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Lymphland International Lymphedema Online
| AUGUST 2007 Published: August 31, 2007 12:00 am Treating the swelling effects of lymphedema By Rx for Health , Kathleen Edwards Eagle-Tribune Lymphedema is a very common condition affecting more than 3 million Americans. However, very few people have a true understanding of what it is. Lymphedema is the swelling of a body part. It is most often found in the arms and legs, but may also affect the face, trunk, abdomen or genital area. In order to classify swelling as lymphedema, the fluid must not only be water-based but also contain proteins. To understand where this fluid comes from and the significance of what it contains, you must first have an understanding of the lymphatic system and how it works. A two-layered system comprised of a superficial and a deep layer, the lymphatic system is present in all of our bodies. It consists of lymphatic vessels and lymph nodes that, with a few exceptions, run through all areas of the body with a blood supply. While lymph nodes vary from person to person, we average about 600 to 700 lymph nodes throughout our bodies. The majority are positioned in the intestines and head or neck area, where they act as a powerful line of defense against common entry ways for pathogens, better known as germs. Lymph nodes primarily protect us by filtering harmful materials like cancer cells, pathogens, dust and dirt, and improving immunity through the production of antibodies. The lymph vessels help to move the lymph fluid away from our vital tissues to the lymph nodes, taking along with it waste products, bacteria, dead cells and large cells that our body cannot transport or break down. Here, these waste products are broken down and destroyed, leaving any beneficial fluid to be transported back to our heart and lungs to re-enter the blood stream. There are multiple causes of lymphedema. One common type results from surgery or radiation used as part of cancer treatment. Other common causes can be surgical procedures in which lymph nodes are removed (i.e. mastectomies or lumpectomies) , trauma or infection of the lymph system, severe venous insufficiencies, and hereditary issues present at birth or triggered later in life at the occurrence of puberty or with pregnancy. Initially symptoms of lymphedema may be reduced by elevating the affected area. However, without proper treatment, lymphedema will continue to progress through its stages and worsen, leading to hardening of the affected area. As the limb grows progressively larger and harder, it becomes more prone to complications such as fungal infections. Many treatments are available. Most often, medicines such as diuretics are prescribed. But without additional treatments, diuretics have very poor long-term results and should not be used solely to treat lymphedema. Diuretics only help to remove water from the affected area, leaving the proteins behind. When a patient comes off the diuretics, the protein-rich area may attract the water once again, causing the swelling to return. Sometimes, pneumatic compression pumps can be used. However, if used alone, they also present downfalls similar to using diuretics without additional treatment. Pneumatic compression pumps temporarily remove the water, leaving the proteins behind to potentially attract more water once the pump is removed. In addition, the pump may actually destroy remaining functional lymph vessels, causing an increase in lymphedema with long-term use. Currently, the treatment of choice is complete decongestive therapy. This type of therapy consists of four components: manual lymph drainage, compression therapy, exercise and skin care. Manual lymph drainage is a gentle technique in which the accumulated fluid is manually moved out of the congested area and re-routed, sending the lymph liquid to a clear area where it can successfully move back into the body's normal circulation. Compression therapy, done through the use of bandages and compression garments, helps prevent future accumulation of fluid once it has been manually removed. Exercise is important in this method of therapy, if done properly. If the wrong exercises are performed, they can actually make the condition considerably worse. A trained professional will develop a customized exercise program designed to facilitate the use of muscle activity to push the fluid out of the affected limb. Finally, information is given on the importance of skin care and how to care for the swollen limb properly to avoid infection and avoid triggers that may cause the recurrence of lymphedema. When treated properly, lymphedema can be sent into remission. If patients initially receive proper treatment for this life-long condition and learn how to prevent its recurrence, they can return to their daily activities and a normal way of life. nnn Kathleen Edwards DPT, CLT is a doctor of physical therapy and certified lymphedema therapist at The Center for Rehabilitation and Sports Medicine at Beverly Hospital. Downtown Milford gets a new pink door By Alison Bergsieker STAFF WRITER Non-profit opens up shop There isn't anything more uncomfortable than wearing a paper dressing gown, sitting alone in a doctor's office and waiting for an expensive mammogram that could turn up positive for cancer. But there is one non-profit group working to make mammograms more affordable, while pampering those patients who need it most. And they've just moved in on Main Street. Julie Durham, owner and co-founder of the Pink Door, a non-profit organization helping women pay for mammograms to detect early warning signs of breast cancer, will open up shop at 239 N. Main St. on Aug. 24 in the old Shelton Windows building. Durham is a mammographer at Botsford General Hospital in Farmington Hills. After receiving countless calls from patients with no insurance or other situations who couldn't afford mammograms, she founded the Pink Door. "A lot of people out there are the working poor," Durham said. "We lose lives based on the fact that there's nothing there to help these women." Durham had been searching for a location in Highland for several months with no avail. She was sold when she came across the Shelton Windows building, which has a perfectly painted pink door. "God closed the door and opened the windows — Shelton windows," Durham said. "After we got every door slammed we ended up in downtown Milford." Debbie Shew, special services coordinator, said the store will carry an endless supply of "comfort." "We've got golf shirts, fleeces, robes, T-shirts, sweatshirts, pants — just a variety of clothing for men and women," Shew said. "We have a 'Sirvivor' line for men too." The store will sell T-shirts designed with a little door that opens across the chest, so patients can opt out of wearing the uncomfortable dressing gowns offered at hospitals. "When people have cancer, they don't feel good, and they don't feel pretty," Shew said. "Our goal is to help them out with that." There will be a few new editions too — Susan's Special Needs will offer pre-imposed mastectomies once a month, and other items available for purchase include a line of chocolates, radiation soothing creams, journals and attractive hats for patients who've lost their hair. Shoppers also can purchase a "Remembear," a teddy bear made with clothing of loved ones who've passed. "If someone happens to pass away, you can take a piece of their clothing, and we fashion a teddy bear out of it," Durham said. "The teddy bear will actually be named after the person." A massage therapist will be available for lymphedema patients who are suffering from fluid build up in their arms, Shew said. Shew and her husband, Larry, co-authored the book, "The Home Report Card," a book that lets family members fill out grading scales for each other. The couple will hold a book-signing at the store on Aug. 25. Durham will perform a ribbon cutting ceremony at the store on Aug. 24. The non-profit also will host a dinner theater event at 59 West on Aug. 23. For more information about the dinner theater contact Andrea Bronson at (248) 320-4585. Store hours are from 10 a.m. to 6 p.m. Wednesday and Friday, 10 a.m. to 7 p.m. Thursday and 10 a.m. to 4 p.m. Saturday. "This is for a great cause," Shew said. "There's nothing between Highland and Detroit that provides these services for both men and women." Alison Bergsieker is a reporter for the Milford Times. She can be reached by phone at (248) 685-1507. Precision Dynamics Corporation Offers Color Coded Alert Band Wristbands for Patient Safety SAN FERNANDO, Calif.--(BUSINESS WIRE)--Precision Dynamics Corporation (PDC), a leader and innovator of automated wristband identification, announces the release of color coded Alert Band Wristbands for patient safety. Throughout the United States, healthcare facilities have long used color-coded wristbands to signal important medical information. In fact, according to the 2005 Patient Safety Authority Survey of Pennsylvania Hospitals four out of five respondents’ facilities used color-coded patient wristbands. However, the lack of consistency in wristband meanings and how they are applied presents problems when patients are transferred among facilities and when patients are cared for by clinicians in multiple hospitals. This challenge was highlighted when a patient was nearly not resuscitated during a cardiopulmonary arrest because she was incorrectly designated “DNR” with a color-coded wristband by a nurse who worked in multiple facilities and was confused about the meanings of different colors.(a) Events such as these increase the risks of making potentially fatal patient errors. Precision Dynamics’ color coded Alert Band wristbands greatly minimize the chance of error by providing pre-printed, large visible text/cues and an extensive range of vibrant colors that allow healthcare workers to immediately identify patient medical conditions. Each band is equipped with PDC’s patented SecurSnap® closure for optimum patient comfort and safety. While at this time there isn’t a national standard assigning specific color wristbands to specific alerts, individual states such as Arizona, New York, Pennsylvania, Ohio and others are adopting standards, and PDC supports these and all patient safety initiatives. In support of these initiatives, PDC’s Color Coded Alert Bands provide maximum patient protection and comfort in one total wristband solution. PDC’s Color Coded Alert Wristbands provides healthcare professionals with the following advantages: Clear Visibility of patient alerts even if the patient shifts or the patient cannot be disturbed. SecurSnap® closures for patient security, safety and comfort. Flexibility in size for patient comfort. Custom printed text to fit any standardized level now and in the future. Custom alert logos to allow for less common conditions such as “Limb alert” or “Lymphedema Alert” etc. Latex-free. For more information on PDC’s color Alert Bands, please visit call 800-772-1122. For media inquiries and requests for hi-resolution product photos, please contact: Adrienne S. Lamm at 818-897-1111 ext. 1330 About Precision Dynamics With over 50 years of experience, PDC is a global leader and pacesetter in the development of Auto ID wristband systems for healthcare, leisure and entertainment, and law enforcement. The company introduced the first patient Bar Code ID Wristband, patented Smart Band® Radio Frequency Identification (RFID) Wristbands, the AgeBand® Age/ID System, and PDC Smart Kiosk® Cashless RFID System. PDC is committed to 100% quality in service, design, and manufacturing and has ISO- 9001: 2000 and ISO-13485: 2003 certification. For more information, visit www.pdcorp.com. Precision Dynamics Corporation name and logo, Securline®, SecurSnap®, Smart Band®, AgeBand®, and PDC Smart Kiosk® are registered trademarks of Precision Dynamics Corporation. All other product names, company names, marks, logos and symbols mentioned herein are trademarks of their respective owners. A surgeon at the University of Arkansas for Medical Sciences (UAMS) has developed a new procedure to prevent one of the most common side effects associated with breast cancer treatment lymphedema or swelling of the arms due to faulty drainage of the lymph nodes. V. Suzanne Klimberg, M.D., director of the UAMS breast cancer program, led a study funded by the Tenenbaum Breast Cancer Research Foundation of breast cancer patients at risk for developing lymphedema. Her findings were published in the February issue of the Annals of Surgical Oncology, and she will present the study March 17 at the Society of Surgical Oncology 60th Annual Cancer Symposium in Washington, D.C. "The removal and analysis of the lymph nodes under the arm remains the most important factor in determining the severity of disease in breast cancer patients," Klimberg said. "In the past, surgery to remove the lymph nodes and most of the fat and tissue in the armpit often resulted in complications, including lymphedema." Five percent to 50 percent of women undergoing surgical treatment for breast