknowledged that she cut the corner because she became confused about which lane to use after making the turn and at one point came to a complete stop. Kimbrough figures her 16:27 winning time would still put her well under 17 minutes, her goal for the race, even with the extra 15-25 meters. She was awarded first place despite taking the wrong side of the road. The next women's finisher was more than two minutes back. http://www.statesman.com/sports/content/sports/stories/other/04/28/0428hoban.html --------------------------------- http://www.philly. com/philly/health_and_science/cancer/20090423_You_ve_survived_cancer__Now_what_.html You've survived cancer. Now what? Facing the long-term side effects By STACEY BURLING Inquirer Staff Writer WHEN GWEN DARIEN was treated for non-Hodgkin's lymphoma 15 years ago, no one gave much thought to how she might feel if she lived. "Everything was focused on treating the disease and getting the cancer out of your body," said Darien, now director of survivor and patient advocacy at the Philadelphia-based American Association for Cancer Research. Long-term survival after cancer treatment was still so unusual that no one considered that the radiation and chemotherapy she received might cause side effects years later. No one talked to her about work or the psychological impact of her treatment. "Nobody talked to me about fertility," Darien said. "Nobody talked to me about potential long-term events." Increasingly, cancer experts are devising ways to warn patients like Darien - there are 12 million cancer survivors in this country - about problems their treatments or the cancer itself can cause later on. The information is crucial because primary-care doctors often do not connect a new heart or nerve problem to cancer treatment that occurred years ago. The "survivorship" phase is a hot topic. The Institute of Medicine pushed for greater attention to post- treatment needs in an influential report called Lost in Transition in 2005. Cancer centers are forming survivor clinics that help patients watch for new cancers and manage treatment-related symptoms. They are studying survivors' needs and improving coordination of care by cancer specialists and other doctors. "It's really a culture change that has to occur in terms of how patients view themselves, how providers view the patients they're following," said Linda Jacobs, director of the University of Pennsylvania's LIVESTRONG Survivorship Center of Excellence. In this region, a computerized survivorship program from Penn's OncoLink, a Web site devoted to cancer, recently got a big boost from the Lance Armstrong Foundation (LAF). The foundation will give $2.3 million over four years to OncoLink, which creates individualized treatment plans for survivors. Andy Miller, LAF's vice president of programs and policy, said OncoLink was ahead of the curve in creating survivorship care plans that many people can use easily. "What we've heard from survivors, this is what they need," he said. "This is what the Institute of Medicine is calling for." LAF is joining with Penn to market the computerized-care plan, which will be called the LIVESTRONG Care Plan Powered by Penn Medicine's OncoLink. "The reach of the Lance Armstrong Foundation is so great that we have an ability to get this out to many more people," said James Metz, a Penn radiation oncologist who is editor in chief of OncoLink. Patients need such reports, Metz said, because cancer care increasingly involves multiple types of drugs, often combined with radiation and surgery. It's saving lives, but patients need to be aware of the long-term consequences. "These treatments we give are the gifts that keep on giving," he said. "Toxicities can happen months, years, decades after treatments were given." At OncoLink, cancer patients can type in information about their cancer and treatments. The program generates a report outlining medical tests they should receive, possible side effects of their treatments, and what they can do to keep cancer at bay. Breast-cancer patients who have taken the chemo drug Adriamycin, for example, can later develop heart problems. People who have had surgery risk lymphedema, which causes tissue swelling, even years later. Many patients are unprepared for sexual and fertility problems that cancer treatment can cause. It doesn't seem fair, but if you have had one cancer, the report will tell you that you are more likely to get another one. Ellen Stovall, acting president and chief executive of the National Coalition for Cancer Survivorship, has been advocating for better care planning since 1994 and is still pushing Medicare to pay for the time- consuming work of producing good treatment summaries and care plans. Stovall's chest was radiated to treat Hodgkin's disease in 1971. In 2007, doctors found cancer in both breasts "along the fault lines" of her radiation treatment. She also has a type of blood-vessel damage often found in people who have received radiation. Stovall said she was "very excited" about the OncoLink project. "It's very easy to use," she said. "I really liked it." Darien checked out her OncoLink care plan earlier this month. She already knew that her chemotherapy could damage the heart. She has had gum problems she traces to her treatment. Much of the OncoLink care plan was old news to her, but she thought many patients who had just finished treatment would find it helpful. She had not previously heard of connections between her treatments and bladder cancer or blood-vessel and swallowing problems. She liked the section on chemo brain, the fuzziness many cancer patients say they experience after treatment. "It's wonderful to see that taken seriously," she said. Denise Shaw urged her husband, Bob, an esophageal-cancer survivor who was treated at Penn, to try the care plan. "I wanted him to see in print what some of these poisons they gave him to kill the cancer could do to him," the Drexel Hill woman said. The information was not a surprise, but she said she thought it was helpful for her husband to see in writing that his fatigue is likely a result of his treatment. About 5,000 people have tried the computerized plan since its debut in May 2007. Only about 12 percent had received any previous survivorship information. Carolyn Vachani, a nurse practitioner who works with OncoLink, spearheaded the project because doctors told her they had too little time and money to produce care plans for their patients. That left patients "out there with no information and experiencing these problems with no knowledge at all that they could be related to the treatment they received." A weakness of the system is that information about the long-term effects of cancer treatment in adults is spotty, said Patricia Ganz, a UCLA oncologist whose work has focused on cancer survivorship. OncoLink also is not precise enough about the treatment patients received to suit her. As a result, she says she finds the resulting care plans too generic, though improving. Ganz has been developing computerized programs that make it easier for doctors to give patients a precise record of all the treatments they have received, another key aspect of survivorship planning. It includes much more detail than OncoLink's care plan currently requires. The two complement each other, she said. OncoLink's program already is in its fourth version, and the Web site's leaders plan regular revisions. Ultimately, patients may have less need to go to places like OncoLink for survivorship advice. Penn, Fox Chase Cancer Center, and Cancer Institute of New Jersey all are developing or expanding nurse-run survivorship clinics that give patients similar information in person. E-mail sburling@phillynews.com or call 215-854-4944. ---------------------------------- http://www.newswise.com/articles/view/551720/ Professor Using Night Vision Technology to Learn More About Lymphatic System Libraries Medical News Keywords LYMPHEDEMA Description The director of the new Center for Molecular Imaging at The University of Texas Health Science Center at Houston is using near-infrared night vision technology made famous by American soldiers in the First Gulf War to shed light on the lymphatic system. Eva Sevick, Ph.D. Newswise — The director of the new Center for Molecular Imaging at The University of Texas Health Science Center at Houston is using near-infrared night vision technology made famous by American soldiers in the First Gulf War to shed light on the lymphatic system. While much is known about the blood system, Eva Sevick, Ph.D., who leads the 20-person research team in the university’s Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases (IMM), said that until recently comparatively little was known about the lymphatic system, which is a network of vessels that act as the body’s sewer system picking up excess debris and fluid from tissues. Unlike blood, lymphatic fluid is clear, which makes it hard to see. In addition, lymphatic vessels are so small that it is difficult to inject the amount of contrast agents needed for traditional Magnetic Resonance Imaging or X-rays. While lymphatic fluid can be seen with nuclear techniques, actual fluid movement is hard to observe because it typically takes several minutes to acquire an image. Sevick’s solution to these medical imaging issues was to inject micro amounts of fluorescent dye below the skin where the lymphatic system would sweep it up. Then with the aid of a small laser and a night vision camera designed to pick up small amounts of light, Sevick’s team was able to observe the dye move through the lymph system below the surface of the skin. This was possible because the night vision camera can acquire images in less than one second. “No one had ever watched this before,” said Caroline Fife, M.D., clinical associate professor of medicine at The University of Texas Medical School at Houston and director of clinical research for the Memorial Hermann - TMC Wound and Lymphedema Center. “This was like Christopher Columbus discovering America. Until now, we’ve never had a good way to study the lymph system. It felt like being a doctor before antibiotics.” When the lymphatic system is functioning properly, it picks up fluids that leak from blood vessels into the spaces between cells. As this fluid passes between cells it gathers cell waste and debris. The fluid is subsequently taken up by tiny lymphatic capillaries and propelled through lymphatic ducts and nodes until it is returned to the blood. The lymphatic system also contains immune cells named lymphocytes, which guard the body against invading viruses and bacteria. The lymphatic system is of particular interest to cancer specialists because malignant cells will often end up in lymphatic filters. “Lymph nodes filter out bacteria and tumor cells,” said Fife, noting that the lymphatic system processes six liters of fluid every day. Much like plumbing when it backs up, lymphatic drainage problems can cause fluid retention or swelling, which results in a condition called lymphedema. About one in 200 are born with lymphedema, according to the Lymphatic Research Foundation (LRF); however, most in the United States acquire it as result of surgery, infection or trauma that interferes with the lymphatic system. About 30 percent of breast cancer survivors develop lymphedema, the LRF states. While there is no cure, lymphedema symptoms can sometimes be treated with massage and compression bandaging. “The Center for Molecular Imaging is poised to develop and translate molecular imaging agents, instruments and computer algorithms for improving patient care in a variety of diseases,” Sevick said. “With our optical technologies, we could image disease before the onset of symptoms. We also investigate the impact of breast cancer therapy on lymphatic function in order to evaluate how long-term treatments impact quality of life for cancer survivors.” Sevick is working to translate her bench discoveries into patient care. With the approval of the U. S. Food & Drug Administration, the researchers in her lab have begun patient trials using this medical imaging technique, which could aid in the diagnosis and treatment of many diseases including those of the lymphatic system. In one trial, Sevick’s team is recruiting 18 subjects for a clinical study to determine the effect of an automated massage device on lymphatic flow in persons with lymphedema of either one arm or one leg. In a second study, her research team is evaluating the effect of genetic makeup in persons with hereditary lymphedema and acquired lymphedema. More information is available at 713.500.3561. Sevick is professor and Cullen Chair in Molecular Medicine at the IMM. Her research is supported in part by the National Institutes of Health and the Longaberger Foundation through the American Cancer Society. Prior to joining the IMM faculty in 2008, Sevick served as a professor of radiology at Baylor College of Medicine and led that department’s division of molecular imaging. Sevick earned her Ph.D. at Carnegie Mellon University and did postdoctoral work at the University of Pennsylvania. Her honors include the American Cancer Society Research Scholar, Sylvia Sorkin Greenfield Award, Fellow of the American Institute of Medical and Biomedical Engineering and DuPont Young Faculty Award. photos are available on request. ------------------------------ Superior Student Raises Money For Disease Research It was an exciting night for Meagan Barnard. She got to see her hard work pay off, and was feeling mostly pain free. "I'm in high heels for probably the first time in a year and a half," she said. Four years ago, the Superior High School senior was diagnosed with primary lymphedema. It's a condition where under developed lymph nodes cause severe swelling in her right leg. After nine months of therapy, she found out it was incurable. "Because of my leg, I've had to quit everything that meant the world to me," said Meagan. "Basketball, dancing--I mean I used to be there on the stage with those girls dancing. But instead of it, I coach basketball and I coach dance." For her senior project, Meagan organized a benefit dinner and silent auction to spread the word about lymphedema, and raise money for research. Her friends say she has gone above and beyond expectations, both with her project and in her daily life. "She's had some adversity, and she's really taken that in and owned it," said Eric Nordrum, another Superior High School senior. "Meagan is by far one of the strongest people I know." "She's a fighter," said Lee Nagorski, also a senior at Superior. "It's a condition that could put you down for the rest of your life as far as how you feel about yourself. And she has pushed past that and found a positive side to it." All proceeds from the event will go to the Lymphatic Research Foundation, a non-profit group seeking a cure for Meagan's condition and other lymphatic diseases. "Trying to make everything work out and find a cure," Meagan said. "That's my whole goal." As part of that same project, Meagan also started a magazine dedicated to people with uncommon conditions. She says she's hoping to make it a semi-annual publication. http://www.wdio.com/article/stories/S896044.shtml?cat=10349 ---------------------------- Wound care: Giving your body's healing powers a helping hand Published: Monday, April 27, 2009 By Dr. Dennis Monteiro, Pottstown Memorial Medical Center Have you ever watched a scar heal and marveled at the power your body has to repair itself? Or worried over a cut or sore that simply won't go away? The body's ability to heal after illness or injury is a complex process. Many chronic diseases or conditions can compromise our body's restorative capabilities. Unhealed wounds can not only diminish quality of life, but also raise the risk of additional infection and complications. For this reason, wound care is a critical part of disease management or surgical recovery - and a growing medical specialty. Approximately 5 million Americans suffer from chronic wounds that will not heal or heal slowly, from accidents, burns, surgery or disease. Chronic wounds are most often found among the senior population, patients who are bed-ridden, and those who suffer from diseases that affect the circulation and skin, such as diabetes or peripheral artery disease (PAD). According to the Centers for Disease Control & Prevention, diabetes affects 23.6 million Americans or 7.8 percent of the population, and one-third of all diabetics suffer from lower extremity wounds or PAD. These wounds increase the likelihood of foot problems and the potential for amputation. Other conditions that can lead to slow-healing wounds include traumatic injury, complications after surgery, congestive heart failure, lymphedema, and compromised immune systems, including HIV or AIDS infection. Many hospitals have a wound care team, center or clinic, with specialists trained in advanced therapies that help to speed the healing process and promote or rebuild skin integrity. Chronic wounds that are treated in this way include diabetic skin sores, pressure sores, persistent skin irritations, peripheral arterial disease, surgery wound breakdown, traumatic wounds, burns, venous insufficiency, radiation injuries, spinal injury wounds and other non-healing wounds. Many of these wounds become problematic due to limited blood flow in the area, which can slow the body's healing process. Some patients may require treatments that differ from the standard. Wound care treatments may include dressing changes, hyperbaric oxygen therapy to invigorate oxygen-starved tissues and promote healing, and wound debridement (removal of dead tissue). These specialized therapies are administered in conjunction with other medical or surgical treatment for the skin condition. A patient's doctor generally refers a patient to a wound care team or treatment center where specialists evaluate the wound and review the patient's health and medical history. Tests may be conducted to learn more about the patient's blood flow and tissue oxygenation, as well as determine if there is any infection. The team then develops a treatment program based on the patient's individual needs and is part of the patient's comprehensive medical treatment with the primary care doctor. Once the wound is healed, follow-up care is important and should be in conjunction with any care the patient may be receiving for the condition that originally caused the wound, such as diabetes or hypertension. For more information about wound care, visit www.pottstownmemorial.com or the American Diabetes Association (http://www.diabetes.org/home.jsp). Dr. Dennis Monteiro is a member of the medical staff at Pottstown Memorial Medical Center and co- medical director of the Wound Care Center at PMMC. He is a graduate of Jefferson Medical College and both his internship and residency programs were completed at Graduate Hospital. He served a fellowship in plastic surgery at the Hospital of the University of Florida. Monteiro is board certified by the American Board of Plastic Surgery. He is in practice with Plastic Surgery Specialists, PC, 420 W. Linfield-Trappe Road, Limerick. http://www.pottsmerc.com/articles/2009/04/27/life/srv0000005184585.txt ------------------------------------- Bethpage's Schessler copes with lymphedemaBY KIMBERLEY A. MARTIN | kimberley. martin@newsday.com 10:53 PM EDT, April 20, 2009 Curious eyes often watch Jordan Schessler. But she doesn't mind. In fact, she welcomes the stares, the puzzled looks at her tan-colored knee-highs. "People have said, 'Look at the girl with the funny socks.' . . . When I go to Six Flags, I count the stares. It's almost like a game between me and my friends," the 17-year-old Bethpage junior said, laughing. "If someone is looking, I'll say, 'Would you like to know what it is?' And often times, people are like, 'Yeah.' " At the age of 9, Schessler's feet began to swell, turning dark shades of red and purple. But doctors couldn't explain why. "It was annoying and upsetting that most doctors don't even know what it is," she said. "There was a lot of confusion. You didn't know where to turn." A year later, Schessler was diagnosed with lymphedema, a condition that often causes swelling in both the arms and legs because blockages in the lymphatic system prevent lymph fluid from draining properly. As a result she must wear compression stockings and toe socks at all times - except when in the shower - to prevent swelling. But the condition hasn't hampered her playing ability. The centerfielder is batting .571 (24-for-42) for the Golden Eagles (4-3 ABC-II), and she also plays for the Long Island Bandits 18-under Gold travel team. "My feet go to sleep sometimes in the outfield. I can be running and moving, but my feet may be asleep," Schessler said. "But I just ignore it. I don't let it stop me. I don't like when people use that excuse." She has to change her garments twice a day and do half-hour elevation exercises, where she lies on her back and flexes her legs in and out, each morning and night to help circulate the fluid in her legs. "I try not to think about being an old woman trying to put these garments on. Now I'm mobile and flexible, so it's no problem. I'm actually more uncomfortable without them because I start swelling immediately," she said. "I would love to be the guinea pig if there was ever some cure treatment because someone has to be it." But rather than feel sorry for herself, Schessler says she prefers to raise awareness about lymphedema. "When I was first diagnosed, it was upsetting," she said. "But I've come to the realization that I am going to have it for the rest of my life. So now I'm just trying to act like an advocate." With the help of Bethpage social worker Christine Kennedy, Schessler organized "Scavenger Hunt for a Cure" in February to raise money for lymphedema research. The one-hour event after school generated $1,000, which she donated to the National Lymphedema Network. The more stares Schessler encounters, the more opportunities she gets to educate. "Everyone knows what the yellow 'Livestrong' bracelets are about," said Schessler, who also plays varsity volleyball. "The rubber bracelets we have say, 'We Are Here' because it's unknown. But at least in my school, it's very well known." http://www.newsday.com/news/health/ny-skcove2112676253apr20,0,7219223.story?track=rss ----------------------------------------------- http://www.cantonrep.com/lifestyle/advice/x1092980194/Family-Doctor-Orthopedic-massage-may-help- frozen-shoulder Family Doctor: Orthopedic massage may help frozen shoulder -------------------------------------------------------------------------------- By Peter Gott, M.D. United Media Posted Apr 25, 2009 @ 12:00 PM -------------------------------------------------------------------------------- Q: With regard to your column about “frozen shoulders,” I would like to recommend an alternative treatment, orthopedic massage. My 49-year-old husband had a frozen shoulder for 24 years. His right shoulder would go no further than 90 degrees laterally from his body. Ten months ago, he volunteered to be a “demo” for my massage class, and his frozen shoulder was completely cured in less than 15 minutes, no cutting, no drugs, no anesthesia and no pain. The instructor said that it sometimes takes two sessions. My husband did follow-up self-care exercises for about a month, but hasn’t done any since and still has full range of motion. My 82-year-old mother-in-law has also benefited from orthopedic massage. She had chronic pain (to the point of tears) despite taking Ultracet twice a day. She could only walk short distances with a walker. She received orthopedic massage once a week from my instructor and three times a week from me, and, in a couple of weeks, her pain was tolerable. Within a few months, she was off all pain medication and no longer needed a walker. It has been eight months, and she still receives massage three times a week, but she’s happy to be off the pills and able to enjoy life again. I have been a registered nurse for 28 years and was a director of nursing at a long-term-care facility for five years. I now work for a health-insurance company. I originally took the 600-hour massage-therapy training class as a fun bonding experience with my youngest daughter, who wanted to be a massage therapist. To be an orthopedic massage therapist, you must undergo special training. What was supposed to be just a bonding experience has turned into something else. I never knew that so many people who have pain issues could be helped with this simple therapy. Please let your readers about this amazing therapy. A: You have provided two positive cases for this therapy. However, as I am sure you already know, there are several instances where this therapy can cause more damage than good. While many orthopedic conditions, such as muscle or ligament strain, can be treated successfully with massage, there are instances where more serious conditions can mimic the benign symptoms. Heart attack and stroke can cause muscle pain in some sufferers, so it is vital that the therapist be trained to tell the difference. Certain cancers can also be caused to spread by massage therapy. It is also vital to have a properly trained masseuse, because improper technique can lead to problems such as lymphedema. In this condition, the lymph fluid accumulates in the extremities (usually the legs). Lymph fluid flows through the body similarly to blood. If damage is done to a blood vessel, bleeding, bruising and more can occur. With the lymphatic system, the fluid often backs up and accumulates in the tissues leading to swelling, pain and more. I believe this is an appropriate option for people who have persistent pain due to muscular or joint problems. I urge anyone interested in pursuing this avenue of treatment to speak first with his or her physician to discuss whether this is a viable option for the specific condition to be treated. If it is, then it’s time to do homework. In order to get the best treatment, pick an orthopedic massage therapist who has documentation of certification, noting where and how long they trained. Also, if possible, ask for references and speak to past or present clients. --------------------------------------- http://professional.cancerconsultants.com/oncology_main_news.aspx?id=43432 Sentinel Axillary Node Biopsy: Results of a Randomized Trial Reported Researchers from Italy have reported the results of a randomized trial that confirms that sentinel lymph node biopsy with axillary lymph node dissection performed only for women with a positive biopsy does not compromise outcome in women with localized breast cancer. The details of this study appeared in an early online publication in the Annals of Oncology on January 27, 2009.[1] Axillary lymph node dissection is the traditional method for staging women with clinically localized breast cancer. Unfortunately, the removal of axillary lymph nodes (approximately 25 nodes) is associated with chronic side effects, including pain, infection, limited shoulder motion, numbness, and lymphedema. Because these complications can become debilitating, sentinel lymph node biopsy has emerged as an alternative method of staging and is currently being used in most medical centers treating breast cancer. When performed appropriately, there is a 95% correlation between the results of sentinel node biopsy and lymph node dissection. There is also emerging evidence that women who have microscopic positive lymph nodes and receive adjuvant chemotherapy and/or adjuvant hormonal therapy may not benefit from removal of affected nodes. Although sentinel lymph node biopsy has become an accepted practice, there have been few randomized trials to confirm this approach to treating localized breast cancer. The Italian study began in 1998 and randomly allocated 115 women with localized breast cancer to have an axillary lymph node dissection and 110 to have a sentinel lymph node biopsy with an axillary lymph node dissection only if positive. A positive sentinel lymph node was found in 27 patients assigned to axillary lymph node dissection and 31 in the sentinel lymph node biopsy arm of the study. Overall accuracy of sentinel lymph node biopsy was 93%. At a median follow-up of 5.5 years, no axillary recurrences occurred in women undergoing sentinel lymph node biopsy. Overall and event-free survivals were not different between women undergoing sentinel lymph node biopsy and women undergoing primary axillary lymph node dissection. Comments: This is one of the few randomized trials with a long enough follow-up to confirm the relative effectiveness of sentinel lymph node biopsy in women with a clinically negative axillary lymph node status. One of the main unresolved issues is whether or not women with microscopic nodal disease receiving adjuvant therapy benefit from an axillary lymph node dissection. Reference: [1] Canavese G, Catturich A, Vecchio C, et al. Sentinal node biopsy compared with complete axillary dissection for staging of early breast cancer with clinically negative lymph nodes: results of a randomized trial. Annals of Oncology [early online publication]. 2009; January 27. ----------------------------------- DEAR STACY: Whatever became of actress Joanne Dru? — C.D., Kearny, NJ DEAR C.D.: Dru, best- known for such films as "She Wore a Yellow Ribbon" and "All the King's Men" died in 1996 at age 74, of lymphedema. She was survived by her son and two daughters from her marriage to Dick Haymes, and by her younger brother, former "Hollywood Squares" host Peter Marshall I also found only one further paragraph anywhere that explained anything else about the reference to lymphedema and her death, though I did find it on a couple of different sites : Biography: Joanne Dru (January 31, 1922 - September 10, 1996) was an American film actress. She also was the sister of actor Peter Marshall, best known for being the host of "Hollywood Squares." She died in Los Angeles, California at the age of 74 from lymphedema, a disease "which is especially common after surgery or radiation therapy were used in combination to treat cancer", which indicates that she probably had undergone these treatments for cancer (likely breast cancer) prior to her death. found at: http://www.mysticgames.com/famouspeople/JoanneDru.htm ---------------------------------- Massage Therapy works for cancer patients, too May 1, 2009 by Bill Eagle photo by Gloria Eagle It is always a pleasure to do stories about people who help others and Jeni Quiriconi makes a living being helpful. Jeni is a licensed massage therapist of over ten years. My wife and I visited Jeni. Her shop is located on 9th Ave in a quiet residential section of Longview; she calls her business “Heartsong Massage.” Jeni greeted us. She was slim and tall, and seemed to radiate energy. I asked Jeni how she became a Massage therapist. “I originally was in the Army Signal Corps,” sparkled Jeni. “I worked with mainframe computers. I was on active duty for 7 years. Thanks to the Army, I earned a BS in Business Administration at the University of Central Texas. At that time I thought I wanted to be a CPA. I even worked a while in Hawaii as an auditor.” Jeni smiled and looked intently at my wife and I. “Ever since I was a small child, I have always liked touching people…I could not keep my hands off of them. I used to give friends massages, and I seemed to be able to help people feel better. I started to think that it might fun for me to make a healthier, happier life change. I thought it might be the right time for me to consider becoming a massage therapist. I moved from Hawaii to Portland and enrolled in the East West College of the Healing Arts. I graduated in December of 1998.” I told Jeni that I heard that she worked with cancer patients. Jeni said: “About 10% of my customers are cancer patients. When I first graduated from school there used to be a prohibition against working with cancer patients.” I asked Jeni. “This prohibition no longer exits?” “That’s true,” replied Jeni. “Science has changed how we view cancers. We have found that massage increases circulation. Increased circulation does not cause cancer to spread. If it did, Lance Armstrong would have died a long time ago.” I nodded in agreement and Jeni continued. “Massage controls pain, controls stress, and replaces noxious stimulation messages that people can get from being treated for cancer. It gives compassionate touch and reduces the sense of isolation that cancer patients often face.” I asked Jeni if she works with the local hospital. Jeni replied: “I used to volunteer at “Our House of Portland” where I worked with AIDS patients. I did that almost immediately after I left school. I made a similar offer to our local hospital, but they seemed reluctant. They seemed to think that if they allowed me to volunteer, they would appear to be endorsing me and/or my business.” I raised my eyebrows. “Could it be that the medical establishment might be afraid of being accused of endorsing ‘Alternative Medicine?’” Jeni looked directly at me. “Alternative Medicine? We were around first.” The origins of massage go back to well before 3000 BC. According to Wikipedia: Writings on massage have been found in many ancient civilizations including Rome, Greece, India, Japan, China, Egypt and Mesopotamia. A biblical reference from C.493 BC documents daily massage with olive oil and myrrh as a part of the beauty regimen of the wives of Xerxes (Esther, 2:9-12). Hippocrates wrote in 460 BC that “The physician must be experienced in many things, but assuredly in massage.” Other writings seem to indicate that both India and China started practicing massage prior to 3000 BC. Tomb paintings in Egypt depict individuals being kneaded by others. Furthermore, Egyptians are credited with creating reflexology as early as 2500 BC. Jeni shares some patients with an acupuncturist and often receives referrals from medical doctors and chiropractors. Jeni will, at times, refer patients back to doctors. “I know where my skills end, and I know that I can’t help everyone.” Jeni is presently working with people who suffer from consequences from cancer therapy such as Lymphedema. Lymphedema is what happens when the transport system for lymph is disrupted by radiation treatment. Jeni has a webpage: “Healthcare that feels good.” http://www.heartsongmassage.biz/ According to her webpage: Jeni has worked with a wide range of clients and patients including infants and people with lupus, cancer, HIV AIDS, Alzheimer’s, and fibromyalgia. Jeni has much experience working with automobile collision injuries and is a Washington State Dept. of Labor and Industries health care provider. Heartsong Massage is also a preferred provider for Blue Cross, Aetna, the Uniform Medical Plan, American Specialty Health and other insurance companies. Jeni is licensed and certified by both the states of Oregon and Washington. As part of the certification process, she was required to pass both written and hands on tests. She is also required to complete 15 hours a year continuing education to maintain her certification. Jeni considers her profession a ‘calling’. She told us: “Massage has given my life a sense of purpose and meaning I never had. I am honored and privileged to be allowed to have such closeness with people. I can’t see anyone not having a massage. We even work on people who are dying, people who have just a few hours left. It is good to help people relax, and give them some comfort. People need a personal touch, a little bit of warmth…Our hands can become marvelous transmitters for loving kindness.” It is always a pleasure to write about people who help others and Jeni Quiriconi is that sort of person. If you are interested in reading more about Massage: Massage therapy foundation: www.massagetherapyfoundtion.org Searchable database National Society of Medicine: www.pubmed.gov America Massage Therapy Association: www.amtamassage.org/ http://www.valleybugler.com/2009/05/massage-therapy-works-for-cancer-patients-too/ ----------------------------------------------------------------- Let me tell you a little about a side effect called lymphedema Published: Sunday, May 10, 2009 By Ann DeMatteo News Let me tell you a little about a side effect called lymphedema Published: Sunday, May 10, 2009 1 comment(s) | Email to a friend | Print version | ShareThis| RSS Feeds By Ann DeMatteo I’ve been lucky, in this breast cancer battle, to have been educated about the side effects because of the women who’ve suffered before me. After I was diagnosed almost a year ago, my friend Mary Hayashida, who had breast cancer 20 years ago, warned me about something called lymphedema, swelling that occurs when you lift something too heavy or get an infection in the arm from which lymph nodes were dissected. I learned a little bit more about lymphedema from Quinnipiac University physical therapy doctoral candidate Ashley Glenn, who helps breast cancer patients keep lymphedema at bay through a gentle exercise program known as the Lebed Method. (Congratulations to Dr. Ashley, Miss Connecticut 2008, as she receives her well-deserved diploma today.) And, I also learned along the way that if one is obese and has lymph nodes removed as part of breast cancer treatment, the risk for lymphedema is higher. So, I automatically expected that the combination of my rotundity and continuing breast-cancer-related bad luck would bring it on. Almost immediately upon getting radiation — which thankfully was completed on Thursday — my underarm flab started to feel heavy, and the right side of NuBoob, where it meets the armpit, felt swollen. I mentioned this to my radiation technologists, Roseann Perito and Shalene Neeman (miss you guys already), and reported my suspicions to Dr. Joseph Cardinale and nurse Vanna Dest, who take care of me at the St. Raphael’s Father Michael J. McGivney Center for Cancer Care. Dr. Joe and Vanna agreed, and off I went to the Therapeia Lymphedema Center in Hamden for an evaluation. Owner Linda M. Hodgkins measured my right arm versus my left arm and determined that I was in the early stages of lymphedema. So, after the compression sleeve and glove Linda ordered for me arrived, I started my wonderful week of water withdrawal with occupational therapist Janice Catrone. Janice, Linda and Kelly Hochstetler are certified lymphedema therapists