cancer have developed lymphedema, mainly dependent upon the extent of surgery. At the ACRC, surgeons determined that the draining of the first lymph node, known as the sentinel lymph node, is capable of predicting if the cancer has spread to the remaining armpit lymph nodes, known as axillary lymph nodes. This is a less invasive surgery and reduces the likelihood of complications. However, the lymph node system is at risk of disruption during either a sentinel lymph node biopsy or an axillary lymph node dissection, which often leads to swelling in the arm. To prevent the arm swelling, Klimberg has developed the Axillary Reverse Mapping (ARM) procedure. The new technique evaluates the ways in which fluid drains through the lymph node system in the arm through the injection of blue dye. The dye is used to map the drainage of the arm. "Mapping the drainage of the arm decreases the chances of unintended disruption of the lymph node system during surgery and reduces the risk of developing swelling in the arm," Klimberg said. "We are the first to study lymph node drainage in the arm and are now using the ARM procedure as standard procedure at UAMS." Klimberg will soon begin conducting training seminars on the procedure throughout the country. The seminars will be sponsored by the global medical device company Ethicon, a branch of Johnson & Johnson. Klimberg is chief of the Division of Breast Surgical Oncology at UAMS and a professor in the Departments of Surgery and Pathology. She also is director of the Breast Cancer Program at the UAMS' Arkansas Cancer Research Center as well as director of Breast Fellowship in Diseases of the Breast at UAMS. Additional UAMS staff members involved in the published study are Kent Westbrook, M.D.; distinguished professor; Ronda Henry-Tillman, M.D., associate professor of surgery; Margaret Thompson, fellow; Soheila Korourian, M.D., associate professor of pathology; Keiva Bland, fellow; K. Jackman, surgery resident; and Laura Adkins, data manager. UAMS is the state's only comprehensive academic health center, with five colleges, a graduate school, a medical center, six centers of excellence and a statewide network of regional centers. UAMS has about 2,430 students and 715 medical residents. It is one of the state's largest public employers with about 9,400 employees, including nearly 1,000 physicians who provide medical care to patients at UAMS, Arkansas Children's Hospital, the VA Medical Center and UAMS' Area Health Education Centers throughout the state. UAMS and its affiliates have an economic impact in Arkansas of $5 billion a year. University of Arkansas for Medical Sciences 4301 W. Markham St., Slot 716 Little Rock, AR 72205 United States --------------------------------------------------------------------- 83-year-old’s fundraising efforts for disease victims By Nicola Fifield Eileen Rhodes, 83, is fundraising for MacMillan Cancer Support. LIFE has been full of heartbreak for a mother-of-two, who has lost two husbands to cancer and is now facing her own battle with a non-curable disease. But despite the rough deal life has dealt her, Eileen Rhodes is more concerned about the suffering of other people - and has raised thousands of pounds for charities over the years. The 83-year-old, who lives off Poppleton Road, in York, had only one week to say goodbye to her first husband, Jim Smart, who died of prostate cancer in 1983. She said: "We were living in the Scottish Borders at the time. He suddenly fell in and was rushed to hospital in Edinburgh, where he was told he had a week to live. "I was devastated. Neither of us had any idea he had cancer until that moment. It was so sudden. "During that last week he was unconscious throughout and I couldn't even say goodbye properly. That was very upsetting." advertisement Eileen, who is a retired special needs teacher, met Jim when she was 23 and they had been married for 40 years before his sudden death. She said: "After Jim died, I said to my children that I would never get married again. But I moved to York and started working as a volunteer at the St Sampson's Centre and it was there I met Cliff. "After losing Jim, it was so wonderful to be happy again. Cliff was one of those rare gems - everybody loved him. "He proposed to me under the Queen Mother's portrait at the centre and we were married in 1985. For our honeymoon, we went to California. It was so romantic." But her happiness was short-lived after Cliff also fell ill in 1994 - and was diagnosed with leukaemia at York Hospital. Eileen said: "We had just one month together after he was diagnosed before he died. I can't really describe the pain, I was completely devastated. "But I knew I had to get on with my life. My motto has always been to keep going." A year after Cliff's death, Eileen developed the incurable condition lymphedema, which causes her legs to swell to three times their usual size due to an abnormal collection of lymph fluid in her body tissues. She said: "There's no point in feeling sorry for myself because I know there are many people far worse of than myself. "Lymphedema isn't life-threatening, but every day a district nurse has to come to my home to dress both my legs. "It gives me some pain in my back because it increases your body weight so much, but I'm still active." Eileen now focuses all her efforts on fundraising for Macmillan Cancer Support, which provides medical, emotional and financial support for cancer patients and their families. On Saturday, September 29, she is holding a marathon coffee morning at 26 Prior's Walk, in York, from 10am to 6pm. 10:46am Saturday 8th September 2007 CommentPosted by: Tina of Lymphland, New York State USA on 4:17am today Eileen, I'm sorry you lost your husband, what you are doing for the fundraising is awesome. I do have to say though that what you said about lymphedema not being life threatening is not 100% correct. We have to be careful of infections called cellulitis which can and are deadly. I have know 3 people in my group who have lost relatives due to cellulitis, so please be careful. I own Lymphland.com and Lymphland International Support Group, you and anyone else interested can join, the button to join is on the front page of Lymphland.com We have a chatroom that is open daily and alot of information about all aspects of lymphedema and living with the condition. Education is the best thing you can do for any condition especially lymphedema. Tina Budde of Lymphland Treating lymphedema Rezin Orthopedics is the last option for some patients September 5, 2007 Roberta Messmer, of Morris, thought her ordeal with cancer was long over. She had a mastectomy some 22 years ago when she was only 48 and was cancer-free. But after slipping on some wet grass about 13 years ago and breaking her fall with her left arm, she started noticing some swelling in her arm. Lymphedema patients must continue their at-home treatments the rest of their lives. ( At first she just thought it was from the fall itself, but she came to realize that her swelling had its roots in her cancer. Nineteen of Messmer's lymph nodes had been removed during her mastectomy, causing permanent damage to her lymphatic system. Her body had coped with her compromised lymphatic system for years, but the fall had added just enough overload to her lymph system that inflammation and swelling ensued. Her arm and hand swelled so much she had to have her wedding ring cut off her finger. Messmer's situation is not unusual. She had developed lymphedema, an abnormal accumulation of tissue fluids in the soft tissues of the body. Horrendous timing The irony is, just when many recovering cancer patients think their difficult ordeals are over, lymphedema rears its ugly head. American Cancer Society's statistics show that one third of women who have lymph node dissection suffer from lymphedema symptoms. Most commonly seen following breast cancer interventions, lymphedema can also occur after ovarian and cervical cancers. Men can get it after prostate or testicular cancers. Lymphedema can also appear with surgeries, infections, diabetes and some cardiac disorders. A person can be born with lymphedema, too. Doctors often refer to it as "thick legs." Traditional treatments for lymphedema have included diuretics and compression pumps. Julia Rodrick, a master clinician and lymphedema expert at the Hand and Lymphedema Center, a branch of Rezin Orthopedics and Sports Medicine in Morris and Ottawa, believes there is a better way. Rodrick uses manual lymph drainage and complete decongestive therapy. This is a combination of manual tissue techniques, exercise and special compression garments and wraps. Rodrick says she sees many patients who come to her as a last option after seeing health care professionals who do not fully understand the latest treatments. "Lymphedema is not something people have to live in misery with," Roderick says. "It is not curable, but it's manageable. There is hope, and we are excited to get the word out." Common symptoms Rodrick has studied lymphedema treatments with Dr. Michael Foldi in Germany, a leader in the field of lymphology. She's been using his methods successfully on patients since 1999 and has assisted in developing treatment programs throughout Illinois. Symptoms of lymphedema usually begin with a slight swelling in the arms and legs. Rings on the fingers might be tight, or there might be difficulty fitting into a shirt sleeve or pant leg because of the swelling. Left untreated, the limb can grow larger, swelling with fluid and protein trapped in the soft tissues. Cases have turned into major disabilities, disfigurement and even dangerous infections, such as cellulitis. Lymphedema can cause hard-to-heal wounds in limbs, too, leading to complications. The first week Rodrick sees a lymphedema patient she does the treatments daily. After that, she teaches her patients how to do the manual techniques and exercises themselves at home. They return now and then to perfect their techniques. Lymphedema patients must continue their at-home treatments the rest of their lives. When Roberta Messmer finally came to Rodrick for her lymphedema, her goal was to get her arm down to a nice size to fit into a special dress she had bought for an Alaskan cruise for her 50th wedding anniversary. By the time her treatments were through she was able to wear the dress. "It was just such an improvement over the previous therapy I had," she said. "Julia just really knows her stuff. She did a great job." For more information, contact Rezin Orthopedics and Sports Medicine at (815) 318-5650. -------------------------------------------------------- Reported September 14, 2007 Freezing Away Cancer BALTIMORE, Md. (Ivanhoe Broadcast News) -- Many people think of heartburn as something that's slightly uncomfortable. But for some people, it can develop into a life-threatening condition. Years of heartburn forced Bill Mohler to trade in orange juice for coffee at breakfast. "One of my vices is coffee," he says. "I drink about three cups a day." After 50 years of acid reflux, Mohler was still shocked to learn he'd developed Barrett's esophagus -- a condition where acid eats away the esophagus' lining and precancerous cells grow in their place. "They couldn't have cured it," Mohler says. "It would have become cancer." But timing was on Mohler's side. He soon found out he was eligible to take part in a pilot study testing a new device designed to kill precancerous cells. "The low-pressure spray liquid nitrogen is a new technique," says Bruce Greenwald, M.D., a gastroenterologist at the University of Maryland Medical Center in Baltimore. During the procedure, doctors anesthetize patients, send an endoscope down the esophagus and spray the abnormal area with liquid nitrogen. The liquid nitrogen freezes the bad cells and kills them. Doctors let the cells thaw for 45 seconds before spraying and thawing the area three more times. "The patients tolerate the treatment very well," says Dr. Greenwald. "We're seeing a regression of the bad cells." The procedure takes about 20 minutes, and patients feel little discomfort. In fact, they're usually up and about the same day. Dr. Greenwald says the results of the study are promising. "To some degree, [the procedure] helped everyone," he says. Larger trials will now be conducted at several hospitals to confirm the results, and patients like Mohler will continue to be followed. For now, Mohler's bad cells are gone, and he feels great. "I'm blessed," he says. "It's almost like hitting the lottery." Now, he and his wife can enjoy the retirement they always planned on. If you would like more information, please contact: Karen Warmkessel Public Relations University of Maryland Medical Center (410) 328-8919 http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=16959 -------------------------------------------- Recovery through rhythm -- Lebed Method of exercise helps breast cancer survivors By: PATTY McCORMAC - For the North County Times "Surviving is important, but thriving is elegant." That is the motto of Sherry Lebed Davis, one of the founders of The Lebed Method, a program of movement and dance that helps women heal emotionally and physically after breast cancer surgery. She and her two brothers created the program when their mother became depressed after breast cancer surgery in 1979. Lebed Davis, who was formerly a professional dancer with dance studios, used it nearly 20 years later when she herself underwent surgery for breast cancer. The method is so effective that it is practiced today in about 600 hospitals worldwide, she said. And because of growing interest, Lebed Davis will be visiting North County this week to provide a three-day certification program for new teachers and to refresh the skills of existing ones. "We need teachers. California is a big state, and there are a lot of hospitals we need to get into," Davis said. Two main goals The Lebed Method helps reduce two common side effects experienced by breast cancer survivors ---- frozen shoulder, a surgical complication, and lymphedema, or swelling of the lymph glands. "Both of these complications result in a decreased range of motion in the upper body. We have found that the ... classes prevent or minimize this loss of mobility," wrote Simone R. Zappa, a registered nurse and administrator of the Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center in New York City. She was quoted in Radiology Today magazine in 2001. Locally, the Lebed Method is taught at Sharp Hospital in San Diego by Rancho Bernardo resident Terri Wyatt, a registered nurse and the hospital's oncology case manager. She said the exercise and restoration of mobility are not the only positive results of the class. "It is a support group. They bond with each other, and there is a lot of camaraderie," she said. Isobel Chisum of San Carlos, who has been following the program for almost a year now at Sharp Hospital in San Diego, agreed. She and her husband, Bill, met Lebed Davis on a cruise ship where she was teaching the method. Isobel, 71, had been diagnosed with breast cancer the day before leaving for the cruise and had surgery the day after returning. "This has helped with lymphedema (swelling), plus it is uplifting and very much fun, and it's great that my husband can come and support me," she said. Open to all Classes are not limited just to breast cancer survivors. "We open the classes to the community," Wyatt said. According to the Lebed Method Web site, classes are also offered at fitness centers, dance centers, churches and wellness centers nationally. Other local sites include Scripps Center for Integrative Medicine in La Jolla; the U.S. Naval Hospitals at Camp Pendleton and in San Diego; the Green Cancer Center in La Jolla; and through the California Multiple Sclerosis Society. Laurie Mort, who teaches the method at Inner Strength Yoga in Oceanside, said it is very gentle exercise. "Another byproduct of the program is that it creates a positive environment and positive reinforcement, which is a big part of the program as well," Mort said. And positive reinforcement is important. Lebed Davis recalled how devastated her mother had been after her cancer surgery. "My mom used to be a ballroom dancer with my dad, and after surgery she couldn't hook her bra and she couldn't brush her hair. She was from that era of Marilyn Monroe, when breasts were a symbol of sexuality. She went into a crash kind of depression." A family creation Lebed Davis's two brothers, Marc and Joel Lebed, both surgeons at Albert Einstein Medical Center in Philadelphia, wanted to help their mom. "They said, 'Let's all get together: You bring the dance and we will put together a program that is medically sound,' " said Lebed Davis. "So we put together a program for my mom. "Our house was always filled music and dance. That is how my brothers were raised, and they always felt there was more to medicine than just medicine." The results were so impressive that her mother's doctor wanted to know what she was doing and adopted the program at Einstein. In 1996, Lebed Davis underwent surgery for breast cancer. "Recovery was very hard for me. I couldn't move my arm. I called up my brother and said 'I'm so depressed. I don't know what to do.' He said, 'Sherry. Do your program.' It was like, 'Duh.' " That experience convinced her to quit her job as director of marketing for a health care company and devote herself full-time to the Lebed Method. Since then, she said, the program has helped thousands. Lebed Davis will teach Wyatt's class at 10 and 11 a.m. on Thursday at the outpatient pavilion at Sharp Hospital, 3075 Health Center Drive, San Diego. From 8 a.m. to 5 p.m. Friday through Sept. 16, she will give the certification class at Inner Strength Yoga, 2124 El Camino Real, Oceanside. The cost of the three-day class is $500, but scholarships are available to those who might not be able to afford the full fee. Those interested in taking the class for instructors need no prerequisites, Lebed Davis said, and no special skills other than wanting to help others not just to survive, but to thrive. "To me, surviving is just barely holding on," Lebed Davis said. For more information, call (877) 365-6014 Patty McCormac is a freelance writer. SCO Breast: Lymphedema Diagnosis Should Take Patient Perception into Account By Crystal Phend, Staff Writer, MedPage Today Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. September 10, 2007 Add Your Knowledge™ Additional ASCO Breast Coverage SAN FRANCISCO, Sept. 10 -- Arm measurements alone may not identify clinically relevant lymphedema for breast cancer patients after axillary lymph node dissection or sentinel biopsy, researchers said. Action Points Explain to interested patients that the study suggests lymphedema may be experienced even in the absence of changes in arm circumference after axillary lymph node surgery. This study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until they have been published in a peer-reviewed publication. Lymphedema prevalence was 16% to 27% after axillary lymph node dissection and 3% to 5% after sentinel lymph node biopsy in a large study presented here at the American Society of Clinical Oncology's Breast Cancer Symposium. However, patient perception of swelling often did not correlate with clinical measurement, reported Sarah A. McLaughlin, M.D., of Memorial Sloan-Kettering Cancer Center in New York, and colleagues. Only 52% of patients with arm swelling of more than 2 cm reported experiencing it, whereas twice as many reported symptoms in their dominant arm as actually had measurable swelling (P=0.002). Diagnosis "should incorporate both measurements and patient perceptions," Dr. McLaughlin said. Although "lymphedema is one of the most feared complications of breast cancer surgery," definition and measurement of this complication have not been standardized, leading to wide ranges for incidence, she noted. Her group prospectively followed 936 women with clinically node-negative breast cancer for a median of five years after they had sentinel lymph node biopsy (600, mean three nodes removed) or lymph node biopsy followed by axillary lymph node dissection (336, mean 19 nodes removed). Measurements of both arms were taken for all women before the procedure and at follow-up. Lymphedema was also determined by patient report of perceived arm swelling during a standardized interview that also elicited risk factors and precautionary behaviors. The prevalence of lymphedema was higher for axillary lymph node dissection than for sentinel lymph node biopsy regardless of the method used to define lymphedema. The respective findings were: 16% for axillary lymph node dissection versus 5% for sentinel lymph node biopsy when defined by arm swelling of more than 2 cm (P<0.0001). 27% versus 3% when defined by patient perception only (P<0.0001). 16% versus 4% when defined by a validated instrument (P<0.0001). Although clinical measurement and patient perception agreed in most cases (786 without and 45 with), there were 64 women who perceived swelling without measured swelling of more than 2 cm and 41 women who had measured swelling without symptoms. Notably, symptomatic lymphedema was experienced by only 52% of patients with clinically measured swelling (45 of 86). Risk factors for lymphedema included higher body weight (P<0.0001), higher baseline and current body mass index (both P<0.0001), infection since surgery (P=0.004), and injury since surgery (P=0.03). Surgery in the dominant arm was not a risk factor (P=0.46), but may impact the way women perceive lymphedema, Dr. McLaughlin said. The difference in prevalence was most pronounced in women's dominant arm; 37 perceived swelling when there was no clinical swelling and 15 had swelling without sensing it (P=0.002). The difference was not significant for the non-dominant arm (27 versus 26, P=0.89). "This suggests that patients having axillary surgery ipsilateral to their dominant arm may be more sensitive to subtle changes in arm measurements or may be more significantly affected by sensory changes in that arm," she said. Overall, most women were careful to avoid activities that could contribute to lymphedema. Avoidance behaviors averaged 5.1 among women who had an axillary lymph node dissection, whereas those who had sentinel lymph node dissection practiced 4.3 of these behaviors on average (P<0.0001). The women most commonly avoided intravenous catheters (99% and 81%, respectively), blood pressure measurement (98% and 82%), and blood draws in the affected arm (99% and 82%). They also commonly avoided carrying a purse on the affected arm (33% and 26%) and picking up children (9% and 8%). A substantial proportion of women who had had an axillary lymph node dissection also wore a compression garment on the affected arm (15%). The clinical significance of one additional precautionary behavior is unknown and impact on quality of life warrants further study, she said. Future studies should also correlate the number of nodes removed with lymphedema, commented Emiel J. Rutgers, M.D., Ph.D., of the Netherlands Cancer Institute in Amsterdam, who was a chair of the session at which the study was presented. The researchers provided no information on conflicts of interest. Complete ASCO Breast Coverage Primary source: ASCO Breast Cancer Symposium Source reference: McLaughlin SA, et al "Prevalence of lymphedema in 903 women with breast cancer 5 years after sentinel node biopsy or axillary dissection: Measurements and patient perceptions" ASCO Breast 2007; Abstract 145. Managing chronic pain: Some things really do help Their chronic pain may not go away, but they've found a way to fight through it and keep going 12:00 AM CDT on Tuesday, September 11, 2007 By NANCY CHURNIN / The Dallas Morning News For the lucky ones, pain is a passing thing. REX C. CURRY/Special Contributor Breast-cancer survivor Bettye McQueen receives treatment from massage therapist Jane Kinman at Harris Methodist Hospital's Healing Arts Center. Ms. McQueen began receiving massage therapy after her cancer treatment to help alleviate pain from lymphedema. It's a problem with a solution: Take the right medication; get on the right health and fitness program; wait for the wound to heal, the fever to pass, the bone to set. But there are many for whom the aches, the stiffness, the sensitivity will never fully go away. It can be managed and minimized, but for people with chronic pain, life is a battle that requires constant vigilance, courage and a love of life that refuses to surrender. JUAN GARCIA/DMN A complication from a twisted ankle kept 14-year-old Megan Valdez from being active. Treatment and therapy have lessened the pain and taught her to minimize the pain she still feels. Helping them in their journey is the growing field of pain management. We talked with four patients and their doctors and therapists about how to put chronic pain in its place and keep it from interfering with life. They shared their hard-won knowledge, which took a couple of them decades to acquire, about how essential it is to get the proper medical care, to consider complementary alternative therapies, to exercise even when it hurts and to draw on the emotional support of family and friends through the tough times. Here are their stories. Bettye McQueen, 56, lymphedema MIKE STONE/Special Contributor A lumbar spinal-cord stimulator has helped Don Bell control chronic back pain. A breast cancer diagnosis in 1996 was a shock for Bettye McQueen of Grand Prairie. But even the lumpectomy, chemotherapy and radiation did not prepare her for the pain that hit a year ago. LOUIS DeLUCA/DMN Lifestyle changes and a positive, aggressive attitude help 68-year-old Bob Johnston live with the pain of rheumatoid arthritis. "I don't have any movement in my left hand or my thumb at all. And the pain was so bad, I could hardly bear it." It turned out that she had developed lymphedema, a condition in which a body area collects protein-rich fluid that causes it to swell. It can be caused by trauma injuries, such as the surgery for carpal-tunnel syndrome that Ms. McQueen had just before the pain started. Breast-cancer