through the Lymphology Association of North America. They believe that the treatment they give is part of wellness and recovery for cancer patients, and they are proud of the relaxed, spa-like, family atmosphere they provide. Let’s back up a bit. What is lymphedema? The lymphatic system is made up of a network of vessels that remove fluid, protein and waste from the body. When these vessels or the lymph nodes are removed or damaged, waste fluid begins to accumulate, causing swelling known as lymphedema. The condition usually occurs in the arms or legs but can show up anywhere. Besides occurring after radiation therapy or surgery, it can also occur after an injury, infection, or as a result of obesity or a genetic condition. It can occur soon after or many years after cancer surgery. The guesstimate is that 30 percent of women with breast cancer will have lymphedema in their lifetime because the lymph nodes that remain may not be sufficient to drain the fluid daily. The guesstimate is as high as 40 percent if the person gets radiation. So, if you’re feeling tightness, stiffness, heaviness, fullness or discomfort in your chest, upper back or armpit following surgery, then you probably need to get checked out for lymphedema. Linda and Janice had been occupational therapists at Gaylord Hospital who were treating outpatients, some for lymphedema. About 4½ years ago, Linda started her practice because she "wanted to follow the standard of care and create an environment unique from a hospital setting." Lymphedema treatment started in Europe in 1936 and came to America in 1985. Most Connecticut hospitals have trained lymphedema therapists and there are one or two other private practices in the state. I can attest that it works. In the week that I was treated by Janice, I lost fluid in my arm and chest, and now have to wear a compression sleeve and glove daily so that the fluid doesn’t build up. The therapy included gentle skin stretching along the neck, breast area and abdomen, and Janice gave me a daily at-home guide to follow. It was also fun to get to know Janice, a cheerful, caring therapist. And, she now knows more about me than any human would want to. But, as she says, everyone who crosses the threshold at 3074 Whitney Ave., is family. And, you get a free cup of coffee on the way out. What can be better? ‰On another note, I wanted to say happy Mother’s Day to all and to mention a fundraiser and two health- related items. ‰The CUREChief Foundation will be holding a fundraiser at 7 p.m. Saturday at the High Lane Club in North Haven. For more information, call (866) 868-2873 or e-mail founder Sandy Centorino at sandy@curechief.org. ‰The Jewish Community Center of Greater New Haven wants to start a 10-week fitness plan for breast cancer survivors. Group classes will be tailored for different surgeries and fitness levels. "The Pink Program" is the only breast cancer recovery program approved by the American Council on Exercise. For details, call Susan Donovan at (203) 387-2522, ext. 265. ‰"Are Your ‘Fat’ Pants Too Tight?" is the name of a June 9 program presented by my friends at the New Haven Hair and Skin Studio in North Haven. It will benefit the Get in Touch program and will be an informative and interactive presentation about health and nutrition with the Transitions Lifestyle System. It will be hosted by Kristin Huffman, a former Miss Ohio and runner-up to Miss America and Broadway performer, and Nutraceutical consultant Andrew Reimann. More info? Call (203) 776-6447. Ann DeMatteo can be reached at (203) 789-5716. http://nhregister.com/articles/2009/05/10/news/doc4a04dea1d0c86019264220.txt --------------------------------------- MEDICALLY SPEAKING: Lymphedema clinic helps patients cope with cancer treatment side effect By Dr. Anthony Jennings Tuesday, May 12, 2009 3:14 AM CDT You know that your lymph nodes swell when you get an infection, but do you know that they're just part of the lymph system, which is responsible for moving excess fluid and proteins from the tissues to the bloodstream? Usually the lymph system functions well, but it's not infallible. When the lymph system is damaged or blocked, fluid builds up and results in swelling. This is called lymphedema. One of the most common triggers for lymphedema is cancer treatment, and as much as 30 percent of breast cancer patients develop lymphedema of the arm and hand. "Radiation treatments or scar tissue due to surgery can disrupt the lymph system," says Melissa Thess, PT, a lymphedema therapist. Thess works in the new Lymphedema Clinic, developed by SSM Rehab, in the SSM Cancer Care building on the campus of SSM St. Joseph Hospital West. While cancer treatment is one of the main culprits causing lymphedema, it may also occur in the legs if an individual has poor vascular flow because of diabetes, smoking, obesity or genetics. Thess uses a combination of approaches, customized for each patient, to help control lymphedema. "Lymphedema can't be cured, but it can be managed," she says. Thess' tools include exercises, manual lymphatic drainage (a type of massage therapy), range of motion and strength training, and pain management. She also educates patients about how to care for their skin in affected areas, which is important for avoiding infections, and advises them on the use of compression garments or bandages to prevent further fluid buildup. "Lymphedema can cause patients to experience trouble moving their joints, difficulty wearing regular clothing, and uncomfortable sensations of skin tightness, itching or burning that can disrupt sleep," she says. "But by using one or more therapeutic approaches, we can minimize and control the symptoms, which is very important for helping people achieve the best quality of life possible." A report presented at the American Association of Plastic Surgeons annual meeting this month identifies a new microsurgery procedure that can "reduce the fluid buildup in women with lymphedema by 25 percent to 39 percent in a year." The procedure reroutes lymph fluid to open vessels, enabling it to drain. If the procedure continues to show positive results, it could become another type of standard treatment. However, the best approach is prevention, and Thess also works to help cancer patients avoid lymphedema in the first place. Preventive measures include protecting the limb from any type of injury or trauma, avoiding strenuous activity while recovering from surgery or radiation therapy, avoiding heat and tight clothing, and elevating the limb. If you or someone you know has lymphedema and would like to schedule a consultation with Thess at the Lymphedema Clinic, call 636-695-2070 or 636-498-7474. Help is available to ensure you return to health and well-being as soon as possible. Dr. Anthony Jennings is director of the Department of Emergency Medicine at SSM St. Joseph Hospital West in Lake Saint Louis. He is board-certified in emergency medicine and is a fellow of the American College of Emergency Physicians and is president-elect of the American College of Osteopathic Emergency Physicians. http://suburbanjournals.stltoday.com/articles/2009/05/16/stcharles/news//0513stc-jennings0.txt ------------------------ The sky's the limit for Superior teen fighting debilitating disease Wed, 05/06/2009 - 9:10pmCommunity Health Twin Ports By Nicolette Helling, FOX 21 News SUPERIOR - Nearing the end of her freshman year at Superior High School, Meagan Barnard was ready to conquer the world. But one year was all she would get before her ideas about a normal high school experience were turned upside down. "When I was thinking about my high school years I was thinking about, you know, prom queen, homecoming queen," said Meagan. Meagan woke up one morning with swelling in her right leg. It was gone the next day, but then came back. It kept coming back until it stayed and Meagan spent the next five months seeing doctors. She was finally diagnosed with lymphedema in December of her sophomore year. "When they told me, the Mayo Clinic told me, that it was not going away, that was when everything actually came clear to me that I was going to live with this for the rest of my life," said Meagan. Her diagnoses means the lymph nodes in her right leg cannot drain fluid adequately. Fluid goes in, but it doesn't come out. The devastating realization that her illness was chronic and incurable brought Meagan to a new low. "My personality definitely changed from it. Everything about me changed," said Meagan. Meagan says she used to be critical of other students wearing sweatpants to school, but now that her leg was swollen, regular pants caused her pain. "To stay away from the pain it was either, look nice and have pain, or just be underdressed and not have to worry about my leg so much," said Meagan. Dressed in clothes she hated, Meagan went to school everyday feeling different. Family members say she never wanted to talk about her disease. "We didn't realize how sensitive she was to it," said Meagan's sister Kaitlyn Barnard. "So it was hard for everybody." As the months passed, Meagan continued to change. She stopped playing basketball because the running caused her leg to swell. She stopped dancing and twirling baton because the costumes revealed her leg. She even stopped hanging out with friends as much as she used to. "I just kinda felt like, at 15 years old my life was over," said Meagan. As her painful junior year faded into summer and summer into fall, Meagan began preparing for her senior year. Most teenage girls enjoy shopping for back to school clothes, but Meagan was constantly reminded of her condition in every store. "I've never been able to go and look for pants or look for bottoms," Meagan said. "I always buy tons of shirts but I have nothing to wear them with." Beyond frustrated, Meagan stayed up late that night searching the internet for clothes that would fit her. At midnight, Meagan found a website that caught her attention. She read about a company that made clothes for people with broken bones, amputees and for people with lymphedema. But as Meagan continued searching The Cast Clothing Company's website, her heart sank when she noticed there were no clothes for young women. She wrote the company's president and the response she received changed her life. Mike Harding is the president and founder of The Cast Clothing Company in Palm Springs, Florida. When he read Meagan's late-night plea for help, he knew he had to act. "It was all about giving her something that she can feel good about," said Harding. "It was about taking away the self-consciousness that she's went her whole high school career with and giving back the dignity that's important to all of us. We all take clothing for granted. We don't have anything wrong so we take it for granted. Well these people, they need it." Harding asked Meagan what she liked and what she wanted to wear. A few weeks later, she received a pair of custom-made jeans. "They're exactly what I like to wear," said Meagan. "And you can't even notice that I'm wearing cast clothing. So, it's amazing." Meagan was in jeans heaven. "I wanted it to look as much like everybody else is wearing as possible. I didn't want the focus to go to my leg," said Meagan. "When they sent me my first pair of jeans it kinda like made me realize that I can overcome things." A year later, Meagan's life is completely different thanks to that first pair of jeans. "It made me think, well maybe I can do sports again, maybe I can do everything else that I've let go of," said Meagan. "So they kinda gave me that little bit of courage to try harder and to work around things." Meagan started looking forward to the future, instead of being frightened by what her disease had in store for her. Meagan decided to start playing recreational basketball. Then, she started coaching younger dancers at the same studio where she used to dance. But one final hurdle sat in the way of Meagan's graduating and moving on: a senior project. With new found courage and optimism, Meagan decided she wanted to learn more about the disease that had changed her. Working with The Cast Clothing Company, Meagan decided to create a magazine that would provide the same kind of information she had needed so badly. "Right now in the media it's, fit in, look this way, be beautiful, and if you have an abnormality you definitely don't fit that description," said Meagan. "I think that's pretty much why I started it because I was like, I needed this, I needed this tool to help me." But after working on the magazine for five months, Meagan realized it wasn't enough. "Learning about all of the things that I'm going to have to face if there isn't a cure, scared me. So I was like, what if I threw a fundraiser?" The same young woman who had been stalled and side-tracked by lymphedema was now enthusiastic about finding a cure. At her fundraiser last month at Superior Middle School, Meagan, the girl who never wanted to talk about her condition, took the stage to tell others how far she had come. Her benefit for lymphedema was a success. "That night it just clicked, that people actually saw that this was going to help them," said Meagan. The disease that had caused her so much pain is now pushing Meagan to bring healing and hope to others. And in the process, Meagan is healing. "It made her realize that she can make a difference and that's made her feel like she has more of a place in this world," said Meagan's sister Kaitlyn. Meagan says the journey from freshman to senior year has taught her how to look for the positive in the most negative of situations. "I don't have cancer. I don't have something that's going to kill me," said Meagan. "I do have something that has no cure, I don't know how I got it or if it will ever go away, but it could be a lot worse. And so I like to try and think that way, and it makes my problem seem a lot smaller." By the age of 18, Meagan Barnard has learned that no problem is without an answer and no illness is without the possibility of healing. Meagan's fundraiser raised more than $3,000, but she continues to receive donations from people who have heard her story. She hopes to raise a total of five thousand dollars before writing a check to the Lymphadic Research Foundation. If you would like to help Meagan find a cure for lymphedema, email her at Meaganbarnard@ymail.com. -------------------- Moves combat lymphedema Lisa Newman • Special to The Clarion-Ledger • May 12, 2009 Side Tricep Extension with Lateral Leg Lifts ... Purpose: The Steel Magnolia series is designed to raise awareness for breast cancer while providing support and hope for those who have been diagnosed. It is believed that gradual progression of flexibility and resistance exercises can help survivors regain their normal range of shoulder and arm movement. Working out may help prevent lymphedema by pumping lymph fluid out of the arm through the undamaged lymph vessels. Plan: The sixth exercise of the Power and Perseverance combination in the Steel Magnolia fitness series is the alternating side tricep extension with lateral leg lifts. This exercise works the arm and shoulder, helping with lymphedema, and strengthens the hip/buttocks area. Start with your feet shoulder- width apart and dumbbells (1-5 pounds) in the hands. You can use an ankle weight (1-5 pounds) on each ankle for added resistance to better shape the buttocks and thigh muscles. Inhale to start, then exhale while lifting one leg out to the side in combination with extending the same arm or opposite arm for a counter balance. Inhale returning to start, then exhale to rest 3-5 seconds or repeat combination sequence 1-2 set of 10-15 repetitions. PERFIT Trainer's Tip: Try to stay upright through the core (torso and spine) with movement. Think tighten tricep and lift upward with the heel. Variations: Depending on tolerance, use no resistance to ensure that the arms/shoulders are ready and capable of the exercise range of motion. Progression with resistance should be gradual. POWER Points to Ponder: "Never, ever, ever, ever, ever, ever, ever give up!" Lisa Newman is a personal fitness trainer, exercise physiologist and owner of Perfit Inc. E-mail questions to perfitlisanewman@aol.com. http://www.clarionledger. com/article/20090512/HEALTH/905120322/1242/health/Moves+combat+lymphedema ---------------------- Team Tracks Nanotube Cancer Killers in Live Tissue CANCER, NANOTECHNOLOGY, LASERS, IN VIVO. Description Collaboration between scientists at medical school and nearby metropolitan campus in Arkansas detected, tracked and killed cancer cells in real time in living system with carbon nanotubes. Newswise — Nanotechnology scientists at two Arkansas research institutions have developed a method of detecting, tracking, and killing cancer cells in real time with carbon nanotubes. The discovery opens the prospect of a new, major front in the fight to eradicate cancer with promise for a new generation of cancer treatment beyond surgery, radiation, and chemotherapy. Dr. Alex Biris, University of Arkansas at Little Rock (UALR) chief scientist at the Nanotechnology Center and assistant professor of applied science in University's Donaghey College of Engineering and Information Technology, and Dr. Vladimir P. Zharov, professor and director of the Phillips Classic Laser and Nanomedicine Laboratories in the University of Arkansas for Medical Sciences (UAMS) Winthrop P. Rockefeller Cancer Institute, published their findings in the latest issue of the Journal of Biomedical Optics. “Until now, nobody has been able to fully understand and study in vivo and in real time how these nanoparticles travel through a living system,” Biris said. “By using Raman spectroscopy, we showed that it is possible not only to monitor and detect nanomaterials moving through the circulation, but also to detect single cancer cells tagged with carbon nanotubes. In this way, we can measure their clearance rate and their biodistribution kinetics through the lymph and blood systems.” Zharov emphasized that in vivo Raman flow cytometry is promising for the detection and identification of a broad spectrum of various nanoparticles with strong Raman scattering properties, such as cells, bacteria, and even viruses. “Before any clinical application of nanoparticles, it is imperative to determine their pharmacological profiles,” Zharov said. “And this tool will provide this function as a supplement or even an alternative to the existing methods.” In their research, Biris, Zharov, and UAMS colleague Ekaterina Galanzha, M.D., injected a single human cancer cell containing carbon nanotube material in the tail vein of a test rat. They were able to follow the circulation of the carbon nanotubes in the blood vessels to the rat’s ear, tracking the cell through the rat’s blood stream, lymphatic system, and tissue with a Raman spectrometer. In the same issue of the scientific journal, Biris and Zharov published a second paper discussing how nanoparticles can tag cancer cells. A laser then heats the nanoparticles, killing the cancer cell. “If we are able to target cancer cells using these nanomaterials, we can monitor where the cancer cells are specifically located, and then we can kill them,” Biris said. He said