patients are at particular risk if they have had their lymph nodes removed, as Ms. McQueen did. MIKE STONE/Special Contributor 'I used to have a walker to get from room to room, and now, I can walk throughout the house,' Don Bell says. She's grateful, she says, for the Healing Arts Center at Harris Methodist Fort Worth Hospital, where she is learning the benefits of massage therapy, reflexology, lymphedema therapy and aromatherapy under the guidance of Ellen Kerr, a registered nurse and licensed massage and lymphedema therapist. "It surprised me that the massage therapy, along with the lymphedema therapy, reduced the amount of swelling, which reduced the pain," Ms. McQueen says. "I've been able to reduce the amount of pain medication." That's given her hope. "I'm feeling much better, and I'm hoping to get back 100 percent. They've told me they can't make any guarantees. But along with the therapist and my faith in God, I feel I can get total use in my arm and hand again. I have the fighting spirit, and I intend to fight this." Her advice: Study your condition: "There are women out there who don't even know there is treatment for lymphedema. Consult with your physician on how to get relief." She suggests seeking out complementary methods, "because sometimes we can help manage pain in different ways." Therapy is work: "You have to take on extra pain if you want to get better. I go to therapy every day, Monday through Friday. By the time I'm finished, I'm so wiped out I have to lie down and rest. But while it's painful going through it, in the evenings when I sit down to rest, the pain isn't there. I also have exercises they've given me to do at home. They're painful, but I'm resolved to do them." Family support: "I have three nieces and a brother and friends. They have taken time off from work to take me to my treatments. You don't know how that makes you feel that someone thinks enough of you to take time off from his job to take you where you need to be." Don Bell, 69, lumbar spinal stenosis Don Bell of Lucas has suffered from back problems for 35 years. As a young man, he compensated for spinal weakness by working out. But when he went into sales to support his wife and five children, the sitting reduced the muscles that had been keeping his back straight. He developed chronic pain syndrome and lumbar spinal stenosis – a narrowing of the back spinal canals that causes compression of the nerve roots. At age 40, Mr. Bell had the second of two back surgeries to alleviate the condition, but he was left with so much pain that he could barely get out of bed for the next two years. "It became a depressing situation. You can't sleep good, so you don't care to go to bed," he says. "Then it's hard to face the day. The hardest part is that I had to stop being active with my kids, and I couldn't carry any of my grandchildren. That's a big part of my life I had to miss. That makes me ache." He suffered for years until someone at his health club advised him to look into pain management. Mr. Bell had never heard of that field. Then he met Dr. Jerry W. Lewis, a pain-management specialist at Baylor Regional Medical Center at Plano, who "turned my life around," he says. Dr. Lewis gave him injections that alleviated the nerve pain and told him he was a good candidate for a lumbar spinal-cord stimulator, which Mr. Bell had implanted in his back six months ago. The implant blocks the pain signal at the spinal cord before it reaches the brain, so the brain doesn't recognize the pain. Mr. Bell says he feels 80 percent to 90 percent better. The stimulator also helped correct his posture. "I used to have a walker to get from room to room, and now, I can walk throughout the house," he says. "Recently, I was playing golf with my son. It's the first time I've played golf in more than 10 years." Mr. Bell also enjoys his job as a security guard at Allen High School. Before the implant, he worried that he might not be able to continue. Now, if he sits too long, all he has to do is reach for the bionic implant, "crank it up for five minutes," and it relieves the pain. "I love it," he says. "I get to intermingle with all the teenagers. That's an experience!" His advice: Family helps: "I married a good woman. And all our children built homes around us. I have 13 grandchildren, and they like to come over on weekends. We're so blessed." Take care of yourself: "I had to lose some weight and start exercising. That got me through several years. Now that I feel better, I can start exercising again, and I think I will be much better off." Embrace technology: "My wife got me a PlayStation for Christmas, and my grandsons and I really enjoy playing while I charge my bionic implant. I always keep this unit with me. I hook it around my belt like a cellphone." Bob Johnston, 68, rheumatoid arthritis Bob Johnston first noticed that something was wrong during a trip from Oklahoma to the State Fair of Texas 28 years ago. His legs were cramping, and he struggled to walk. He had no idea then that he had rheumatoid arthritis, a condition in which painful, widespread inflammation leads to an increased risk of heart disease and early death. And that it was going to get worse, a lot worse. "I didn't know what it was for a couple of months," says Mr. Johnston, who now lives in Farmers Branch. "It just devastated me. Once you get in that cycle of pain, stress and fatigue, it's real hard to get out of it. If you're not seeing a good doctor who knows what he's doing, and you're not on good medication, it will drive you to despair." He consulted a series of doctors, some more helpful than others. Among "the others" was one who prescribed liniment used for racehorses. Mr. Johnston has tried various medications over the years and is very happy with the ones prescribed by Dr. Yijun Fan, a rheumatologist at Presbyterian Hospital of Dallas. After a stroke in 2000, he followed Dr. Fan's lifestyle advice, too. He had been a smoker, so he quit. He gave up red meat in favor of turkey and chicken. He retired, started exercising and began taking time to enjoy life. He recently returned from a cruise he and his wife took to celebrate their 25th wedding anniversary. No doubt about it, he says, he feels better at 68 than he did at 45. His advice: Get help: "You've got to find a good physician and have support at home, because you're not going to always feel up to things. When you're in pain, sometimes just putting on your pants can be a struggle." Don't give up: "The alternative isn't good. You can't just sit there and feel sorry for yourself. I'm not brave, but I feel better when I get on the treadmill about 30 minutes every other day." It gets better: He retired six years ago, which, he says, reduced his stress level. That lifestyle change, along with giving up smoking, making more healthful food choices and exercising, has helped a lot. "I've been lucky," he says, noting that it's important not to give up, because by taking the right steps and getting the proper help and support, things can improve over time. Megan Valdez, 14, complex regional pain syndrome In March 2006, Megan Valdez twisted her ankle in gym class. But as the ankle healed, the pain got worse. She began using one, then two crutches. It hurt when air from a fan hit the ankle. Putting on her shoes and socks was excruciating. Megan had developed complex regional pain syndrome. In the condition, diagnosed by the multidisciplinary pain-management clinic at Children's Medical Center Dallas, the nerves don't get the message that the injury has healed. Symptoms include swelling, a change in skin color, a change in nail and hair growth patterns and a cool temperature at the original injury site. The diagnosis was a relief, the Lewisville teen says, because it meant that she would get help and had an answer for kids who teased her for making "a big deal" out of what they thought was nothing. "I would cry a lot because it would be hurting," Megan says. "People thought I was lying. I felt sad, and I would get mad because people were not believing me." Understanding the condition didn't make the pain itself easier to handle, however. Dr. Alan Farrow- Gillespie at Children's gave her spinal blocks and inserted an IV line for epidural injections when needed. After the hospital treatment, she struggled to do intensive physical therapy at Greater Lewisville Therapy Center for a year. "I would always want to stop because it hurt so much. Sometimes, I was crying at physical therapy, but my physical therapist was very nice and would always make me laugh." It's been hard, too, to accept that the pain will never fully go away. But Megan is happy because, on Aug. 20, she did something she never thought she'd do again. She ran a half-mile around her neighborhood. "At the beginning, I thought I would always be on crutches. Now, I feel better about myself. I'll be happy when I start school and can be in athletics because I love playing volleyball." Her advice: Face it: At first, Megan wanted to do anything she could to avoid the pain, including exercises that made her foot hurt. But now she's glad she persevered. And she's made peace with it. "I'm OK with the pain. I can fight through it because distraction is the best thing for it." Love that bro: It's hard when others don't believe you. That's why it means so much to have family members who understand. Megan's brother, Mark, now 10, "was very supportive" and would get things she needed when it hurt too much for her to move. Tough love helps: On orders from the doctor and therapist, Megan's parents would touch her injured foot. "I would start crying, and they would keep doing it. My mother said it was tough love because they were trying to help me get better." Tuesday, September 11, 2007 Shop offers dose of dignity for patients By BLYTHE BERNHARD The Orange County Register A boutique specializing in products for breast cancer patients and new mothers recently opened alongside Saddleback Memorial Medical Center in Laguna Hills. Transitions for Women, which is sponsored by the nonprofit hospital, offers custom-fitted bras, prosthetics, wigs, scarves and more. Compression garments for women with lymphedema are also available. Items for nursing mothers include specialty bras, pumps and pads. Mary Bowman, a registered nurse and manager of the boutique, talks about the new store and how it will serve women in Orange County. Q: How did the idea for the separate store come about? A: Our vision was basically continuum of care. We wanted to be able to provide a full-service cancer center. We wanted a full line for women. It was very frustrating for them and for us to have to send them to three different places to get the things they needed such as mastectomy bras, (arm) compressions and wigs. Q: Where do women typically find these items? A: Some went to department stores, some went to pharmacies, some went to wig stores. The problem was they had to go to different places to find different things. It's such an emotional time in a woman's life. Transitions represents our commitment to fulfilling all of a woman's health care needs, whether it's motherhood or facing cancer. Q: Can you describe the store? A: It doesn't look clinical, which is what we wanted. It's lavender, very warm colors. It's 2,000 square feet. We have a wig room. When they're in that room they're in there by themselves. If they want to be fitted for a bra or a prosthetic, that's also a separate room. They need their dignity. We wanted them to be able to come in and try on hats and try on wigs without everyone else there as well. When they would go into a regular store, there would be other people around. We definitely felt there was a need in the community; there really isn't another place like this. Q: Where did the name for the store come from? A:The way we came up with the name Transitions was from one of our employees who is a survivor of breast cancer. Women have many transitions they go through in their lives. Some are happy, some are sad. We wanted to help them in the happy times and in the times that they're struggling. Q: How does it work to have products for both new mothers and cancer patients? A: Our theme is hope and inspiration and belief. We have formed a sisterhood. It signals to new mothers that doing those self-breast exams is very important. The women who are going through cancer see that life. They see the babies. With the two combined, it's women helping women. Q: How many people work in the store? A: We have two certified fitters for maternity and oncology. We have an assistant for the office who helps women get pre-authorization for insurance. There are some oncology products you can get reimbursement for. We have five registered nurses who are also lactation consultants that do inpatient and outpatient services. Q: What have you learned from working in the store? A:I'm amazed how strong these women are. They come in here and they want to fight. They want to fight the disease. We have learned a lot from them. I used to work labor and delivery and that was so rewarding and gratifying, but this is just