the live rat experiment shows how the cancer killing process leaves only a dead cell and nanoparticles that, within a matter of hours, disintegrate and die. Dr. Mary Good, dean of UALR’s Donaghey College of Engineering and Information Technology, said the medical and economic ramifications of the discovery are significant. “The research Dr. Biris and Dr. Zharov have conducted indeed is significant and promising,” said Good, former technology undersecretary of Commerce in the Clinton administration. “It points to a whole new direction for medical applications for nanoparticles. There still is extensive time needed for research into the ultimate utility for these approaches and for human subject experiments. But this early work is exciting and provides long-term hope for more effective cancer treatments.” Biris, 34, said the UALR Nanotechnology Center’s aim is to accelerate the development of commercial applications of nanotechnology and its potential to revolutionize medical advancements and the next generation of manufacturing of other products. “The close location of UALR with its cutting-edge analytical chemistry and nanotechnological tools, along with UAMS and its established biological and medical infrastructures, provides unique opportunities for comprehensive pre-clinical evaluation of nanotechnological products,” Zharov said. “That allows for us to accelerate Nanotechnology advances from bench to bedside, providing breakthroughs in early diagnosis, prevention and effective treatment of cancers, stroke, heart attack, infections, and neurological disorders which remain the leading cause of death in the U.S.” About the scientists Zharov obtained his Ph.D and DSc degrees at Moscow State Technical University and completed a postdoctoral fellowship at Lawrence National Laboratory of the University of California. He served as professor and chairman of the Biomedical Engineering Department at Moscow University. Since 2000, he is a professor and director of the Phillips Classic Laser and Nanomedicine Laboratories at the UAMS Winthrop P. Rockefeller Cancer Institute. Zharov has authored and co-authored five books, 40 patents, and published close to 200 papers. He is the principle investigator in 12 grants from the NIH, NSF, and DoD. He has unique interdisciplinary skills in physics, biology and medicine. Zharov’s research interests include the development and medical application of advanced laser, nanotechnology and imaging and he was the first recipient of the United States Maiman Award, named after the inventor of the first laser. His laboratories have pioneered laser-ultrasound microsurgery, phototherapy of post-mastectomy lymphedema, photoacoustic tweezers, multiplex imaging of cancer cells, laser-gene therapy, laser-based chemosensitivity and radiosensitivity tests, in vivo noninvasive photoacoustic cytometry and blood and lymph cancer tests. In particular, Zharov invented one of the first applications of nanotechnology for treating cancer and infections using laser-activated gold nanoparticles (U.S. Patent, 2000). Recently, he was awarded by the $1.5 million five-year grant from the National Cancer Institute supporting one of the first clinical application of nanomedicine technology for early cancer diagnosis. Biris earned his Ph.D. at UALR and joined the faculty in 2006. He and his team have filed 11 patent applications in nanotechnology, bio-nanotechnology, space exploration, and materials science areas. He is fully involved in studying the interaction of nanomaterials with biological systems and using use such novel nanostructures for targeting and killing cancer cells. He has more than 160 papers published in peer reviewed journals or presented at international conferences. He was part of the team that designed and developed a newly patented electrodynamic screen for space exploration in collaboration with NASA. Patent applications are pending on his new method and technology for producing large quantities of carbon nanotubes with high purity. He led the design and development of carbon nanostructures-based filters to efficiently remove bio-chemical contaminants from air and water. Biris also developed a unique tissue regeneration system that has been used successfully in 33 clinical studies to grow bone tissue. The work has been licensed to a spin-off company, Orlumet LLC, in which Biris serves as Chief Technical Officer.The co-founder is Peder Jensen. Biris is honorary president and co-founder of the Romanian Nanomedicine Institute in his native country. In addition to his groundbreaking research and work with graduate and undergraguate students, Biris works one-on-one with gifted middle- and high school students in Arkansas. He said the key to the Nanotechnology Center at UALR is its aggressive outreach program to train and educate young people and other world-class scientists who will serve and attract business and industry to Arkansas from the region and the nation. http://www.newswise.com/articles/view/552591/ ----------------------------- Breast Cancer Patients May be Spared Additional Surgery NorthShore University HealthSystem Researcher reports in the Journal of Clinical Oncology. The surgical community now has confirmed evidence to demonstrate there is no need for aggressive surgery if limited microscopic breast cancers are detected Evanston, IL (Vocus) May 20, 2009 -- A recent study in the Journal of Clinical Oncology, authored by David J. Winchester, FACS, M.D., Chief of General Surgery and Surgical Oncology, NorthShore University HealthSystem, concludes that women whose breast cancer has spread to the lymph nodes may not need a radical lymph node surgery. The observational study of more than 97,000 women whose breast cancer spread to the lymph nodes indicates that women with microscopic lymph node metastases detected on sentinel lymph node (SLN) biopsy, shared the same benefit and survival rate as those who underwent a SLN biopsy with a more invasive completion axillary lymph node dissection (ALND). The analysis was conducted using the National Cancer Database of the American College of Surgeons and was published in the Journal of Clinical Oncology, May 2009. Dr. Winchester, along with the other study authors, analyzed data from approximately 1,400 hospitals. The women whose breast cancer cases were analyzed underwent SLN biopsy for clinically node-negative breast cancer from 1998 to 2005 and were found to have nodal metastases. The authors report that some patients with lymph node metastases identified on sentinel node biopsy may not need to have the rest of their lymph nodes removed. "The surgical community now has confirmed evidence to demonstrate there is no need for aggressive surgery if limited microscopic breast cancers are detected," said Dr. Winchester. "Treating cancer is as much about improving quality of life for our patients as it is about long-term survival." We have relied upon that operation too much, and this paper points out we may not need to do it in terms of a survival difference or a regional recurrence difference, Winchester explained. This is an operation associated with significant morbidity. Among the morbidities linked to ALND are a lifetime risk of lymphedema, problematic cosmetic outcomes, longer recovery times and more postoperative pain than SLN biopsy alone. The National Cancer Data Base, which is a joint program supported by the American College of Surgeons Commission on Cancer and the American Cancer Society, is recognized as the largest clinical registry in the world. It is a nationwide oncology outcomes database for more than 1,460 Commission on Cancer accredited cancer programs in the United States and Puerto Rico, and captures approximately 70 percent of all new invasive cancers diagnosed annually. About NorthShore University HealthSystem Headquartered in Evanston, Ill., NorthShore University HealthSystem (NorthShore) is a comprehensive, fully integrated, healthcare delivery system that serves the greater North Shore and northern Illinois communities. The system includes four Hospitals - Evanston Hospital, Glenbrook Hospital, Highland Park Hospital and Skokie Hospital. In addition, the health system has more than 2,400 affiliated physicians, including a 600-physician, multispecialty physician group practice with over 70 office locations - NorthShore University HealthSystem Medical Group. Further, NorthShore is committed to excellence in its academic mission and supports teaching and research as the principal teaching affiliate for the University of Chicago Pritzker School of Medicine. The NorthShore University HealthSystem Research Institute focuses on clinical and translational research, including leadership in outcomes research and clinical trials. The NorthShore University HealthSystem Foundation is a leading philanthropic entity of NorthShore. It raises charitable contributions, engages volunteer friends and invests in community partnerships. NorthShore has annual revenues of $1.5 billion and a staff of more than 8,000. The HealthSystem has significant capabilities in a wide spectrum of clinical programs, including cancer, heart, orthopaedics, high- risk maternity and pediatrics. NorthShore is a national leader in the implementation of innovative technologies, including electronic medical records, (EMR ). In 2003, the HealthSystem was among the first in the country to successfully launch a systemwide EMR with demonstrable benefits in quality, safety, efficiency and service to patients. NorthShore has been recognized by multiple national organizations for this notable achievement. ### Trackback URL: http://www.prweb.com/pingpr. php/U3VtbS1GYWx1LUNvdXAtSGFsZi1IYWxmLUNvdXAtWmVybw== See the original story at: http://www.prweb.com/releases/2009/05/prweb2446044.htm ============================== BraveHearts Dragon Boat Team Courier-IslanderMay 27, 2009 The BraveHearts Dragon Boat Team was formed in 2006 under the North Island Dragon Boat Society, a registered non-profit Society. In the beginning, the team was little more than just an idea of the founding members, who were all Breast Cancer survivors. Traditionally, Dragon Boats have been embraced by women who have survived Breast Cancer, and what started in Vancouver as a medical experiment has become an international phenomenon and today, there are Breast Cancer teams all over the world. These founding members, having experienced the sport themselves, began to think that anyone who had experienced any type of cancer could benefit from the supportive and healthy lifestyle derived from these ancient Chinese boats, because the long term emotional and physical effects of any cancer can be the same. Dragon Boats were initially used as a medical research project on Lymphedema, a side effect on Breast Cancer survivors who had their lymph nodes removed. Besides reaffirming the obvious physical benefits, particularly in increasing upper body strength, researchers also found that the sport could provide a much needed positive attitude in these patients, get them to exercise, and certainly uplift their spirit. These are crucial elements in the treatment for these individuals and empowers them to face their illness with greater confidence. Most importantly, it provided them with a supportive and healthy environment. Since that initial study, research has confirmed that patients with other cancers can derive the same benefits as those Breast Cancer patients had realized. Thus, the idea became a reality as a few members became many as the word spread. The BraveHearts Dragon Boat Team would become Canada's first co-ed Dragon Boat team for survivors of ALL cancers! Together, the BraveHearts fundraised for their paddles, their life vests, and most importantly, their very own Dragon Boat, complete with the beautiful dragon head and tail and the scales along the boat in green, the chosen colour to represent themselves with. Soon, a custom trailer was added that could take them and their 48 foot, 800 pound vessel to a number of Dragon Boat festivals and racing events all over the west coast. The BraveHearts invite all cancer survivors to join them and experience this life changing and positive activity. This is one that just about anyone can do. There are no limits as to your age, gender, or physical strength. We are also now accepting applications from "supporter" Associate members who wish to participate with us while helping us to bring a kinder experience to cancer survivors. For membership or for more information about sponsoring our team please call Marianne at 287-2327 The BraveHearts are very grateful to the people and businesses in their community of Campbell River for having believed in their idea, and for their generosity in giving this team the means to make this idea a reality. We proudly display their business logos on our boat. We are immensely proud to represent our community at the events we participate in. Our hope is that other communities will follow our lead and form similar teams in their own towns. Most importantly, these cancer survivors are grateful for the means with which we can enrich our lives and prove to ourselves and to others that there can be LIFE after cancer. Together, we all can win the battle against cancer. As we say... "Paddles Up!" http://www.canada.com/BraveHearts+Dragon+Boat+Team/1633561/story.html ============================== http://www.stamfordplus.com/stm/information/nws1/publish/health/New-cancer-survivor-clinic-created-by- the-Connecticut-Challenge-and-St-Vincent-s-Medical-Center5084.shtml New cancer survivor clinic created by the Connecticut Challenge and St. Vincent’s Medical Center By St. Vincent’s Medical Center Chuck Mattes, St. Vincent’s Medical Center Foundation board member and capital campaign co-chair, and Bob Mazzone, executive director of the CT Connecticut Challenge discuss plans for the future cancer survivor clinic at St. Vincent’s Medical Center St. Vincent’s Medical Center of Bridgeport, Connecticut has formed a new partnership with the Connecticut Challenge of Fairfield. The partnership will result in the formation of a survivor clinic at the new Elizabeth M. Pfriem SWIM Center for Cancer Care due to open January 2010. The new survivor clinic will include wellness and fitness education, free lectures, nutritional counseling, psychosocial support, and complimentary spa therapies such as massage, yoga and reiki. St. Vincent’s has begun recruiting physicians who are interested in the needs of survivors. St. Vincent’s Medical Center Foundation Board Member and Co-chair of St. Vincent’s Capital Campaign, Chuck Mattes of Redding helped create the partnership. “It seemed only natural for these two organizations to partner together. In addition to providing cancer screening and education programs, St. Vincent’s SWIM Across the Sound’s mission is also to help cancer patients and their families both in the form of financial assistance while they are in treatment, and also in the form of support programs throughout both treatment and recovery. With the help of the Connecticut Challenge that commitment will continue long after they’ve completed treatment. Many survivors experience recurrences of cancer and this clinic will direct them to change behaviors and reduce their risks,” said Mattes. Founded by Jeffrey Keith, a cancer survivor of Fairfield, John Ragland of Westport and Matthew Vossler of Darien, the Connecticut Challenge is a non-competitive bike ride that raises money for cancer survivors. The relationship between Keith, Vossler and St. Vincent’s dates back to 1987 with St. Vincent’s first SWIM Across the Sound. Corporate Senior Vice President of St. Vincent’s Medical Center and President of the St. Vincent’s Medical Center Foundation Ronald J. Bianchi had worked closely with Jeff Keith in the early days of the SWIM Across the Sound. “It is very rewarding to be working with Jeff again and sharing a commitment to help cancer survivors in Connecticut. Both the SWIM and the Connecticut Challenge share a vision of helping those at risk and making a difference in their lives,” he said. “The Connecticut Challenge is honored to support St. Vincent’s. They have a vision for caring for cancer survivors that is unique and far-reaching,” said Keith. “Their exceptional work will improve the lives of cancer survivors and that is the mission of our organization. This will also mean a lot to our thousands of cyclists, volunteers and donors from the greater Bridgeport community. We are excited to move forward,” he added. There are an estimated 120,000 cancer survivors living in Connecticut today. Many of them will battle long- term medical problems as a result of their chemotherapy and radiation treatments, including lymphedema, heart disease, nerve damage, sexual dysfunction and early menopause in women. By screening for long-term health and psychosocial effects from the disease and treatments, the goal of the CT Challenge survivor clinic at St. Vincent’s will be to educate and empower survivors to optimize their health, quality of life and longevity. Connecticut is among the very few states with a comprehensive program dedicated to meeting the needs of cancer survivors. About St. Vincent’s Medical Center St. Vincent’s Medical Center in Bridgeport, CT is a 473-bed community teaching and referral hospital with a Level II trauma center and a 76-bed inpatient psychiatric facility in Westport. St. Vincent’s provides a full range of inpatient and outpatient services with regional centers of excellence in cardiology, surgery, cancer care, orthopedics, diagnostics, women’s and family services, behavioral health, senior health and an array of specialized services. St. Vincent’s Medical Center is a subsidiary of St. Vincent’s Health Services, which include St. Vincent’s Behavioral Health Services, Westport Campus, St. Vincent’s College, St. Vincent’s Special Needs Services, St. Vincent’s Medical Center Foundation and St. Vincent’s Immediate Health Care Centers. It is a member of Ascension Health, the nation's largest Catholic healthcare system. St. Vincent's is a teaching affiliate of the University of Connecticut’s School of Medicine and of New York Medical College. The Medical Center is also sponsor of SWIM Across the Sound, one of the nation’s largest hospital-based cancer prevention and patient support programs. For referral to a St. Vincent’s physician or about programs and services, call the toll-free Care Line at 1-877-255-SVHS (7847) About the Connecticut Challenge The Connecticut Challenge is a non-competitive bike ride based in Fairfield, CT that raises money for the cancer survivorship programs of the Connecticut Challenge, including survivorship clinics, research grants, symposiums and survivor education and awareness events. Riders of all ages and skill levels can register for a 12, 25, 50, 75 or 100-mile ride and raise funds from personal sponsors to support their efforts. The 2009 Connecticut Challenge will take place on Saturday, July 25th, starting and finishing in Fairfield, CT. To register to ride, volunteer or make a contribution to the 2009 event, please visit www.ctchallenge.org. ====================== Program offers camaraderie for breast cancer survivors May 20, 2009 - by Karen Longwell A program offering fellowship, fitness and education for women who have had breast cancer surgery came to Bracebridge this spring. A pilot of YWCA’s Encore program, the eight-week, specifically designed program of gentle land and water exercises for women who have had breast cancer surgery, ran at the sportsplex. The final class for this first session took place on May 12. Program facilitator Silvia Smith said the 12 women in the class are remarkable. “I just think they are very brave women who have to deal with the reality of a compromised health scenario. They wake up every day and realize that life is never going to be the same, but sometimes it can be better,” said Smith. “It (breast cancer) has really helped them focus on what is important.” The program is offered free of charge. It aims to improve upper body mobility and flexibility, boost self- esteem and help prevent or manage lymphedema. Lymphedema, which can occur after breast cancer surgery, is a condition of localized fluid retention caused by a compromised lymphatic system. The lymphatic system is often referred to as the body’s second circulatory system. Participants, some of whom were not comfortable giving their name, enjoyed hearing from informative guest speakers and learning exercises geared toward regaining mobility after surgery. In surgery, nerves and muscles are cut. Encore participant Marilyn said she lost the use of her right arm. “The exercises stretch the muscles and ligaments — everything that went to sleep (after surgery),” said Marilyn. Recovery is different for everyone, depending on the extent of the surgery, said Nancy, another participant. “The exercises have been helpful. They help us get back into shape,” said another participant. Smith teaches therapy pool classes at the sportsplex, but the exercises for breast cancer recovery are different. They focus on the lymphatic system. “This is a unique course because the lymphatic system is so different from the circulatory system,” said Smith. “The lymphatic moves a lot slower … so the exercises are much slower. It would be more like yoga or tai chi.” Participants also learned land-based exercises, which they can take home with them. Any woman who has had breast cancer surgery at any time in their lives can join an Encore program. Women in this first group in Bracebridge ranged from less than one year after diagnosis up to 30 years, said Smith. While the women enjoyed learning exercises and hearing from speakers every two or three weeks, they also learned a lot from each other. The camaraderie in the group was wonderful, said one participant. “We have learned that we are not alone,” said Marilyn. Smith found the women enjoyed swapping stories. “They love to share information,” said Smith. “Other people just don’t understand what they have gone through.” Encore facilitators Smith and Sarah Hill took training for the program in the fall. They are hoping to continue with more sessions. This session was partially funded through the Canadian Cancer Society and YWCA Muskoka, said Hannah Lin, youth programs facilitator for the YWCA. The program was held in partnership with the Town of Bracebridge. http://www.gravenhurstbanner.com/article/136355 --------------------------------- http://suburbanjournals.stltoday.com/articles/2009/05/20/stcharles/news//0513stc-jennings0.txt MEDICALLY SPEAKING: Lymphedema clinic helps patients cope with cancer treatment side effect By Dr. Anthony Jennings Tuesday, May 12, 2009 3:14 AM CDT You know that your lymph nodes swell when you get an infection, but do you know that they're just part of the lymph system, which is responsible for moving excess fluid and proteins from the tissues to the bloodstream? Usually the lymph system functions well, but it's not infallible. When the lymph system is damaged or blocked, fluid builds up and results in swelling. This is called lymphedema. One of the most common triggers for lymphedema is cancer treatment, and as much as 30 percent of breast cancer patients develop lymphedema of the arm and hand. "Radiation treatments or scar tissue due to surgery can disrupt the lymph system," says Melissa Thess, PT, a lymphedema therapist. Thess works in the new Lymphedema Clinic, developed by SSM Rehab, in the SSM Cancer Care building on the campus of SSM St. Joseph Hospital West. While cancer treatment is one of the main culprits causing lymphedema, it may also occur in the legs if an individual has poor vascular flow because of diabetes, smoking, obesity or genetics. Thess uses a combination of approaches, customized for each patient, to help control lymphedema. "Lymphedema can't be cured, but it can be managed," she says. Thess' tools include exercises, manual lymphatic drainage (a type of massage therapy), range of motion and strength training, and pain management. She also educates patients about how to care for their skin in affected areas, which is important for avoiding infections, and advises them on the use of compression garments or bandages to prevent further fluid buildup. "Lymphedema can cause patients to experience trouble moving their joints, difficulty wearing regular clothing, and uncomfortable sensations of skin tightness, itching or burning that can disrupt sleep," she says. "But by using one or more therapeutic approaches, we can minimize and control the symptoms, which is very important for helping people achieve the best quality of life possible." A report presented at the American Association of Plastic Surgeons annual meeting this month identifies a new microsurgery procedure that can "reduce the fluid buildup in women with lymphedema by 25 percent to 39 percent in a year." The procedure reroutes lymph fluid to open vessels, enabling it to drain. If the procedure continues to show positive results, it could become another type of standard treatment. However, the best approach is prevention, and Thess also works to help cancer patients avoid lymphedema in the first place. Preventive measures include protecting the limb from any type of injury or trauma, avoiding strenuous activity while recovering from surgery or radiation therapy, avoiding heat and tight clothing, and elevating the limb. If you or someone you know has lymphedema and would like to schedule a consultation with Thess at the Lymphedema Clinic, call 636-695-2070 or 636-498-7474. Help is available to ensure you return to health and well-being as soon as possible. Dr. Anthony Jennings is director of the Department of Emergency Medicine at SSM St. Joseph Hospital West in Lake Saint Louis. He is board-certified in emergency medicine and is a fellow of the American College of Emergency Physicians and is president-elect of the American College of Osteopathic Emergency Physicians. ------------------------------ http://www.ecancermedicalscience.com/news-insider-news.asp?itemId=580 Sentinel node biopsy is an effective option for early-stage cervical cancer Published: 31/05/2009 A prospective multicenter study conducted by researchers in France suggests that the majority of women with early-stage cervical cancer can safely undergo sentinel node (SN) biopsy – a technique in which only one to three lymph nodes are removed to determine whether cancer has spread – in lieu of the traditional, more invasive pelvic lymph node removal. This study, presented at the American Society of Clinical Oncology 2009 meeting, showed that SN biopsy was just as useful as full pelvic lymph node removal for identifying even small amounts of cancer cells that spread to lymph nodes in atypical areas of the pelvis. "Sentinel node biopsy is a good option for women with cervical cancer because it enables us to remove fewer lymph nodes to get information about cancer spread, and could decrease the risk of complications from surgery, such as lymphedema," said Dr. Fabrice Lecuru, professor at George Pompidou European Hospital in Paris, and the study’s lead author. "Previous studies have shown that sentinel node biopsy can be used to assess cancer spread in usual areas of the pelvis, but our findings add to this growing body of research by showing that this approach is also effective for identifying cancer spread in less common areas of the pelvis and the abdomen. This approach may become a new standard of care for early-stage cervical cancer." Ten to 15 per cent of patients with early-stage cervical cancer experience recurrence. Some are due to lymph nodes that were missed during surgery or because of undetected cancer spread to other lymph nodes. During standard surgery, several pelvic lymph nodes are removed and examined for the presence of cancer cells. During SN biopsy, however, a blue dye and radioactive substance that can be traced with imaging techniques are used to locate the first lymph node (the sentinel node) where cancer cells would travel after leaving the cervix. If this node is free of cancer cells, no other lymph nodes should be removed. Since the removal of lymph nodes may impair lymphatic drainage and cause uncomfortable swelling in the legs called lymphedema, doctors have been assessing SN biopsy (which is routinely used for breast cancer and melanoma patients) to see if it can be used to gauge cervical cancer spread. Prior studies have shown that SN biopsy can be used in cervical cancer patients to predict cancer spread to lymph nodes in the pelvis most likely to contain cancer cells. But in this study, Dr. Lecuru and his colleagues also evaluated the biopsy of sentinel nodes in atypical areas of the pelvis in 128 women with early-stage cervical cancer who also had full pelvic lymph node removal for comparison. They then analysed sentinel nodes for micrometastastic cancer (0.2 to 2 mm in size) and isolated tumour cells as well as areas of cancer greater than 2 mm (macrometastases). After analysing these nodes, researchers demonstrated that full pelvic lymph node removal and its associated complications could have been avoided in 81.2 per cent of women. Researchers also found that in nearly 40 per cent of women, SN biopsy alone would have provided additional, important information about patients’ disease; for example, SN biopsy was more useful than routine techniques for showing that lymphatic drainage occurred via unusual pathways to less commonly explored areas of the pelvis or of the abdomen, and for detecting micrometastases or isolated tumour cells. ---------------------- 1. Clin Exp Dermatol. 2009 May 18. [Epub ahead of print] Localized bilateral lymphoedema of the ear lobes secondary to mesothelioma. Gudi V, Chan SK, Laroche C, Ford HE, Darrah R, Love K. Department of Dermatology, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, Suffolk, IP33 2QZ, UK. PMID: 19456781 [PubMed - as supplied by publisher] ================ 2. Int J STD AIDS. 2009 Jun;20(6):437-9. Vulval lymphoedema following pulmonary tuberculosis. Talwar A, Puri N, Sandhu HP. Department of Surgery & Dermatology, GGS Medical College & Hospital, Faridkot 151203, Punjab, India. Acquired lymphoedema of the vulva is induced by impaired lymph flow. We present the case of a 35-year- old woman having lymphoedema of the vulva following pulmonary tuberculosis, which she had developed four years back for which she had taken a full course of antitubercular treatment for nine months from the Chest and Tuberculosis department. The biopsy taken from the perianal swellings showed hyperkeratosis and acanthosis with multiple dilated lymph specs. PMID: 19451336 [PubMed - in process] ====================== 3. Dermatol Online J. 2009 Apr 15;15(4):13. Lympangiectasia of the vulva accompanying congenital lymphedema. Okur MI, Köse R, Yildirim AM, Cobanoglu B. Lymphangiectasia is a benign condition with multiple dilated lymph vessels in the dermis. Vulvar localization is rare and mostly depends on disturbing the lymphatic flow. We present a patient with vulvar lesions and ipsilateral congenital lower extremity lymphedema. Surgical excision eliminated the lymphangiectasia and improved the appearance of the edematous vulva. Publication Types: Letter PMID: 19450406 [PubMed - in process] ============================ 4. Circ Res. 2009 May 14. [Epub ahead of print] Activated Forms of VEGF-C and VEGF-D Provide Improved Vascular Function in Skeletal Muscle. Anisimov A, Alitalo A, Korpisalo P, Soronen J, Kaijalainen S, Leppänen VM, Jeltsch M, Ylä-Herttuala S, Alitalo K. Molecular/Cancer Biology Laboratory, Biomedicum Helsinki, Department of Pathology, Haartman Institute and Helsinki University Central Hospital, University of Helsinki, Finland; and Department of Biotechnology and Molecular Medicine, A. I. Virtanen Institute for Molecular Sciences, University of Kuopio, Finland. The therapeutic potential of vascular endothelial growth factor (VEGF)-C and VEGF-D in skeletal muscle has been of considerable interest as these factors have both angiogenic and lymphangiogenic activities. Previous studies have mainly used adenoviral gene delivery for short-term expression of VEGF-C and VEGF-D in pig, rabbit, and mouse skeletal muscles. Here we have used the activated mature forms of VEGF-C and VEGF-D expressed via recombinant adeno-associated virus (rAAV), which provides stable, long-lasting transgene expression in various tissues including skeletal muscle. Mouse tibialis anterior muscle was transduced with rAAV encoding human or mouse VEGF-C or VEGF-D. Two weeks later, immunohistochemical analysis showed increased numbers of both blood and lymph vessels, and Doppler ultrasound analysis indicated increased blood vessel perfusion. The lymphatic vessels further increased at the 4-week time point were functional, as shown by FITC-lectin uptake and transport. Furthermore, receptor activation and arteriogenic activity were increased by an alanine substitution mutant of human VEGF-C (C137A) having an increased dimer stability and by a chimeric CAC growth factor that contained the VEGF receptor-binding domain flanked by VEGF-C propeptides, but only the latter promoted significantly more blood vessel perfusion when compared to the other growth factors studied. We conclude that long-term expression of VEGF-C and VEGF-D in skeletal muscle results in the generation of new functional blood and lymphatic vessels. The therapeutic value of intramuscular lymph vessels in draining tissue edema and lymphedema can now be evaluated using this model system. PMID: 19443835 [PubMed - as supplied by publisher] ========================= 5. Indian J Dermatol Venereol Leprol. 2009 May-Jun;75(3):290-2. Kaposi's sarcoma in an HIV-positive person successfully treated with paclitaxel. Dongre A, Montaldo C. Medicines sans Frontieres Belgique, HIV/AIDS Khar Clinic, Mumbai, India. atul507@yahoo.co.in Epidemic Kaposi's sarcoma is one of the malignant neoplasms, which can develop in HIV-infected patients. Although the prevalence of HIV infection is reported to be high in Asian countries, Kaposi's sarcoma is rarely reported. We report a case of Kaposi's sarcoma involving the skin and oral mucosa along with extensive bilateral lymphedema of lower extremities, treated successfully with paclitaxel and antiretrovirals. PMID: 19439884 [PubMed - in process] ============================== 6. J Pak Med Assoc. 2009 May;59(5):282-7. Post mastectomy adjuvant radiotherapy in breast cancer: a comparision of three hypofractionated protocols. Shahid A, Athar MA, Asghar S, Zubairi T, Murad S, Yunas N. Institute of Nuclear Medicine & Oncology (INMOL), Wahdat Road, Lahore, Pakistan. OBJECTIVES: To compare three hypofractionated protocols in postmastectomy cancinoma breast in terms of local control, toxicity and work load. METHODS: A total of three hundred patients suffering from cancer breast stage T2-4, N any were randomized into three arms after mastectomy. All the patients were treated with four fields on Co60 i.e. two tangential portals for chest wall, one anterior supraclavicular and axillary field and a posterior axillary boost and were randomized into three arms i.e. 2700 CGy in 5 fractions (one week) arm A, 3500 CGy in 10 fractions (2 weeks) arm B and 4000 CGy in 15 fractions (3 weeks) arm C. Skin, cardiac, pulmonary and haematological toxicities and lymphoedema were compared in addition to local control and work load. RESULTS: The locoregional relapses were 11%, 12% and 10% in arms A, B and C respectively. 26%, 24% and 28% patients developed metastatic disease and 17%, 18% and 20% died in the three arms. G3 and G4 skin toxicities were 37%, 28% and 14%. G2 and G3 lymphedoema was 21%, 22% and 27%. Cardiac toxicity was 5%, 6% and 5% while pulmonary toxicity was 4%, 5% and 5% respectively. All the differences except skin toxicity were statistically insignificant. There were no cases of haematological depression or rib fractures. CONCLUSION: All the three short protocols were equally effective in locoregional disease control and toxicity was also comparable. They were helpful in reducing the work load and can be safely recommended for routine clinical use. PMID: 19438129 [PubMed - in process] ============================= 7. Zhong Xi Yi Jie He Xue Bao. 2009 May;7(5):418-21. [Relationship between ultrasound imaging and traditional Chinese medicine syndrome in limb lymphedema.] [Article in Chinese] Liu M, Zhang Y, Song FC, Cheng ZX. Department of Peripheral Vascular Surgery, Affiliated Hospital, Shandong University of Traditional Chinese Medicine, Jinan 250011, Shandong Province, China; E-mail: liuming404@sina.com. Objective: To study the correlation between traditional Chinese medicine (TCM) syndrome type and the ultrasound imaging changes in patients with limb lymphedema, and to provide evidence for TCM syndrome differentiation. Methods: Syndrome typing was done and ultrasonography was performed in 107 patients with limb lymphedema. The thickenings of derma, hypodermis and deep-fascia were measured. The ultrasound echo intensity and the morphology of the hypodermis were classified into five degrees according to the ultrasonogram. The ultrasound indexes in the limb lymphedema patients with different syndromes were compared, and the relationship between TCM syndromes and the ultrasound indexes was analyzed. Results: There were specific ultrasound image features in different TCM syndromes of limb lymphedema. The thickenings of derma, hypodermis and deep-fascia in the limb lymphedema patients with downward migration of damp-heat or phlegm stagnation and blood stasis were more significant than those in the patients with collateral obstruction due to cold-dampness (P<0.05, P<0.01). The thickenings of derma and hypodermis in the patients with phlegm stagnation and blood stasis were obviously more severe than those in the patients with downward migration of damp-heat (P<0.01). The maximum and minimum ultrasound echo intensities of hypodermis were in phlegm stagnation and blood stasis and downward migration of damp-heat respectively (P<0.05), and there was a significant difference in the hypodermal morphology among the three syndrome types (P<0.05). The most obvious structure disturbance was observed in the patients with phlegm stagnation and blood stasis syndrome. Conclusion: TCM syndrome type of limb lymphedema is related to ultrasound image changes. The imaging data can be regarded as new objective indexes for TCM syndrome defferentiation, and it has an important value for diagnosis and treatment of limb lymphedema. Publication Types: English Abstract PMID: 19435554 [PubMed - in process] ================================ 8. Aesthetic Plast Surg. 2009 May 12. [Epub ahead of print] Suction-Assisted Lipectomy for Treatment of Lower-Extremity Lymphedema. Eryilmaz T, Kaya B, Ozmen S, Kandal S. Department of Plastic, Reconstructive and Aesthetic Surgery, Gazi University School of Medicine, Ankara, Turkey, mdtolgaer@yahoo.com. Lymphedema typically occurs on the extremities and affects millions of people throughout the world. Although currently there is no single treatment proven effective for lymphedema in every patient, suction- assisted lipectomy has been shown to be effective in some patients. Suction-assisted lipectomy offers patients with lower-extremity lymphedema a less invasive, less morbid surgical option compared with traditional excisional techniques. In this article we present a case of lymphedema reduction with suction- assisted lipectomy in a patient with bilateral lower-extremity lymphedema. PMID: 19434444 [PubMed - as supplied by publisher] ==================================== 9. Ann Diagn Pathol. 