as rewarding. To be in a position to help women who are going through cancer is phenomenal. Q: What would you like to say to women who have been diagnosed with breast cancer? A:What is really important for women to know is that Transitions is a sensitive and professional setting where they can shop with dignity for these personal health care products. We spend time with them. The other thing is we went out shopping. We went to see what the best products were. The products we have to offer are the best out there, and we have variety. Contact the writer: 714-796-6880 or bbernhard@ocregister.com Artificial lymph node transplanted into mice NewScientist.com news service Michael Reilly An artificial lymph node has been transplanted into mice, where it successfully produced immune cells. The new form of bioengineered tissue marks a significant step towards transplanting an entire immune system into patients dying of AIDS, cancer or other diseases, say the researchers who carried out the transplant. Takeshi Watanabe at the RIKEN Institute in Japan and colleagues used a "bioscaffold" made of collagen impregnated with stromal and dendritic cells extracted from the thymus of newborn mice. The entire package – a collagen sponge about 3 to 4 millimetres across – was then implanted into mice with healthy immune systems that had been vaccinated against a harmless antigen (something that triggers an immune response). In a natural lymph node, stromal cells act as "organiser" cells, arranging the various components of the node and aiding its development. Watanabe found that the same was true of the artificial nodes. The implanted stromal cells attracted T and B immune cells (lymphocytes) that were already circulating in the healthy mouse, then organised them into compartments segregated from one another, just as they appear in natural nodes. Empty nodes After the artificial node had filled with antigen-specific T and B cells, Watanabe transplanted it into a mouse with no functioning immune system. The lymphocytes quickly spread out from the artificial node into the animals' own lymph nodes, which lay empty due to the lack of immune activity. When Watanabe injected the same harmless antigen into the immuno-deficient mouse, its transplanted immune system responded vigorously, producing massive numbers of lymphocytes to neutralise the foreign molecule. After a month, these cells’ "memory" was still maintained, and they were able to fight off challenges from the antigen. “It’s one tiny step towards use in humans,” says Watanabe. “The next step is to use human cells in humanised mice. Then, maybe in four or five years, we might be able to make the first prototypes of a human model.” Eventually, Watanabe hopes this technology will provide a revolutionary treatment for patients with AIDS or cancer. By implanting artificial nodes plump with healthy T and B cells in AIDS patients, he believes he might be able to revitalise their damaged immune systems. For cancer, he hopes to adopt a similar approach in which the transplanted nodes will contain T cells trained to hunt down the antigens produced by tumour cells and kill them off. Journal reference: Journal of Clinical Investigation, doi:10.1172/JCI30379 isitor Ratings: Healthcare Professional: General Public: UroToday.com- Lymph node density is a surrogate marker of the extent (i.e. 'quality') of lymph node dissection during radical cystectomy and impacts patient outcome There is a growing body of literature which suggests that the quality of a lymph node dissection radical cystectomy for bladder cancer is a predictor of recurrence-free survival of patients with node positive bladder cancer after cystectomy involvement. However, the 'ideal template' for pelvic node dissections is not standardized and there is a wide variation in extent of dissection. A surrogate marker of quality of node dissection is lymph node density defined as the ratio (percentage) of the number of positive nodes divided by the total number of nodes examined. In the April issue of Journal of Urology, Herr presents data from 5 studies on a total of 979 patients. In 4 studies, higher lymph node density (> 25 or 25%) was a significant predictive factor for survival when adjusted for various patient, tumor and treatment co variables. This remained true even when adjuvant chemotherapy was accounted for, in the one study which examined the same. What is also worth noting from the article is that the range of lymph nodes removed, even in academic centers, can be as few as 1 to as many as 96. Amazingly, data from the SEER registry suggest that, across the country, as many as 40% patients do not undergo a lymph node dissection at all. While the ideal situation would be to have a standardized template which all can agree upon, this is likely to prove difficult to 'regulate'. Lymph node number (and density) is more objective data which can be used to not only risk stratify patients more appropriately, but also serve as a surrogate marker for quality of surgical dissection. Herr HW J Urol. 2007 Apr; 177(4):1273-5 Reviewed by UroToday.com Contributing Editor Ashish M. Kamat, MD UroToday - the only urology website with original content written by global urology key opinion leaders actively engaged in clinical practice. To access the latest urology news releases from UroToday, go to: www.urotoday.com Immune cells known as macrophages linked to growth of lymph vessels in eyes, Medical Studies/Trials Scientists at Schepens Eye Research Institute have discovered that a particular immune cell contributes to the growth of new lymph vessels, which aid in healing. This cell, known as a macrophage, is called in by the body during the wound healing process. The discovery of this new role for the macrophage, published in the September 2005 Journal of Clinical Investigation, may ultimately inspire innovative treatments for blinding eye disease, as well as for other diseases, such as cancer, that rely on the lymph vessels to spread abnormal cells throughout the body. "This is a very significant finding," according to Joan Stein-Streilein, PhD, and Patricia A. D'Amore, PhD, senior authors of the study, Senior Scientists at SERI and members of the Departments of Medicine and Ophthalmology at Harvard Medical School, respectively. "It unlocks a whole new dimension in our understanding of these important cells." The body uses lymph vessels to bring immune cells to an injured organ to carry away debris and fluid to aid healing. Lymph vessels can play a different kind of role in cancer, offering tumor cells a pathway for spreading to other body parts, in a process known as metastasis. Macrophages are large white blood cells called in during wound healing to ingest foreign invaders such as bacteria. They can also present pieces of those intruders to the immune system to jump-start the immune response. Produced in the bone marrow, they can be found in almost all tissues of the body. Unlike many other parts of the body, the clear outer layer of the eye, known as the cornea, does not normally have lymph vessels, except when injury causes lymph vessels to sprout from the edge of the cornea to help heal the wound. Dr. Kazuichi Maruyama, a post-doctoral fellow in D'Amore's and Stein-Streilein's laboratories at SERI, began to suspect a new connection between macrophages and lymph vessels while studying corneal transplants in mice. He became aware of lymph vessels that seemed to be forming "in place," away from those produced at the edge of the cornea. He also noticed that these lymph vessels disappeared after the wounds were healed. Because the cell structure of the new vessels resembled that of macrophages, he began to believe there might be a relationship. In the JCI study, he tested this idea by placing sutures in the corneas of two groups of mice to create injuries that would induce a healing response. Then he gave one group of mice a drug to cause macrophages to commit suicide. When he examined the eyes of both groups, he found those given the drug did not grow as many lymph vessels as the control group without the drug. The implications of this link between macrophages and lymph vessels are far-reaching, according to Stein-Streilein, D'Amore, and Maruyama. D'Amore and Stein-Streilein believe that harnessing this newly found ability of the macrophages could lead to the creation of new drugs or therapies for eye disease. For instance, inducing new "temporary" lymph vessels in retinas could aid in treating diabetic retinopathy by removing fluids leaking from abnormal blood vessels. It is this leaking fluid, characteristic of diabetic retinopathy that can permanently damage the retina and vision. Maruyama speculates that the involvement of macrophages in forming lymph vessels may be universal and may also be involved in spreading cancer. If that were the case, blocking macrophages from helping to grow lymph vessels could inhibit the spread of tumors. The team is now researching the same process in skin wounds and cancer. http://www.eri.harvard.edu/ ------------------------------------------------------------------------ Acroangiodermatitis Marissa Heller MD, Julie K Karen MD, William Fangman MD Dermatology Online Journal 13 (1): 2 New York University Department of Dermatology -------------------------------------------------------------------------------- Abstract A 26-year-old man with a history of chronic primary lymphedema of the left lower extremity presented with elephantiasis, confluent, violaceous, mascerated plaques, and ulcers on the dorsal aspects of the toes of the left foot. Histopathologic examination showed a proliferation of small blood vessels associated with extravasated erythrocytes and hemosiderin deposits consistent with the diagnosis of acroangiodermatitis. Treatment of the focal ulcers includes compression therapy, local wound care, and surgical elimination of the shunt if there is an associated arteriovenous malformation. -------------------------------------------------------------------------------- Clinical synopsis A 26-year-old man was referred to the Charles C. Harris Skin and Cancer Pavilion for the evaluation and treatment of ulcers of the toes of the left foot. There was a remote history of a fractured left leg. Chronic primary lymphedema of the left leg developed three years ago. He subsequently developed a deep venous thrombus in his left leg with a pulmonary embolism that required pulmonary endarterectomy. A filter was placed in the interior vena cava, and he was treated with coumadin. Over the past three years, he noted purple skin lesions and development of ulcers on the toes. Physical examination revealed confluent, violaceous, mascerated plaques with ulcers were present on the dorsal aspects of the toes of the left foot. The dorsal aspect of the foot exhibited verrucous changes. There was 1+ edema of the left foot, and a 1+ dorsalis pedis pulse was noted. The right foot was uninvolved. Figure 3 Histopathology reveals a thick papillary dermis with proliferation of capillaries and venules with plump endothelial cells. There are extravasated erythrocytes and hemosiderin deposition. There is an infiltrate of plasma cells and some lymphocytes. Comment Acroangiodermatitis, a rare condition that is also known as pseudo-Kaposi sarcoma, is a proliferation of the preexisting vasculature. Clinically, it appears as violaceous or brown macules, patches, papules, or plaques on the distal aspects of the lower extremities. It may be unilateral or bilateral and is commonly located over the extensor surfaces, the lateral malleoli, and the dorsal aspects of the feet. Ulcers may develop over the affected areas [1]. Acroangiodermatitis can be associated with venous hypertension, with an arteriovenous malformation, or with an acquired iatrogenic arteriovenous fistula [1, 2]. A variety of other vascular conditions has been reported in association with acroangiodermatitis. These include limb paralysis, vascular damage from amputation or intravenous drug abuse, the thrombophilic 20210A mutation in the prothrombin gene, and Klippel-Trenaunay syndrome [1, 3, 4, 5]. Histopathologic examination shows proliferation of the capillary bed throughout the dermis. Extravasated erythrocytes, fibrosis with spindle cells, and hemosiderin pigment deposition are noted. There may be a superficial, perivascular infiltrate of lymphocytes, macrophages, and eosinophils. Endothelial cells lining the vessels stain with CD34. A differentiating factor between acroangiodermatitis and Kaposi sarcoma is that in the former, the vascular hyperplasia is of preexisting vasculature and in the latter, the vascular hyperplasia is independent of preexisting vasculature [6]. Treatment of acroangiodermatitis involves correction of the underlying vascular pathology. Mainstays of therapy include compression stockings or a compression pump for venous stasis and local wound care for ulcers. In the case of arteriovenous malformations, surgical correction of the shunt can be employed [7]. Medical therapy options are limited. There is one case report of regression of lesions