2009 Jun;13(3):147-50. Epub 2009 Apr 1. Angiosarcoma of the breast: a clinicopathologic analysis of cases from the last 10 years. Wang XY, Jakowski J, Tawfik OW, Thomas PA, Fan F. Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA. Breast angiosarcoma may occur de novo, or as a complication of radiation therapy, or chronic lymphedema secondary to axillary lymph node dissection for mammary carcinoma. In our effort to characterize the clinicopathologic features of breast angiosarcoma, we reviewed all breast angiosarcoma cases in the University of Kansas Medical Center and Ohio State University Medical Center archives from 1997 to 2007. Clinical histories and follow-up data for identified patients were reviewed. The tumors were graded histologically according to Rosen's method. Only 11 angiosarcomas were identified among more than 5000 malignant breast neoplasms (0.1%-0.2% incidence) for the last 10 years. Eight cases (6 high grade, 1 intermediate grade, 1 low grade) were identified as postradiation angiosarcoma (postradiation time interval, 4-12 years), and 3 cases were identified as primary angiosarcomas (1 high grade, 2 low grade). Follow-up (median, 36 months) revealed that 3 cases of postradiation angiosarcoma recurred as skin and/or chest wall lesions and 1 case of primary angiosarcoma developed liver metastases (all high-grade). In conclusion, breast angiosarcoma remains a rare disease. Rosen's method for grading breast angiosarcoma is easy to implement and correlates well with clinical outcome. There are no distinct clinical or histologic differences between primary and postradiation breast angiosarcomas. PMID: 19433291 [PubMed - in process] ============================================ 10. Int J Palliat Nurs. 2009 Apr;15(4):162, 164, 166-9. Understanding the management of lymphoedema for patients with advanced disease. Honnor A. Loros Hospice, Leicester, England. AmandaHonnor@loros.co.uk The problems associated with lymphoedema can be devastating, particularly for patients with lymphoedema and advanced disease. All lymphoedema treatment is palliative in nature as the underlying condition is incurable; however, much can be done to relieve the symptoms associated with the oedema. It is important to remember that the burden of treatment on the patient should not exceed the benefit gained and, therefore, treatment may have to be adapted and modified to suit patients individual needs. This article describes the classification, aetiology and nursing management of lymphoedema with an emphasis on the management of lymphoedema in the patient with advanced disease. PMID: 19430411 [PubMed - in process] ================================== 11. Hum Mol Genet. 2009 May 9. [Epub ahead of print] Vascular defects in a mouse model of hypotrichosis-lymphedema-telangiectasia syndrome indicate a role for SOX18 in blood vessel maturation. Downes M, François M, Ferguson C, Parton RG, Koopman P. Institute for Molecular Bioscience, Brisbane, QLD 4072, Australia. Mutations in the transcription factor gene SOX18 cause vascular, lymphatic and hair follicle defects in humans with dominant and recessive forms of hypotrichosis-lymphedema-telangiectasia (HLT) syndrome. Here, we clarify the role of SOX18 in the vascular dysfunction in HLT by ultrastructural, immunofluorescence, molecular and functional analysis of vascular anomalies in embryos of the naturally occurring Sox18-mutant mouse strain ragged-opossum (Ra(Op)). Early genesis and patterning of vasculature was unimpaired in Ra(Op) embryos, but surface capillaries became enlarged from 12.5 dpc and embryos developed massive surface haemorrhage by 14.5 dpc. Large focal breaches in the endothelial barrier were observed, in addition to endothelial hyperplasia associated with impaired pericyte recruitment to the microvasculature. Expression of the genes encoding the endothelial factors MMP7, IL7R and N- cadherin was reduced in Ra(Op) embryos, suggesting these are downstream targets of SOX18. Together our results indicate that vascular anomalies in HLT arise from defects in regulation of genes required for the acquisition of structural integrity during microvascular maturation. PMID: 19429912 [PubMed - as supplied by publisher] =================================== 11. Hum Mol Genet. 2009 May 9. [Epub ahead of print] Related Articles, Links Vascular defects in a mouse model of hypotrichosis-lymphedema-telangiectasia syndrome indicate a role for SOX18 in blood vessel maturation. Downes M, François M, Ferguson C, Parton RG, Koopman P. Institute for Molecular Bioscience, Brisbane, QLD 4072, Australia. Mutations in the transcription factor gene SOX18 cause vascular, lymphatic and hair follicle defects in humans with dominant and recessive forms of hypotrichosis-lymphedema-telangiectasia (HLT) syndrome. Here, we clarify the role of SOX18 in the vascular dysfunction in HLT by ultrastructural, immunofluorescence, molecular and functional analysis of vascular anomalies in embryos of the naturally occurring Sox18-mutant mouse strain ragged-opossum (Ra(Op)). Early genesis and patterning of vasculature was unimpaired in Ra(Op) embryos, but surface capillaries became enlarged from 12.5 dpc and embryos developed massive surface haemorrhage by 14.5 dpc. Large focal breaches in the endothelial barrier were observed, in addition to endothelial hyperplasia associated with impaired pericyte recruitment to the microvasculature. Expression of the genes encoding the endothelial factors MMP7, IL7R and N- cadherin was reduced in Ra(Op) embryos, suggesting these are downstream targets of SOX18. Together our results indicate that vascular anomalies in HLT arise from defects in regulation of genes required for the acquisition of structural integrity during microvascular maturation. PMID: 19429912 [PubMed - as supplied by publisher] =========================== 12. Int J Radiat Oncol Biol Phys. 2009 May 8. [Epub ahead of print] Related Articles, Links Time Course of Mild Arm Lymphedema After Breast Conservation Treatment for Early-Stage Breast Cancer. Bar Ad V, Cheville A, Solin LJ, Dutta P, Both S, Harris EE. Departmentof Radiation Oncology, University of Pennsylvania, Philadelphia, PA. PURPOSE: Arm lymphedema is a potential consequence of the treatment for breast carcinoma. The objective of this retrospective study was to characterize the progression of mild arm lymphedema after breast conservation treatment for breast cancer. METHODS AND MATERIALS: The study cohort was drawn from 1,713 consecutive Stage I or II breast cancer patients who underwent breast conservation therapy, including axillary staging followed by radiation. Arm lymphedema was documented in 266 (16%) of 1,713 patients. One hundred nine patients, 6% of the overall group and 40% of the patients with arm lymphedema, presented with mild arm lymphedema, defined as a difference of 2 cm or less between the measured circumferences of the affected and unaffected arms. RESULTS: Among the 109 patients with mild arm lymphedema at the time of arm lymphedema diagnosis, the rate of freedom from progression to more severe lymphedema was 79% at 1 year, 66% at 3 years, and 52% at 5 years. The patients who were morbidly obese, had positive axillary lymph nodes, or received supraclavicular irradiation at the time of breast cancer treatment were at higher risk of progression from mild arm lymphedema to more severe edema. CONCLUSIONS: Mild arm lymphedema, generally considered to be a minor complication after breast conservation treatment for breast cancer, was associated with a risk of progression to a more severe grade of arm lymphedema in a substantial fraction of patients. PMID: 19427748 [PubMed - as supplied by publisher] ================================ 13. Int J Radiat Oncol Biol Phys. 2009 Jun 1;74(2):349-54. Related Articles, Links Extrapulmonary soft-tissue fibrosis resulting from hypofractionated stereotactic body radiotherapy for pulmonary nodular lesions. Kawase T, Takeda A, Kunieda E, Kokubo M, Kamikubo Y, Ishibashi R, Nagaoka T, Shigematsu N, Kubo A. Department of Radiology, Keio University School of Medicine, Tokyo, Japan. PURPOSE: To clarify the incidence, symptoms, and timing of extrapulmonary fibrosis developing after hypofractionated stereotactic body radiotherapy. PATIENTS AND METHODS: We analyzed 379 consecutive patients who underwent stereotactic body radiotherapy for lung tumors at four institutions between February 2001 and March 2007. The median follow-up time was 29 months (range, 1-72). We investigated the subjective and objective characteristics of the extrapulmonary masses, redelineated the origin tissue of each on the treatment planning computed tomography scan, and generated dose-volume histograms. RESULTS: In 9 patients (2.4%), extrapulmonary masses were found 3-36 months (median, 14) after irradiation. Coexisting swelling occurred in 3 patients, chest pain in 2, thumb numbness in 1, and arm edema in 1 patient. Extrapulmonary masses occurred in 5 (5.4%) of 92 and 4 (1.4%) of 287 patients irradiated with a 62.5-Gy and 48.0-Gy isocenter dose, respectively. The mean and maximal dose to the origin tissue was 25.8-53.9 Gy (median, 43.7) and 47.5-62.5 Gy (median, 50.2), respectively. In 5 of 9 patients, the standardized uptake values on 18F-fluorodeoxyglucose-positron emission tomography was 1.8- 2.8 (median, 2.2). Percutaneous needle biopsy was performed in 3 patients, and all the specimens showed benign fibrotic changes without malignant cells. CONCLUSION: All patients should be carefully followed after stereotactic body radiotherapy. The findings of any new lesion should prompt an assessment for radiation-induced extrapulmonary fibrosis before an immediate diagnosis of recurrence is made. Careful beam-shape modification and dose prescription near the thoracic outlet are required to prevent forearm neuropathy and lymphedema. Publication Types: Multicenter Study PMID: 19427551 [PubMed - indexed for MEDLINE] ===================================== 14 Gynecol Oncol. 2009 Jun;113(3):299-300. Related Articles, Links Comment on: Gynecol Oncol. 2009 Jun;113(3):301-5. Patient-reported outcomes in sentinel lymph node procedure versus inguinofemoral lymphadenectomy: what is the next step? Wenzel L. Publication Types: Comment Editorial PMID: 19426884 [PubMed - indexed for MEDLINE] -------------------------------------------------------------------------------- 14. J Helminthol. 2009 May 8:1-10. [Epub ahead of print] Related Articles, Links A cohort study on anti-filarial IgG4 and its assessment in good and uncertain MDA-compliant subjects in brugian filariasis endemic areas in southern Thailand. Jiraamonnimit C, Wongkamchai S, Boitano J, Nochot H, Loymek S, Chujun S, Yodmek S. Filaria Division, Ministry of Public Health, Nonthaburi Province, Thailand. The prevalence of Brugia malayi was surveyed in three highly endemic provinces in southern Thailand as part of an ongoing evaluation of the effectiveness of two rounds of mass drug administration (MDA). Prior to MDA IV, and thereafter every 6 months up to 18 months, including MDA V at 12 months, nocturnal blood sampling was assayed for microfilaria (mf) and IgG4 antibodies in 200 subjects from Nakorn Srithammarat and Surathani provinces. From an additional 300 subjects from Narathiwatt province, daytime blood was also examined for IgG4 antibodies for 1 year. Subjects who tested positive, with reciprocal IgG4 titres above 100, were dichotomized in the 'good compliant' or 'uncertain compliant' groups. Stool samples were examined for intestinal parasites from all 500 subjects simultaneously. Only two subjects (1%) tested positive for mf, while 98 subjects (19.6% of 500) tested positive for IgG4. In general, the good drug- compliant subjects were less likely to exhibit the IgG4 response than subjects in the uncertain compliant group. Only six subjects (1.2%) exhibited lymphoedema while 68 subjects (13.6%) had a total of 105 parasitic infections, with female instances of protozoan infections exceeding male instances of helminth infections. It was concluded that the two MDA rounds were highly successful in not only in reducing mf to negligible levels but also in lowering antifilarial IgG4 titres in the good compliant subjects. The IgG4 assay is a sensitive and cost-effective surveillance tool for the early detection of brugian infections that is not contingent on nocturnal blood collections. PMID: 19422729 [PubMed - as supplied by publisher] =================================== Forsch Komplementmed. 2009 Apr;16(2):117-22. Epub 2009 Apr 9. Related Articles, Links [Inpatient treatment for CRPS I by use of complementary medicine] [Article in German] Schencking M, Bohmhammel J, Keller C. Kneipp'sche Kliniken, Kneippstrasse 8, Bad Wörishofen, Germany. dr.schencking@barmherzige-bad- woerishofen.de INTRODUCTION: Complex regional pain syndromes (CRPS) are mainly characterized by a burning, intense spontaneous pain,mechanical allodynia of the affected limb, disorders of the skin,local hyperhidrosis, lymphedema as well as trophic disorders of the skin, bones and joints. The overall clinical appearance is dominated by a dysfunction of the sympathetic nervous system. One dominant etiological hypothesis is that major mechanisms for CRPS symptoms, which might be present during the course of CRPS, are trauma- related cytokine release, exaggerated neurogenic inflammation, sympathetically maintained pain, and cortical reorganization in response to chronic pain. CASE REPORT: We report the case of a 33-year-old female patient who suffered from a CRPS type I (cold type) of the left foot which had been traumatically induced 9 months before. The patient presented with a severe pain syndrome, an allodynia of the dermatomes L5 and S1 left with significant trophic skin disturbances, followed by a lymphedema and a malposition (pronation) of the left dorsum pedis. METHODS: In the course of a 10-week in-house treatment the patient received a multidisciplinary therapy-management based on complementary medicine with intensive use of hydrotherapy according to Kneipp, and physiotherapy. RESULTS: Pain intensity over treatment decreased from 8 (initial) to 2 (after 8 weeks) ona 10-point numeric rating scale. Furthermore, local symptoms of the left foot, i.e. hyperhidrosis, trophic skin disorders and lymphedema decreased significantly. CONCLUSIONS: Therapeutic strategies derived from complementary medicine may be an effective approach to the complex treatment of CRPS. Their effects should be further investigated in controlled clinical trials. Copyright (c) 2009 S. Karger AG, Basel. Publication Types: English Abstract PMID: 19420958 [PubMed - in process] ==================== 15. J Helminthol. 2009 May 8:1-10. [Epub ahead of print] Related Articles, Links A cohort study on anti-filarial IgG4 and its assessment in good and uncertain MDA-compliant subjects in brugian filariasis endemic areas in southern Thailand. Jiraamonnimit C, Wongkamchai S, Boitano J, Nochot H, Loymek S, Chujun S, Yodmek S. Filaria Division, Ministry of Public Health, Nonthaburi Province, Thailand. The prevalence of Brugia malayi was surveyed in three highly endemic provinces in southern Thailand as part of an ongoing evaluation of the effectiveness of two rounds of mass drug administration (MDA). Prior to MDA IV, and thereafter every 6 months up to 18 months, including MDA V at 12 months, nocturnal blood sampling was assayed for microfilaria (mf) and IgG4 antibodies in 200 subjects from Nakorn Srithammarat and Surathani provinces. From an additional 300 subjects from Narathiwatt province, daytime blood was also examined for IgG4 antibodies for 1 year. Subjects who tested positive, with reciprocal IgG4 titres above 100, were dichotomized in the 'good compliant' or 'uncertain compliant' groups. Stool samples were examined for intestinal parasites from all 500 subjects simultaneously. Only two subjects (1%) tested positive for mf, while 98 subjects (19.6% of 500) tested positive for IgG4. In general, the good drug- compliant subjects were less likely to exhibit the IgG4 response than subjects in the uncertain compliant group. Only six subjects (1.2%) exhibited lymphoedema while 68 subjects (13.6%) had a total of 105 parasitic infections, with female instances of protozoan infections exceeding male instances of helminth infections. It was concluded that the two MDA rounds were highly successful in not only in reducing mf to negligible levels but also in lowering antifilarial IgG4 titres in the good compliant subjects. The IgG4 assay is a sensitive and cost-effective surveillance tool for the early detection of brugian infections that is not contingent on nocturnal blood collections. PMID: 19422729 [PubMed - as supplied by publisher] ============================ 17. Forsch Komplementmed. 2009 Apr;16(2):117-22. Epub 2009 Apr 9. Related Articles, Links [Inpatient treatment for CRPS I by use of complementary medicine] [Article in German] Schencking M, Bohmhammel J, Keller C. Kneipp'sche Kliniken, Kneippstrasse 8, Bad Wörishofen, Germany. dr.schencking@barmherzige-bad- woerishofen.de INTRODUCTION: Complex regional pain syndromes (CRPS) are mainly characterized by a burning, intense spontaneous pain,mechanical allodynia of the affected limb, disorders of the skin,local hyperhidrosis, lymphedema as well as trophic disorders of the skin, bones and joints. The overall clinical appearance is dominated by a dysfunction of the sympathetic nervous system. One dominant etiological hypothesis is that major mechanisms for CRPS symptoms, which might be present during the course of CRPS, are trauma- related cytokine release, exaggerated neurogenic inflammation, sympathetically maintained pain, and cortical reorganization in response to chronic pain. CASE REPORT: We report the case of a 33-year-old female patient who suffered from a CRPS type I (cold type) of the left foot which had been traumatically induced 9 months before. The patient presented with a severe pain syndrome, an allodynia of the dermatomes L5 and S1 left with significant trophic skin disturbances, followed by a lymphedema and a malposition (pronation) of the left dorsum pedis. METHODS: In the course of a 10-week in-house treatment the patient received a multidisciplinary therapy-management based on complementary medicine with intensive use of hydrotherapy according to Kneipp, and physiotherapy. RESULTS: Pain intensity over treatment decreased from 8 (initial) to 2 (after 8 weeks) ona 10-point numeric rating scale. Furthermore, local symptoms of the left foot, i.e. hyperhidrosis, trophic skin disorders and lymphedema decreased significantly. CONCLUSIONS: Therapeutic strategies derived from complementary medicine may be an effective approach to the complex treatment of CRPS. Their effects should be further investigated in controlled clinical trials. Copyright (c) 2009 S. Karger AG, Basel. Publication Types: English Abstract PMID: 19420958 [PubMed - in process] ================================= 18. Arch Phys Med Rehabil. 