with treatment with oral dapsone 50 mg twice daily for three months in combination with leg elevation and compression [8]. There are case reports of improvement with oral erythromycin in patients with arteriovenous fistulas for hemodialysis [9]. References 1. Rongioletti F, Rebora A. Cutaneous reactive angiomatoses: patterns and classification of reactive vascular proliferation. J Am Acad Dermatol 2003;49:887 2. Samad A, Dodds S. Acroangiodermatitis: review of the literature and report of a case associated with symmetrical foot ulcers. Eur J Vasc Endovasc Surg 2002;24:558 3. Gucluer H, et al. Kaposi-like acroangiodermatitis in an amputee. Br J Dermatol 1999;141:380 4. Martin L, et al. Acroangiodermatitis in a carrier of the thrombophilic 20210A mutation in the prothrombin gene. Br J Dermatol 1999;141:752 5. Lyle WG, Given KS. Acroangiodermatitis (pseudo-Kaposi sarcoma) associated with Klippel- Trenaunay syndrome. Ann Plast Surg 1996;37:654 6. Calonje E, Wilson-Jones E. Vascular tumors: tumors and tumor-like conditions of blood vessels and lymphatics. In: Elder D, et al, eds. Lever's Histopathology of the Skin. 8th ed. Philadelphia: Lippincott- Raven, 1997:914 7. Pires A, et al. Effect of compression therapy on a pseudo-Kaposi sarcoma. Dermatology 1999;198: 439 8. Rashkovsky I, et al. Acro-angiodermatitis: review of the literature and report of a case. Acta Derm Venereol (Stockh) 1995;75:475 9. Kim TH, et al. Pseudo-Kaposi's sarcoma associated with acquired arteriovenous fistula. J Dermatol 1997;24:28 --------------------------------- Survivor seizes chance to make people aware Mark Goldstein, 74, developed, overcame bout of breast cancer BY DAVE BENJAMIN Staff Writer Mark Goldstein JACKSON - He is a survivor and his aim is to heighten the awareness that men can develop breast cancer. "Statistically, this is a woman's disease and there is no doubt about that" said Mark Goldstein, 74, a 19- year survivor male breast cancer. Goldstein, who lives in northern New Jersey, spoke to the Men's Club at the Westlake Golf and Country Club adult community on Sept. 20. "There are about 185,000 women diagnosed with breast cancer each year, compared to 2,030 men who are diagnosed yearly, but it's just as tragic for a man lose his life to this form of the disease as it is for a woman to lose her life," he said. Goldstein said many men cannot believe they can develop what is thought as a woman's disease, "If you don't think that is shocking then all you would have to do is to have been in my shoes at that time when everybody around me expressed, some seriously and some with a wink, that 'Mark got what women get,' " he said. Before that, Goldstein said, he did not have a clue that men could develop breast cancer. That all changed in 1988. Goldstein said one day in February 1988 he was shaving when he looked in the mirror and noticed that his left nipple was receding and beneath it he could feel a lump. In typical male fashion he did nothing. "Had that been my wife, we would have been in the doctor's office the next day, but for me there was not only no reaction, there was inaction," he said. "I did nothing for three months." He said about 2,000 men are diagnosed with breast cancer every year and about 450 succumb to the disease. That number is increasing, he said. "But you can't find (male) breast cancer listed under the 15 conventional cancers," he said. "There's prostate, colon, bladder, melanoma, lymphoma and on and on. We're off the radar in terms of awareness." He told his audience that if breast cancer was a sport, men would know all about it. "We would have all the statistics on it," he said. "We would chart it. We would socialize about it and it would probably have a uniform, but it's not a sport." Goldstein said embarrassment, fear and denial all play a role in the delay of seeking help. He said the public and insurance companies must be educated on the subject. "I submitted a claim to my wife's company and it came back with a note that said the service that has been billed cannot be performed on a person of this sex," Goldstein said. "I called them up and I didn't have to say much, just the word 'sue.' " Goldstein underwent treatment for the disease - chemotherapy, radiation and a modified radical mastectomy - and from 1988 and 1992, "I lived a relatively normal post-breast cancer life," he said. "I did my job. I engaged in activities that I had done before and about halfway through [that period of time] I felt I transitioned from being a survivor to being a conqueror. Then one day in September 1992 I felt I reached a transition [again] from a survivor and conqueror to becoming an advocate." Goldstein said he heard about a race in New York City and knew he had to participate in the "For Women Only Race for the Cure." He filled out the race application using only his first initial and paid the entry fee with a money order. On race day he appeared at the starting line. "This was the start of my advocacy," he told the audience. "When I presented myself they said I couldn't run because I was a man," but that did not stop Goldstein and off he went. Goldstein said there are different kinds of tragedies and said they typically happen to somebody else. "When these tragedies occur there is a response," he said. "People who see these tragedies say, 'Thank God it wasn't me.' " Goldstein said there are also personal tragedies where people ask "Why me?" Those individuals focus on questions like "What did I do to bring this to myself?" "What could I have done to stop it from happening?" and "What should I do about what's happened to me?" It is the "see and seize" group that converges with the "what should I do?" people from the "why me?" group who act. "From that comes the 'why not me?' group who says they can do something and the most perfect symbol of this is Nancy Brinker, who in 1982 made a pledge to her dying sister Susan (Komen) that she would do everything she could to eradicate breast cancer," Goldstein said. "That was the start of the Susan G. Komen Breast Cancer Foundation, the foundation we support here at Westlake." Goldstein said that in their response to breast cancer, women have started foundations, initiated crusades, designated awareness months, formed networks, lobbied public officials, walked, run and marched. "Twenty years ago breast cancer was a closeted subject and no one spoke about it," he said, "but the Komen Race for the Cure has turned that around." Goldstein said he has run in every Susan G. Komen Race for the Cure, and others, for a total of 167 races throughout the United States and internationally. In 2005 he was inducted into the National Distance Running Hall of Fame "I am fortunate to have the endorsement by way of sponsorship of the New Balance Athletic Shoe Company. I am a member of the honorary Team New Balance which is a team of survivors and I'm the only male survivor on that team." Goldstein, said he participates in the Race for the Cure to dispel the misconception that breast cancer is only a women's disease. Goldstein said he appreciates what the Westlake Men's Club has done in its support of the Race for the Cure, Goldstein said he lives with lymphedema, which is the byproduct of excessive lymph removal that occurred during the modified radical mastectomy he underwent 19 years ago. Lymphedema is incurable. Men's Club Vice President Larry Hartman said the organization is 6 years old. Between 80 and 100 men attend monthly meetings. The club sponsors a Little League baseball team, provides scholarships to Jackson high school students, raises funds to send phone cards to New Jersey soldiers who are serving in Iraq and Afghanistan, helps fund the Race for the Cure and supports research into prostate cancer and autism. Living Columnist Kathy Kemp Miss Ezell: A treasure and friend One spring day in 1990, I decided to help a little old lady fix her roof. It was ancient and leaking, Nora Ezell told me. She had been up there, hammering shingles, the day I stopped by to interview her for a story about her quilts. I'd already seen pictures of her colorful bed covers. Some of her designs- such as the "wedding ring" and the "friendship chain" - had been passed through generations. It was her "story" quilts, whose panels often celebrated the accomplishments of black Americans, that were attracting folklorists and art dealers. (See them in the Alabama Folk Art exhibit in the Young & Vann building, 1731 First Ave. North, through December). "Miss Ezell," as I came to call her, quit hammering long enough to tell me her life's story: One of 10 children, she was born in Mississippi and grew up west of Birmingham. Her father farmed and her mother quilted. Young Nora dropped out of school, married, divorced, married again, worked in a garment factory, underwent a double mastectomy and beat cancer, only to lose her only child, Annie Ruth, to the same disease. Miss Ezell took up quilting in the 1980s to entertain her sick daughter. She told me this, and much more, during my visit to her modest frame house, in the tiny Greene County town of Mantua. She was then 72 and suffering from lymphedema, which caused her arm to swell. I was decades younger and physically fit. So when Miss Ezell told me of her roof problems, I offered to help. Never mind my fear of heights, or the fact that my construction skills mostly involved nailing picture hangers to the wall. The following Saturday, a friend and I drove to Mantua and found Miss Ezell in her backyard, a ladder propped against the house. A roll of tar paper lay on the grass. "Let us do that," I told her as I grabbed one end of the roll and my friend the other. It must have weighed 75 pounds. We couldn't budge it. Miss Ezell eyed us with disdain. Something she had told me in our interview kept ringing in my ears: "I cannot stand stupid people." She stepped past us, lifted that roll to her shoulder and climbed the ladder to the roof. "Y'all coming?" she asked. By then we were all giggling. "Watch what your mama does," Miss Ezell said as she tarred and nailed down the roofing paper. Needless to say, she did all the work. My friend didn't have much of a clue, and I sat on the ridge, too terrified to move. Even so, I got covered in tar. Miss Ezell loaned me a muumuu to wear on the ride home. We'd had such fun that I returned to "help" her with other home repairs. Or I'd see her at art shows, where she regularly introduced me as her daughter. Miss Ezell died of a stroke earlier this month at age 88. Around the world, various obituaries noted that her quilts have hung in the Smithsonian Institution and in New York's American Folk Art Museum, and that she won a National Heritage Fellowship in 1992. There are plenty of folks like me, in Alabama and beyond, who also admired her spirit and benefited from her kindness and wisdom. She was a national treasure, in more ways than one. E-mail kkemp@bhamnews.com. ------------------------------------------------------- Hereditary Breast Cancer Linked to new Cancers (Ivanhoe Newswire) -- The risk for a new cancer in the unaffected breast substantially increases in women diagnosed with unilateral, hereditary breast cancer, according to a recent study. The study, led by Katarina Shahedi, M.D., of the Umeå University and the Karolinska Institute in Stockholm, Sweden, reveals women younger than 50 diagnosed with hereditary (non-BRCA) breast cancer are at a significantly higher risk for developing cancer in the other breast, all known as contralateral breast cancer (CBC). Researchers reviewed data from 120 families and 204 women with unilateral breast cancer and a family history of breast cancer but no BRCA mutations to better characterize the CBC risk for the women. They found the long-term CBC risk is significantly higher in women with hereditary breast cancer compared to the risk of developing a primary breast cancer in the general population. Women taking adjuvant hormonal therapy, however, had a significantly lower risk for CBC compared to those not taking it. According to study authors, adjuvant chemotherapy had no apparent effect on risk. Study authors say the impact of these results is most apparent for premenopausal women, as one in five will develop CBC after only 10 years. It is therefore important to consider and provide information about the risk of CBC to women with unilateral breast cancer or a family history of breast cancer. SOURCE: CANCER, published online Feb. 13, 2006 Doctor Shortage NEW YORK (Ivanhoe Broadcast News) --- You could be waiting weeks or months for a doctor’s appointment, traveling further to get there and spending less time with your doc when you do … that’s if you get to even see a physician! The reason -- experts say we’re headed for a doctor shortage in this country. Eight months into a high risk pregnancy and Barbara Chorzempa was doing well. But one obstacle stood between her and the birth of her baby -- a grueling drive up and over this mountain -- with its hairpin turns and steep cliffs. “I was very nervous about having to make that trip. I was worried about the jolting of the car. Definitely scared,” says Chorzempa. There was no way around it. Chorzempa couldn’t deliver in the rural town she lives. There’s no hospital with a maternity ward and not a single obstetrician for miles. “It’s a scary thought, not being close to a hospital and not having a doctor close.” But it’s a thought Americans everywhere may have to get used to. Rising malpractice premiums, falling reimbursement and fears of being sued have forced obstetricians in some states into early retirement. It’s creating a shortage in this specialty. In fact, 1,500 counties in the United States do not even have a single obstetrician. Patrick Vetere, M.D., used to deliver babies. He now just practices gynecology. “We have a medical liability system that’s out of control. I felt not doing obstetrics, you could avoid quite a bit of that,” Dr. Vetere, who practices in Garden City, N.Y., says. But the shortage won’t be limited to obstetricians. As 79 million baby boomers reach old age, experts predict we’ll be short 200,000 physicians by the year 2020. “Any disaster that calls forth the need for lots of doctors, they just aren’t there,” says Richard Cooper, M.D., with the Council of Physician and Nurse Supply and the University of Pennsylvania. That’s because in the mid 90s, congress capped spending on medical residencies, the key on-the-job training program that all doctors need before they are allowed to practice. And only three medical schools have opened since 1982. Now, older physicians are retiring in large numbers, and younger doctors, many of them women with children, are demanding shorter workweeks. “Even this newer generation of men, male physicians tend to want to be more involved with their families, tend to want to work fewer nights, fewer weekends,” says Dr. Cooper. The trend is causing emergency rooms across the country to scramble to get doctors to cover shifts, especially overnight. In geriatrics, the shortage is also acute. There are 7,600 in practice, while some estimate need 20,000 to meet our need. That’s forcing seniors, like Henry Fischel, to live with his pain. “It took me over three years to find the medical help that I needed,” says Fischel. “It’s a very significant problem, especially because you have an enormous aging population,” says Beatriz Korc-Grodzicki, M.D., Ph.D., an assistant professor of geriatric medicine at Mount Sinai School of Medicine in New York. Other specialties that will suffer: Oncology -- the demand is projected to increase by 48 percent because of more cancer survivors, but supply is only projected to increase by 14 percent. Experts predict a 20- percent decrease in the number of cardiologists by 2020. And one report suggests the United States should have more than 30,000 child psychiatrists, but there are less than 7,000 in practice right now. For patients like Chorzempa, help was on the other side of the mountain. At eight months pregnant, she moved to a friend’s basement to be closer to her doctor and avoid that treacherous ride. She’s now got a healthy baby girl. Experts say we’ll need to train 10,000 more physicians each year to meet our needs. Medical schools are considering slightly increasing enrollment, but there’s no quick fix. It takes about seven years to train new doctors. And congress has not yet approved enough spending to add to the number of residency positions. For more information, please contact: Richard A. Cooper, M.D. Professor of Medicine and Senior Fellow Leonard Davis Institute of Health Economics University of Pennsylvania 3641 Locust Walk Philadelphia, PA 19104 Doctors for Sale NEW YORK (Ivanhoe Broadcast News) -- Robert Goodman, M.D., usually spends his lunch hour alone. He doesn’t want drug reps to treat him to free meals in exchange for a Noon-time sales pitch. “When we receive a gift, even a small gift, we have a very strong need to reciprocate,” says Dr. Goodman, an internist at Montefiore Medical Center in New York. Some argue doctors may be choosing your drugs, not on the basis of the best medicine, but the best marketing. “Reps come up to them and say, 'hey doc, what’s the deal? We’ve been going out to dinner and you’re not prescribing my product,'” says Dr. Goodman. Pharmaceutical companies offer physicians free meals to the tune of 4 million dollars a day. It’s all part of a staggering 12 billion dollars they spend each year marketing directly to doctors. “If you have to know what drug companies are about, you need to know three things: marketing, marketing, marketing,” says David Rothman, Ph.D., with The Prescription Project. Every day, as many as 100,000 drug reps, called detailers, fan out across the country. Each one meets with as many as eight doctors a day. “I was not compensated for helping doctors help patients, I was compensated for getting the doctors in my territory to write more of my particular pills,” says Kathleen Slattery-Moschkau, a former detailer. She says she and most of her colleagues were never trained in medicine. “Most of us had no business talking to doctors about these drugs that could mean the difference between, sometimes mean the difference between life and death,” she says. The reps are armed with sophisticated information. Using a technique called data-mining, the pharmaceutical companies provide the sales reps with weekly records on exactly what brand of drugs and in what amount each doctor is prescribing. “So the sales rep goes in, he or she talks to the doctor, pushes a certain product, then the next week, they’ll look at the prescribing and see if it worked,” explains Susan Chimonas, Ph.D., with The Prescription Project. The companies counter they play a role in educating doctors about the new medications. Some doctors say it's information they want. “We’re busy in our practice. It’s hard to keep up with the most up to date literature, so at times, it’s helpful,” says Heather Fullerton, M.D., a pediatric neurovascular specialist at the University of California, San Francisco. And what about those free samples? “The samples can really help patients who are financially disadvantaged. They don’t have health insurance,” says Katrina Bramstedt, a clinical ethicist at California Pacific Medical Center in San Francisco. She says considering the patient's need is paramount. “Patients come first, before making money, before aging, before fame. That’s why we go into medicine is to help our patients,” says Bramstedt. Doctors can access unbiased information about medication on the Internet, so depending on the pharmaceutical companies is not necessary. “Information on costs, side effects, interactions with other drugs, place and therapy information that, let's face it, a salesperson is not likely to give you,” says Dr. Goodman. Dr. Rothman says more needs to be done. “Keep the drug reps out of doctors’ offices. Abolish gifts. Abolish samples,” he says. These are changes he says could be a prescription for better health care. For more information, please contact: The Prescription Project 30 Winter Street Boston, MA 02108 (617) 275-2853 Institute on Medicine as a Profession Columbia College of Physicians & Surgeons 630 W, 168th Street Box 11 NY, NY 10032 (212)305-4184 Stress Increases Skin Infections (Ivanhoe Newswire) -- You know stress can affect your health as it weakens the immune system, but how exactly does it happen? New research from the University of California, San Francisco finds a mechanical link in mice between psychological stress and the increased risk of skin infections. The study shows mice put in conditions of psychological stress are more susceptible to group A Streptococcus skin infections than normal mice. Researchers say psychological stress disrupts the skin’s antimicrobial barrier – essentially stressed-out skin loses its antimicrobial defense mechanism. Results also show stress increased the production of glucocorticoids which blocked the synthesis of fats in the epidermis of the skin. These findings suggest the immune function of the skin may be improved in stressed-out people by inhibiting the action of glucocorticoids. SOURCE: The Journal of Clinical Investigation, 2007;117:3339-49 Related Articles in Archives:Precision Dynamics Corporation Offers Color Coded Alert Band Wristbands for Patient Safety SAN FERNANDO, Calif.--(BUSINESS WIRE)--Precision Dynamics Corporation (PDC), a leader and innovator of automated wristband identification, announces the release of color coded Alert Band Wristbands for patient safety. Throughout the United States, healthcare facilities have long used color-coded wristbands to signal important medical information. In fact, according to the 2005 Patient Safety Authority Survey of Pennsylvania Hospitals four out of five respondents’ facilities used color-coded patient wristbands. However, the lack of consistency in wristband meanings and how they are applied presents problems when patients are transferred among facilities and when patients are cared for by clinicians in multiple hospitals. This challenge was highlighted when a patient was nearly not resuscitated during a cardiopulmonary arrest because she was incorrectly designated “DNR” with a color-coded wristband by a nurse who worked in multiple facilities and was confused about the meanings of different colors.(a) Events such as these increase the risks of making potentially fatal patient errors. Precision Dynamics’ color coded Alert Band wristbands greatly minimize the chance of error by providing pre-printed, large visible text/cues and an extensive range of vibrant colors that allow healthcare workers to immediately identify patient medical conditions. Each band is equipped with PDC’s patented SecurSnap® closure for optimum patient comfort and safety. While at this time there isn’t a national standard assigning specific color wristbands to specific alerts, individual states such as Arizona, New York, Pennsylvania, Ohio and others are adopting standards, and PDC supports these and all patient safety initiatives. In support of these initiatives, PDC’s Color Coded Alert Bands provide maximum patient protection and comfort in one total wristband solution. PDC’s Color Coded Alert Wristbands provides healthcare professionals with the following advantages: Clear Visibility of patient alerts even if the patient shifts or the patient cannot be disturbed. SecurSnap® closures for patient security, safety and comfort. Flexibility in size for patient comfort. Custom printed text to fit any standardized level now and in the future. Custom alert logos to allow for less common conditions such as “Limb alert” or “Lymphedema Alert” etc. Latex-free. For more information on PDC’s color Alert Bands, please visit call 800-772-1122. For media inquiries and requests for hi-resolution product photos, please contact: Adrienne S. Lamm at 818-897-1111 ext. 1330 or adrienne@pdcorp.com. About Precision Dynamics With over 50 years of experience, PDC is a global leader and pacesetter in the development of Auto ID wristband systems for healthcare, leisure and entertainment, and law enforcement. The company introduced the first patient Bar Code ID Wristband, patented Smart Band® Radio Frequency Identification (RFID) Wristbands, the AgeBand® Age/ID System, and PDC Smart Kiosk® Cashless RFID System. PDC is committed to 100% quality in service, design, and manufacturing and has ISO- 9001: 2000 and ISO-13485: 2003 certification. For more information, visit www.pdcorp.com. Precision Dynamics Corporation name and logo, Securline®, SecurSnap®, Smart Band®, AgeBand®, and PDC Smart Kiosk® are registered trademarks of Precision Dynamics Corporation. All other product names, company names, marks, logos and symbols mentioned herein are trademarks of their respective owners. A surgeon at the University of Arkansas for Medical Sciences (UAMS) has developed a new procedure to prevent one of the most common side effects associated with breast cancer treatment lymphedema or swelling of the arms due to faulty drainage of the lymph nodes. V. Suzanne Klimberg, M.D., director of the UAMS breast cancer program, led a study funded by the Tenenbaum Breast Cancer Research Foundation of breast cancer patients at risk for developing lymphedema. Her findings were published in the February issue of the Annals of Surgical Oncology, and she will present the study March 17 at the Society of Surgical Oncology 60th Annual Cancer Symposium in Washington, D.C. "The removal and analysis of the lymph nodes under the arm remains the most important factor in determining the severity of disease in breast cancer patients," Klimberg said. "In the past, surgery to remove the lymph nodes and most of the fat and tissue in the armpit often resulted in complications, including lymphedema." Five percent to 50 percent of women undergoing surgical treatment for breast cancer have developed lymphedema, mainly dependent upon the extent of surgery. At the ACRC, surgeons determined that the draining of the first lymph node, known as the sentinel lymph node, is capable of predicting if the cancer has spread to the remaining armpit lymph nodes, known as axillary lymph nodes. This is a less invasive surgery and