2009 May;90(5):803-9. Related Articles, Links Validity for the simplified water displacement instrument to measure arm lymphedema as a result of breast cancer surgery. Sagen A, Kåresen R, Skaane P, Risberg MA. Cancer and Surgical Division, Department of Breast and Endocrine Surgery, Ullevaal University Hospital, Oslo, Norway. aase.sagen@uus.no OBJECTIVES: To evaluate concurrent and construct validity for the Simplified Water Displacement Instrument (SWDI), an instrument for measuring arm volumes and arm lymphedema as a result of breast cancer surgery. DESIGN: Validity design. SETTING: Hospital setting. PARTICIPANTS: Women (N=23; mean age, 64+/-11y) were examined 6 years after breast cancer surgery with axillary node dissection. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The SWDI was included for measuring arm volumes to estimate arm lymphedema as a result of breast cancer surgery. A computed tomography (CT) scan was included to examine the cross-sectional areas (CSAs) in square millimeters for the subcutaneous tissue, for the muscle tissue, and for measuring tissue density in Hounsfield units. Magnetic resonance imaging (MRI) with T2-weighted sequences was included to show increased signal intensity in subcutaneous and muscle tissue areas. RESULTS: The affected arm volume measured by the SWDI was significantly correlated to the total CSA of the affected upper limb (R=.904) and also to the CSA of the subcutaneous tissue and muscles tissue (R=.867 and R=.725), respectively (P<.001). The CSA of the subcutaneous tissue for the upper limb was significantly larger compared with the control limb (11%). Tissue density measured in Hounsfield units did not correlate significantly with arm volume (P>.05). The affected arm volume was significantly larger (5%) than the control arm volume (P<.05). Five (22%) women had arm lymphedema defined as a 10% increase in the affected arm volume compared with the control arm volume, and an increased signal intensity was identified in all 5 women on MRI (T2-weighted, kappa=.777, P<. 001). CONCLUSIONS: The SWDI showed high concurrent and construct validity as shown with significant correlations between the CSA (CT) of the subcutaneous and muscle areas of the affected limb and the affected arm volume (P>.001). There was a high agreement between those subjects who were diagnosed with arm lymphedema by using the SWDI and the increased signal intensity on MRI, with a kappa value of .777 (P<.001). High construct validity for the SWDI was confirmed for arm lymphedema as a volume increase, but it was not confirmed for lymphedema without an increase in arm volume (swelling). The SWDI is a simple and valid tool for estimating arm volume and arm lymphedema after breast cancer surgery. Publication Types: Research Support, Non-U.S. Gov't PMID: 19406300 [PubMed - in process] =================================== 19. Microsurgery. 2009 Apr 27. [Epub ahead of print] Related Articles, Links Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Demirtas Y, Ozturk N, Yapici O, Topalan M. Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey. Recent supermicrosurgical techniques have developed the possibility for vascular anastomosis of smaller vessels and it is now safe and sound to perform precise anastomoses between lymphatics and venules. Reported here is the 2 years experience on supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation combined with a nonoperative physical therapy for treatment of lower extremity lymphedema. Microlymphatic surgery was performed in 42 patients with unilateral lower extremity lymphedema. Thirty patients were women and 12 were men with a mean age of 34. Lymphaticovenular anastomoses were performed in 37 patients with an average of 2.5 anastomoses per patient, and lymphaticovenous implantations were made in 36 patients with an average of 2.4 implantations per patient. The lymphatics that were larger than 0.3 mm were anastomosed to venules with supermicrosurgical technique. Lymphaticovenous implantation technique was used for thinner lymphatics in a particular incision. Postoperatively, 18 patients used continuous compressive garments, 9 patients used garments but discontinued after 6 months, and no compression was used in 9 patients. The results of surgery were assessed both clinically with volume measurements and by lymphoscintigraphy and were classified as good, moderate, or ineffective. The mean decrease in the volume of the edema was 59.3% at an average follow- up of 11.8 months. Six outcomes were classified as ineffective, eight outcomes as moderate, and 28 outcomes as good. Supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation seems to be highly beneficial, especially in the early stages of peripheral lymphedema and may be offered as the treatment of choice in selected patients. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009. PMID: 19399890 [PubMed - as supplied by publisher] =========================== 20. Microsurgery. 2009 Apr 27. [Epub ahead of print] Related Articles, Links Supermicrosurgical lymphaticovenular anastomosis and lymphaticovenous implantation for treatment of unilateral lower extremity lymphedema. Demirtas Y, Ozturk N, Yapici O, Topalan M. Department of Plastic, Reconstructive and Aesthetic Surgery, Ondokuz Mayis University Medical School, Samsun, Turkey. Recent supermicrosurgical techniques have developed the possibility for vascular anastomosis of smaller vessels and it is now safe and sound to perform precise anastomoses between lymphatics and venules. Reported here is the 2 years experience on supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation combined with a nonoperative physical therapy for treatment of lower extremity lymphedema. Microlymphatic surgery was performed in 42 patients with unilateral lower extremity lymphedema. Thirty patients were women and 12 were men with a mean age of 34. Lymphaticovenular anastomoses were performed in 37 patients with an average of 2.5 anastomoses per patient, and lymphaticovenous implantations were made in 36 patients with an average of 2.4 implantations per patient. The lymphatics that were larger than 0.3 mm were anastomosed to venules with supermicrosurgical technique. Lymphaticovenous implantation technique was used for thinner lymphatics in a particular incision. Postoperatively, 18 patients used continuous compressive garments, 9 patients used garments but discontinued after 6 months, and no compression was used in 9 patients. The results of surgery were assessed both clinically with volume measurements and by lymphoscintigraphy and were classified as good, moderate, or ineffective. The mean decrease in the volume of the edema was 59.3% at an average follow- up of 11.8 months. Six outcomes were classified as ineffective, eight outcomes as moderate, and 28 outcomes as good. Supermicrosurgical lymphaticovenular anastomosis and/or lymphaticovenous implantation seems to be highly beneficial, especially in the early stages of peripheral lymphedema and may be offered as the treatment of choice in selected patients. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009. PMID: 19399890 [PubMed - as supplied by publisher] ========================= 21. Psychooncology. 2009 Apr 27. [Epub ahead of print] Related Articles, Links Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Chachaj A, Malyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudelko M, Andrzejak R, Szuba A. Department of Internal Medicine, Wroclaw Medical University, Wroclaw, Poland. Objective: The aim of the study was to identify factors associated with worse physical and emotional functioning of breast cancer survivors with upper extremity lymphedema.Methods: 1250 sets of questionnaires consisting of WHO-DAS II, EORTC QLQ-C30, EORTC QLQ-BR23 and GHQ-30 were mailed to women who underwent a breast cancer surgery at the Lower Silesian Oncology Center in Poland between January 1998 and December 2005.Results and conclusions: The response rate was 33.47%. 117 women were included into a lymphedema group and 211 into a group without this complication. Women with lymphedema were more disabled (overall disability (DAS) score 39.78 versus 34.67; p<0.001), reported symptoms from the upper extremity (shoulder or arm pain and difficulties in arm movement) and from the operated breast (pain and swelling) 2-3 times more often, experienced poorer quality of life (global quality of life (QOL) score 0.50 versus 0.57; p=0.005) and higher psychological distress (GHQ score 10.61 versus 8.01; p=0.007) in comparison to breast cancer survivors without lymphedema. The factors associated with higher DAS score, higher GHQ score and lower QOL score in women with lymphedema were as following: pain in the upper limb (mainly shoulder and arm), pain in operated breast, difficulties with arm movement, localization of lymphedema within the hand or in operated breast, a history of dermatolymphangitis and of receiving chemotherapy. Severity of lymphedema, younger age, BMI and localization of lymphedema within the dominant limb were not considerably related to worse outcomes in these women. Copyright (c) 2009 John Wiley & Sons, Ltd. PMID: 19399782 [PubMed - as supplied by publisher] ========================= 22. J Vasc Surg. 2009 May;49(5):1256-63. Related Articles, Links Compression therapy in breast cancer-related lymphedema: A randomized, controlled comparative study of relation between volume and interface pressure changes. Damstra RJ, Partsch H. Department of Dermatology, Phlebology and Lymphology, Nij Smellinghe Hospital, Drachten, The Netherlands. r.damstra@nijsmellinghe.nl OBJECTIVE: Short stretch bandages are very effective in the initial management of arm lymphedema. However, no studies to date have measured the pressure required to achieve specific amounts of volume reduction. The purpose of this study was to determine whether there is a difference between low and high- pressure bandaging in terms of therapeutically intended volume reduction of the compressed arm. METHODS: Experimental, randomized and comparative study with two study-groups consisting of high and low initial interface pressure bandages. Thirty-six hospitalized patients in Nij Smellinghe hospital suffering from moderate to severe unilateral breast cancer-related lymphedema not responsive to outpatient treatment were included. Bilateral arm volume was measured by inverse water volumetry before, after two hours and after 24 hours of bandaging. The amount of edema was calculated by subtracting the volume of the diseased arm from that of the contralateral side. Sub-bandage pressure was measured after bandage application and two hours later. Bandages were then re-applied and the pressure was measured again. Twenty-four hours later, the pressure measurement was repeated and bandages were removed for final volumetry. Patients were randomized into two groups: group A received low pressure bandages (20-30 mm Hg) and group B received high pressure bandages (44-58 mm Hg). The main outcome measures were reduction of arm volume and edema volume in the affected arm in both study groups. Secondary outcome parameters were changes in sub-bandage pressure and patient comfort. RESULTS: Median arm volume reduction after two and 24 hours was 104.5 mL (95% confidence interval [CI], 51.2-184.2) (-2.5%) (P < .0001) and 217 mL (95% CI, 143.9-280.2) (-5.2%) (P < .01) for group A and 56.5 mL (95% CI, -2.7-123.1) (n.s.) and 167.5 mL (95% CI, 105.2-316.1) (-4.2%) (P < .01) for group B, respectively. There was no statistically significant difference between the volume changes in group A and group B. After 24 hours, edema decreased by median percentage of 9.2% in group A and 4.8% in group B (n.s.). Bandages in group A were better tolerated. The sub-bandage pressure drop in the first two hours was between 41% and 48% in both treatment groups at both measuring sites. After 24 hours, the pressure drop was between 55% and 63%. No proximal swelling above the bandage was observed. CONCLUSIONS: Inelastic, multi-layer, multi-component compression bandages with lower pressure (20-30 mm Hg) are better tolerated and achieve the same amount of arm volume reduction as bandages applied with higher pressure (44-58 mm Hg) in the first 24 hours. Publication Types: Comparative Study Randomized Controlled Trial Research Support, Non-U.S. Gov't PMID: 19394553 [PubMed - indexed for MEDLINE] ==================== 23. J Pediatr. 2009 Apr 23. [Epub ahead of print] Related Articles, Links Sporadic In Utero Generalized Edema Caused by Mutations in the Lymphangiogenic Genes VEGFR3 and FOXC2. Ghalamkarpour A, Debauche C, Haan E, Van Regemorter N, Sznajer Y, Thomas D, Revencu N, Gillerot Y, Boon LM, Vikkula M. Laboratory of Human Molecular Genetics (A.G., N.R., L.B., M.V.), de Duve Institute, Université Catholique de Louvain, Brussels, Belgium; Department of Neonatology (C.D.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Genetic Medicine (E.H.), Women's and Children's Hospital, North Adelaide, Australia, and Department of Paediatrics, University of Adelaide, Adelaide, Australia; Centre de Génétique ULB (N.V., Y.S.), Hôpital Erasme, Brussels, Belgium; Unité de Génétique Clinique Pédiatrique (Y.S.), Université Libre de Bruxelles, Brussels, Belgium; Unité Diagnostic Anténatal, Hôpitaux Iris Sud (D.T.), Brussels, Belgium; Center for Human Genetics (Y.G.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; and Centre for Vascular Anomalies (L.B.), Cliniques Universitaires Saint-Luc, Brussels, Belgium. OBJECTIVES: To investigate the genetic causes of idiopathic sporadic prenatal generalized edema. STUDY DESIGN: In a series of 12 patients, in whom in utero generalized skin edema or hydrops fetalis had been diagnosed, we screened 3 lymphangiogenic genes, VEGFR3, FOXC2, and SOX18. RESULTS: In 3 of the patients, we identified a mutation: 2 in VEGFR3 and 1 in FOXC2. Two of the mutations were de novo and one was either de novo or nonpenetrant inherited. In these patients, the generalized edema resorbed spontaneously, either in utero or after birth. In the 2 individuals with a VEGFR3 mutation, edema remained limited to lower limbs. CONCLUSIONS: Mutations in the VEGFR3 and FOXC2 genes account for a subset of patients with unexplained in utero generalized subcutaneous edema and hydrops fetalis without family history of lymphedema. Lymphangiogenic genes should be screened for mutations in sporadic patients diagnosed with fetal edema. PMID: 19394045 [PubMed - as supplied by publisher] ================== 24. J Pediatr. 2009 Apr 23. [Epub ahead of print] Related Articles, Links Sporadic In Utero Generalized Edema Caused by Mutations in the Lymphangiogenic Genes VEGFR3 and FOXC2. Ghalamkarpour A, Debauche C, Haan E, Van Regemorter N, Sznajer Y, Thomas D, Revencu N, Gillerot Y, Boon LM, Vikkula M. Laboratory of Human Molecular Genetics (A.G., N.R., L.B., M.V.), de Duve Institute, Université Catholique de Louvain, Brussels, Belgium; Department of Neonatology (C.D.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Genetic Medicine (E.H.), Women's and Children's Hospital, North Adelaide, Australia, and Department of Paediatrics, University of Adelaide, Adelaide, Australia; Centre de Génétique ULB (N.V., Y.S.), Hôpital Erasme, Brussels, Belgium; Unité de Génétique Clinique Pédiatrique (Y.S.), Université Libre de Bruxelles, Brussels, Belgium; Unité Diagnostic Anténatal, Hôpitaux Iris Sud (D.T.), Brussels, Belgium; Center for Human Genetics (Y.G.), Cliniques Universitaires Saint-Luc, Brussels, Belgium; and Centre for Vascular Anomalies (L.B.), Cliniques Universitaires Saint-Luc, Brussels, Belgium. OBJECTIVES: To investigate the genetic causes of idiopathic sporadic prenatal generalized edema. STUDY DESIGN: In a series of 12 patients, in whom in utero generalized skin edema or hydrops fetalis had been diagnosed, we screened 3 lymphangiogenic genes, VEGFR3, FOXC2, and SOX18. RESULTS: In 3 of the patients, we identified a mutation: 2 in VEGFR3 and 1 in FOXC2. Two of the mutations were de novo and one was either de novo or nonpenetrant inherited. In these patients, the generalized edema resorbed spontaneously, either in utero or after birth. In the 2 individuals with a VEGFR3 mutation, edema remained limited to lower limbs. CONCLUSIONS: Mutations in the VEGFR3 and FOXC2 genes account for a subset of patients with unexplained in utero generalized subcutaneous edema and hydrops fetalis without family history of lymphedema. Lymphangiogenic genes should be screened for mutations in sporadic patients diagnosed with fetal edema. PMID: 19394045 [PubMed - as supplied by publisher] ===================== 25. Physiother Theory Pract. 2009 Apr;25(3):165-73. Related Articles, Links Pole walking for patients with breast cancer-related arm lymphedema. Jönsson C, Johansson K. Lymphedema Unit, Lund University Hospital, Lund, Sweden. charlotta.jonsson@skane.se Arm lymphedema is a well-known side effect of breast cancer treatment. Studies of the effect of physical exercise on arm lymphedema are very rare. The purpose of this study was to investigate the influence of pole walking on breast cancer-related arm lymphedema when using a compression sleeve. Twenty-six women with unilateral arm lymphedema took part in a clinical study of pole walking on one occasion, 4 kilometers for 1 hour. Measurements were made before, immediately after, and 24 hours later. Results revealed no changes in total arm volume of the swollen arm, measured with water displacement method, or in subjective assessments of heaviness and tightness in the affected arm using visual analogue scale. Immediately after pole walking, a temporary increase in total arm volume of the healthy arm (P=0.037) was found. Twenty-four hours later, no differences were found compared to the measurements before walking. The median for perceived exertion immediately after pole walking, measured with Borg scale, was 11 ("fairly light"). The results suggest that a controlled, short-duration pole-walking program can be performed by patients with arm lymphedema, using a compression sleeve, without deterioration of the arm lymphedema. Publication Types: Research Support, Non-U.S. Gov't PMID: 19384736 [PubMed - in process] ================================= http://www.downeast.com/node/10550 Discover Why More Physicians are Choosing Maine Matchmaking can be stressful work. Will the two parties find each other attractive? How will financial expectations compare? Will the extended family get along? No one understands these stresses better than Jane Ham, director of the Maine Recruitment Center. For the past ten years, Ham’s office, a service of the Maine Hospital Association, has been matching physicians with openings in cities and towns across Maine, and she’s seen everything from the storybook romance to The War of the Roses play out in hospitals and small-town doctors’ offices. “We look at recruitment as you’re recruiting the family,” Ham explains. “We had one physician who was interviewing for an orthopedic position, and her husband was an avid fly fisherman. So we made sure he got out fishing, and that went a long way toward making that situation work.” Across the country, small towns are facing a shortage of physicians, especially in primary care, as medical school graduates are increasingly turning to specialties that allow them to quickly repay huge student loan debts. In Maine, the situation is especially dire: the ninety-one physician openings Ham faced in 1999 have skyrocketed to 272 today. “We’re in a full-blown shortage, and it’s only going to get worse,” she says, as the health-care industry expands to handle the state’s graying population. Since 1980, total employment in Maine has increased 52 percent. That sounds impressive until you contrast it with the 200 percent increase in the state’s health-care industry. So Maine definitely needs doctors. “But the good news is that Maine is still an attractive place for physicians who want four-season recreation and quality of life,” says Ham. Indeed, over the past few years Maine has taken several steps to increase its appeal to both young doctors looking for pleasant, safe communities in which to raise their families and older physicians seeking to finish out their careers. “Maine is sort of out here at the end of the world,” Ham explains. “We have a national reach, but we’re reaching out to docs that we hope have some connection to Maine. Maybe they grew up here and are thinking of returning, or maybe they just have vacation experience in Maine. Then there’s that group of physicians who are on the back side of their career and who think they’re not quite ready to retire and want to work a few more years.” Marian Benner, a physician in the Wound, Lymphedema, and Hyperbaric Medicine Center at St. Joseph Hospital in Bangor, is an example of the vacationer-turned-resident doctor. “I called it my midlife crisis. In 2004, I was in my mid-forties living in northeast Maryland, and I just wanted to do something different,” Benner says. Having been to Boothbay and Bar Harbor on vacation and to Portland for a conference, she decided to take the plunge and contacted the Maine Recruitment Center. “And we’ve had nothing but wonderful experiences ever since. In Maryland I had to become a recluse all summer, since the ninety-degree weather hits in May and June and the windows close up, the air- conditioning goes on. I have a new lease on life here — I’m always outside.” She admits her teenage daughters sometimes complain about the lack of shopping opportunities in Maine compared to elsewhere, a craving that is quickly cured by a weekend in Boston or New York. While Maine’s small towns and outdoor opportunities are often most attractive to physicians’ fly-fishing spouses, the growing trend of doctors becoming employees of hospitals often appeals to the physicians themselves. “We employ close to 80 percent of all the physicians in Lincoln County, and that will go to 100 percent in the not-too-distant future,” says James Donovan, president and CEO of Lincoln County Healthcare, which operates Miles Memorial Hospital in Damariscotta and St. Andrews Hospital and Healthcare Center in Boothbay Harbor. “[The trend] has been evolutionary across the state, but it has rapidly increased in momentum over the last five years or so.” Donovan says doctors, especially in small towns, have discovered that working for the local hospital allows them to pass off bookkeeping and administrative work and instead focus on treating patients. “It’s very difficult to run a physician practice these days,” he says. “It’s a small business, with all the complexities of that, but most physicians want to practice medicine.” Charles Dwyer, director of the Maine Office of Rural Health, agrees that the administrative headaches of running a private practice, including how to deal with low reimbursement rates through MaineCare, can often outweigh the benefits of staying independent. “If I’m struggling to keep the overhead of my back office, and I have one case where I need to rebill something, I’ve basically lost any kind of margin,” he says. Statewide, Maine hospitals now employ 45 percent of the 5,400 licensed doctors, and a whopping 78 percent of all licensed primary care physicians. “For physicians tired of the hassle of paperwork, Maine is very attractive,” Ham says. “We’re so much further along in all of this — we started employing doctors in hospitals in the early nineties, and what I hear from colleagues nationally is that they’ve just started looking at doing this.” But the ability to focus on patient care isn’t always enough when it comes to attracting good doctors to Maine small towns. Pay scales for physicians in Portland are comparable to the national median, but Donovan says rural areas are always hard-pressed to offer the high salaries that doctors need to repay student loans. As the physician shortage in Maine has worsened, hospitals like Donovan’s in Damariscotta and Boothbay Harbor have seen a rapid escalation in salaries required to secure quality doctors. But St. Joseph’s Dr. Benner says the pace of life and work in Maine makes up for the lower pay. “Yes, the pay is a little less, but I don’t work as hard here,” she remarks. “You get paid for how hard you work, and I think if you look across the board, with cost of living and malpractice costs and everything, it all evens out.” The other compensation that doesn’t make it onto a spreadsheet, she says, is the camaraderie that exists among doctors in Maine. “The physician camaraderie is great here — everyone knows each other, as opposed to Maryland, where you came in, worked, and went home, and nobody really knew you.” One program through which Maine has been most successful in attracting new doctors is the J-1 visa waiver program, whereby foreign doctors are allowed to practice in rural areas, including Maine, in exchange for a two-year commitment. Dwyer’s Office of Rural Health surveys these international physicians when their commitment is complete and has found that a surprising majority of them continue practicing in Maine. Of the last group of 116 foreign physicians surveyed, in 2004, 71 percent intended to stay in the state, up from 69 percent the previous year. “I’d be surprised if you did a random sampling of non-foreign physicians if you’d find a higher percentage,” Dwyer declares. “Especially in this labor market, which is fairly fluid.” He says the local community usually deserves as much credit for retaining these doctors as the hospitals that they end up working for. “One of the things that makes a huge difference for whether these physicians stay or go is how well they were integrated into the community. Is there more than a small group of people in your area that has your same religious preference? Are there other people that your family can relate to?” Ham says retaining doctors once they arrive in Maine is especially critical today, when competition for primary care physicians is at an all-time high. “It used to take three to six months to recruit a family practitioner; now it takes a year,” she says. Even if the state is able to entice a doctor from another state to join a Maine practice or hospital, often the sagging real estate situation nationwide will put a cross-country move on hold. “Physicians who are practicing in other parts of the country who might want to move to Maine are hung up in the real estate bust. They have homes, usually expensive homes, that they just can’t sell.” One factor working against Maine’s ability to attract new doctors over the years has been its lack of a traditional medical school (though the University of New England has operated its College of Osteopathic Medicine since 1978). Since building a bricks-and-mortar medical school would be exceptionally expensive, this fall the state will launch a new agreement with Tufts University and the University of Vermont to allow medical students to do some of their clinical rotations in Maine. “We need to grow our own, to let kids see what it’s like to work in Maine,” Ham says. “The more we can expose people in training to physicians in Maine, and to the health-care system in Maine, the more likely they are to stay here.” This period in a medical student’s training is especially critical for states like Maine, Ham says, as this is when young doctors typically marry and choose where they’d like to raise a family. Without doubt, though, the biggest asset Maine can offer its doctors is a quality of life that is the envy of much of the nation. “In my view, spouse and family issues are 51 percent of the decision,” remarks Lincoln County Healthcare’s James Donovan, “Maine is such a great place to practice.” In the end, Maine’s ability to attract new doctors to its small towns will rest not on a single strategy, but rather the multi-faceted approach that has evolved over the past few years: allow doctors to practice more and administrate less by joining hospitals’ payrolls; foster communities that welcome doctors and integrate them into their small town; and create partnerships with out-of-state medical schools to bring physicians in training to Maine and expose them to the quality of life, and of patient care, that the state offers. ===================== From http://blog.diabeticparents.org/ Getting Free Prescriptions When You Make Too Much $$ Let's face it. The majority of our population make well over the federal poverty line to receive any federal aid. In this time of uncertainty in our economy, pinching pennies is something we are all looking to do. As a diabetic parent, we know that the cost of a family and the cost of taking care of ourselves is expensive and never gets any cheaper! That's why a recent television news article caught our attention. Families with insurance and those families who make up to $80,000 a year as a family of four can get free or greatly reduced prescriptions. When my husband and I heard this, we laughed! We've been hearing for years that we don't qualify for anything simply because we make too much. But even if you make well over the federal poverty line, many prescription drug companies will help you--if you ask. If you have a chronic disease like diabetes, or are experiencing financial difficulties paying for your medications there are ways to receive help that won't cost you anything. There are three websites that are available to help. RxAssis allows you to type in the medications you are taking. After typing in your medications, the website pulls coupons, and gives you direct links to the drug manufacturer financial hardship links. While some medications and drug companies list specific income requirements, the article claims that you should still pursue filling out and sending an application. Many families facing financial hardships or who have chronic diseases can qualify for reduced or free medications, whether or not they have insurance, and whether or not you make mo re than the minimum requirement from the drug manufacturer. NeedyMeds.org is another website that can help. The website has an extensive link of coupons available to use at local pharmacies. You can also qualify for financial assistance through the website and even drug discount cards. Montel Williams created a pharmacy program to help assist those who need medications but may not be able to afford them. They cover those who may have reached a gap in their current medical insurance and are now paying for their medications, or those who can't afford the cost of their medications. They state that they will cover those with insurance who take medications not covered by your insurance, and even those with a high deductible co pay. You must earn equal to or less than $41,800 for a single person, $56,000 for couples, or $84,800 for a family of four to be considered for the program. What if you try all these programs, and you still don't qualify for any? Don't despair! Other ideas for saving mo ney include sending a letter directly to the drug manufacturer of your insulin or other diabetic medication or supplies directly and letting them know of your financial hardship. Some companies will send out coupons, savings cards, or will tell you ways to save mo ney on the drugs they sell. Checking with your doctors office or with your local diabetic clinic can also help. They routinely get drug reps in who stock them with samples of some of the medications you may be taking. They also on occasion offer your doctor coupons to give out to patients for free 7, 14, or 30 day supplies. Let your doctor know of your situation and see if they may have any of these things available. Many times doctors get busy and don't think to check the med closet. Sometimes doctors even have new meters and mo re to give out from drug reps! You can check out these websites by going to these links: Rx Assist: www.rxassist.org Needy Meds: www.needymeds.org Montel Williams Pharmacy Program: http://www.freemedicine.com =========== t Large in Ballard: Casting from the curb By Peggy Sturdivant June 1, 2009 updated 6 hours ago Fly fishing entered my life when John Olson parked his City of Seattle Department of Transportation backhoe along the front curb and prepared to eat lunch in the cab. He was the advance team for the crew from the streets division dispatched to lift the concrete at the base of the alley in order to explore the void by a storm water drain (At Large in Ballard: The void). When your vehicle is a four-ton backhoe it isn’t practical to return to the break room at Haller Lake for lunch; besides John prefers the quiet at the job site. Excited at the appearance of equipment that could solve the sidewalk problem I waved up at John in the cab to ask questions. It seemed fitting to learn in our “street talk” that he grew up within a half a mile, back on the street where I lived for the last 21 years. “We played baseball down your way,” he said. “The catch basins were the bases.” It was clear he really knew these streets. Later when the rest of the concrete crew arrived, John climbed into the cab of his machine and donned ear protection while operating a pneumatic hammer drill to break up the sidewalk. While the crew on the ground poked at the revealed drain pipe he gave me a smile. John Olson has a great smile. John was born at Ballard Hospital and went to school at Adams Elementary. He graduated from Ballard High School (1973) as did his father, and his own two children. Three generations of Ballard graduates. In this neighborhood he recalled the phone booth that used to be in front of the Foodtown Grocery on 32nd Avenue Northwest. As a youngster he was intrigued by the hinged doors, but once he got stuck inside. A neighbor finally rescued him, put him under her arm and deposited him at home. Later on when he was learning to drive he got the car underbelly stuck on a bump in the parking lot. He doesn’t miss Foodtown. Like so many kids growing up in Ballard in the 1960s he and his friends would play down at the beach by Ray’s. They’d fish or throw a tennis ball for a dog but then have to swim out for the ball when the dog lost interest. His father had a three stage whistle that he used to call the kids home. With the exception of three weeks working in Idaho soon after high school, John Olson didn’t go far from Ballard. He returned from making orange juice in Idaho (“I cannot stand this”), married a Nathan Hale graduate he’d met while working as a ball field attendant and settled on Northwest 74th. He’s worked for the City of Seattle for 28 years and had the same phone number even longer. He eyed the street where we were standing and recalled that he almost bought a home nearby, but the street condition suggested underlying instability. “I want a house on a street that has curbs and sidewalks because then you have good drainage," he said. He lives in Olympic Manor, but he still owns the house that was next to his on 74th. He paid the back taxes for an elderly neighbor so that she wouldn’t lose her home; then purchased it from her family after her death. He’s had the same tenant for 19 years. When the tenant goes on vacation, John feeds his fish. We talked while John re-attached the bucket to the backhoe and double-checked the fasteners. How did we start discussing fly-fishing? Perhaps anyone who spends time with John hears about tie end casting. John currently teaches fly-tying at the Orvis store in Bellevue, though over the last decades he’s taught classes in Ballard and near by. His classes are geared for adults but he once taught two nine-year old boys, best friends who lived across the street from each other. His oldest student was an 87 year-old widow who had always wanted to learn. He had her come an hour early one week to work with her one-on-one, and, “She really got the hang of it.” Every year John participates in a retreat called “Casting for Recovery,” teaching fly fishing to women recovering from breast cancer. The casting motion is therapeutic, particularly in countering effects of lymphedema that can occur after surgery involving lymph nodes. John demonstrated the motion, a sinew in the air that I couldn’t help but correlate with his controlling the pneumatic drill from 10 feet above the ground. It was the lure of sidewalks and curbs that drew John and his family to Olympic Manor plus a 360 degree view and a veritable boulevard to practice casting. Unless he gets transferred during department changes John works the north division of Seattle, south to Denny and north to 145th. He enjoyed seeing old friends during the sidewalk project on Ballard Avenue. With school boundaries shifting he doesn’t foresee a fourth generation of his family graduating from Ballard High School. “That’s over,” he said, along with getting his chowder fix from Gordo’s on Seaview. He shared a final story before driving back to the Haller Lake facility in his backhoe; which takes much longer returning to the north, than descending to the south. While casting with his fly rod in front of his house he heard a neighbor take a fall. After he’d helped the neighbor and the firemen had patched him up they gathered to ply John with questions about his choice of rod and reel. One of John’s best rods cost more than his $1,000 car - but the rod will last forever. John made another casting motion with his whole arm and then gave a wave. The backhoe took a left at the stop sign; then John and his beaming smile were gone. http://www.ballardnewstribune.com/2009/05/31/features/large-ballard-casting-curb |