reduces the likelihood of complications. However, the lymph node system is at risk of disruption during either a sentinel lymph node biopsy or an axillary lymph node dissection, which often leads to swelling in the arm. To prevent the arm swelling, Klimberg has developed the Axillary Reverse Mapping (ARM) procedure. The new technique evaluates the ways in which fluid drains through the lymph node system in the arm through the injection of blue dye. The dye is used to map the drainage of the arm. "Mapping the drainage of the arm decreases the chances of unintended disruption of the lymph node system during surgery and reduces the risk of developing swelling in the arm," Klimberg said. "We are the first to study lymph node drainage in the arm and are now using the ARM procedure as standard procedure at UAMS." Klimberg will soon begin conducting training seminars on the procedure throughout the country. The seminars will be sponsored by the global medical device company Ethicon, a branch of Johnson & Johnson. Klimberg is chief of the Division of Breast Surgical Oncology at UAMS and a professor in the Departments of Surgery and Pathology. She also is director of the Breast Cancer Program at the UAMS' Arkansas Cancer Research Center as well as director of Breast Fellowship in Diseases of the Breast at UAMS. Additional UAMS staff members involved in the published study are Kent Westbrook, M.D.; distinguished professor; Ronda Henry-Tillman, M.D., associate professor of surgery; Margaret Thompson, fellow; Soheila Korourian, M.D., associate professor of pathology; Keiva Bland, fellow; K. Jackman, surgery resident; and Laura Adkins, data manager. UAMS is the state's only comprehensive academic health center, with five colleges, a graduate school, a medical center, six centers of excellence and a statewide network of regional centers. UAMS has about 2,430 students and 715 medical residents. It is one of the state's largest public employers with about 9,400 employees, including nearly 1,000 physicians who provide medical care to patients at UAMS, Arkansas Children's Hospital, the VA Medical Center and UAMS' Area Health Education Centers throughout the state. UAMS and its affiliates have an economic impact in Arkansas of $5 billion a year. For more information, visit http://www.uams.edu/. University of Arkansas for Medical Sciences 4301 W. Markham St., Slot 716 Little Rock, AR 72205 United States http://www.uams.edu/ -------------------------------------------------------------- Lymphatic vessel and lymph node function are restored with growth factor treatment Medical Research News Published: Tuesday, 4-Dec-2007 The frequent spread of certain cancers to lymph nodes often necessitates surgery or radiation therapy that damages the lymphatic system and can cause lymphedema, a condition of localized fluid retention that often increases susceptibility to infections. The researchers of the University of Helsinki, Finland, and the Ludwig Institute of Cancer Research show that application of vascular endothelial growth factor-C (VEGF-C) to replace excised mouse lymph nodes and lymph vessels ensures formation of mature lymphatic vessels and incorporation of lymph node transplants into existing lymphatic vasculature. An improved outcome of lymph node transplantation is evidenced by improved lymphatic drainage and restoration of normal lymphatic vascular anatomy in VEGF-C-treated mice. The ability to transfer lymph nodes that reconstitute a functional network of lymphatic vessels in adult tissues is of particular importance in cancer follow-up therapy, as lymph nodes can prevent systemic dissemination of metastases. Accordingly, VEGF-C-treated lymph nodes were more effective in trapping metastatic tumor cells than control transplants. It has been estimated that approximately 20-30% of patients that have undergone irradiation or surgery of the armpit in response to lymph node metastases develop lymphedema later on. Damage to the large collecting lymphatic vessels, which resemble smaller veins, causes the vast majority of all lymphedemas. It has been estimated that several million patients suffer from such acquired lymphedema worldwide. The treatment of lymphedema is currently based on physiotherapy, compression garments and occasionally surgery, but means to reconstitute the collecting lymphatic vessels and cure the condition are limited. The Finnish researchers applied vascular endothelial growth factor-C (VEGF-C) gene therapy in mice after surgery removal of axillary lymph nodes, a procedure that mimicked removal of axillary lymph nodes in patients in response to metastatic breast cancer. They found that treatment of lymph node- excised mice with adenoviral VEGF-C gene transfer vectors induced robust growth of the lymphatic capillaries, which gradually underwent an intrinsic remodeling, differentiation and maturation program into functional collecting lymphatic vessels, including formation of uniform endothelial cell-cell junctions and intraluminal valves. As VEGF-C quite potently increases the rate of lymph node metastasis, the researchers sought to develop a mode of therapy that could be safely applied also in patients that had been treated for cancer. They established that the VEGF-C therapy greatly improved the outcome of lymph node transplantation. As a result, they were able to reconstruct the normal gross anatomy of the lymphatic network in the axilla, including both the lymphatic vessels and the nodes, suggesting that VEGF-C therapy combined to autologous lymph node transfer is feasible in the clinical setting. The advantage of this rationale is increased patient safety in instances of recurrent malignancies, as the transplanted lymph nodes provide an immunological barrier against systemic dissemination of cancer cells, as well as other pathogens. The findings demonstrate for the first time that growth factor therapy can be used to generate functional and mature collecting lymphatic vessels. This, combined with lymph node transplantation, allows for complete restoration of the lymphatic system in damaged tissues, and provides a working model for future treatment of lymphedema in patients. Effective lymph node transplantation holds tremendous potential for immunotherapy applications in the treatment of diseases such as cancer and chronic infections. Furthermore, the findings encourage the use of growth factor therapy to enhance the vascular integration and viability of transplanted tissues. The group is currently pursuing this form of therapy in larger animal models in order to eventually treat lymphedema patients. Further the group aims to discover methods that would accelerate lymphatic vessel maturation. http://www.helsinki.fi/ Effect of lymphedema on the recovery of fractures. Arslan H, Uludað A, Kapukaya A, Gezici A, Bekler HI, Ketani A. Department of Orthopedic and Trauma Surgery, University of Dicle, School of Medicine, Diyarbakir, Turkey. BACKGROUND: Lymphedema delays the healing of any wound by negatively affecting its inflammatory period. Whether it affects bone healing in a similar negative manner is unknown. Therefore, we experimentally investigated the effect of lymphedema on fracture recovery. METHODS: We used thirty 200- to 250-g Sprague-Dawley rats for the experiment. The rats were randomly divided into two groups of 15 rats each for the experimental lymphedema and control groups. Lymphedema development was confirmed by measuring the circumference and diameter of the extremities together with lymphoscintigraphy. Twenty days after the development of lymphedema, a fracture model was created in both groups in the right tibia with mid-diaphyseal osteotomy and fixing with an intramedullary Kirschner wire. After 6 weeks, all rats were sacrificed and the callus tissue that formed along the osteotomy was compared between groups with respect to radiographic, histological, and biomechanical characteristics. RESULTS: The three-point bending test yielded an average stiffness value of 1227 N/mm (n = 6) in the control group and 284 N/mm (n = 7) in the experimental lymphedema group (P < 0.05). At the end of week 6, radiographic evaluation showed that solid knitting was obtained in the control group, whereas in the lymphedema group delayed or no knitting was observed. In the control group, histological investigation revealed normal callus morphology. Trabecular bone was normal and osteoblast and osteoclast activity was clearly evident. The bone was stained homogeneously with hematoxylin and eosin, and ossification was within normal limits. In the lymphedema group, however, the histological appearance was mostly that of scar tissue. In addition, osteoblast and osteoclast activity was much less visible or absent. CONCLUSIONS: Lymphedema negatively affected bone healing in rats. However, the mechanism of this negative effect and its occurrence in humans are still unknown. Further experimental and clinical studies are needed to support and extend our findings. PMID: 18040641 [PubMed - as supplied by publisher] HEALTH & SCIENCE Lymphedema no longer rare, still underdiagnosed Climbing rates of obesity may be adding to the burdens of the lymphatic system and boosting the number of cases of lymphedema. By Susan J. Landers, AMNews staff. Dec. 3, 2007. Washington -- Trained in family practice medicine, Caroline Fife, MD, didn't know what she was getting into when she decided to begin treating people with lymphedema. She was operating a wound clinic at Memorial Hermann-Texas Medical Center in Houston and was receiving calls from people seeking relief for their swollen limbs. They seemed to have nowhere else to go. So she thought, "How hard can it be? I know a lot about leg swelling." "Never say that," she cautioned. About nine years ago, she hired a part-time therapist for the clinic. Within a year she had eight therapists. "Patients came out of the woodwork." She's been treating patients with lymphedema ever since, and she's had to reach out to others to learn how best to do so. "I had one lecture on the lymphatic system in medical school. [Lymphedema] seemed so rare I thought I would never need to know about it." "It's an ignored field of medicine," said Saskia Thiadens, RN, the executive director of the National Lymphedema Network, based in Oakland, Calif., which she founded 20 years ago. "I would say that of the majority of patients who go to see their primary care physicians, the chances that he or she will be diagnosed are pretty slim." Many patients are misdiagnosed for years, said Andrea Cheville, MD, associate professor of physical medicine and rehabilitation at the Mayo Clinic in Rochester, Minn. When diagnosing a patient with a swollen leg, for example, physicians tend to think, "Is it the heart? Is there a blood clot? Is there a tumor in the abdomen? Often patients get an echocardiogram. They will get an ultrasound of their leg and a CT scan of the belly. If those are negative, many times they are told, 'Well, this is nothing that is going to kill you. Aren't you glad? Good-bye.' " Women treated for breast cancer have a greater chance of having lymphedema than does the general population. Yet it's not so unusual to see patients, both men and women, with swollen limbs caused by a slowdown in the lymphatic system, which serves as an extensive drainage network to maintain the proper body fluid levels and defend against infections. The numbers of people affected by the condition are difficult to come by. Estimates range from 35% to 45% of women treated for breast cancer -- a large number in itself considering that about 2.4 million women alive today have had breast cancer, according to the Centers for Disease Control and Prevention. This population is more commonly affected, since lymph nodes may be removed during treatment, thus slowing the entire system. The lymphedema network has had a patient questionnaire on its Web site since 2001. Respondents are about equally divided as to whether they have primary lymphedema, which is congenital; or secondary, which seems to be due to a trauma, such as surgery. But even that distinction has blurred as researchers are beginning to understand that everyone's lymph system is not created equal, Dr. Fife said. One person may have a fantastic drainage system that can continue to function well despite a huge assault, such as a radical mastectomy. Another person's system may be less robust and be disrupted by a minor injury. Regardless, any slowdown can lead to the pooling of lymph and its cargo of protein molecules, salts, glucose, urea and other substances. The system carries several liters of fluid a day. An obstruction could result in tremendous amounts of fluid building in the body. Another consequence of obesity The rise in obesity is also contributing to the numbers of lymphedema patients. Ten years ago Dr. Fife didn't have any patients who weighed 500 pounds. Now, 2% or more of her patients are at this weight or heavier. Why morbid obesity leads to lymphedema is unknown, but one theory is that fat may block the system. "So as everyone gets fatter, we have more lymphedema," Dr. Fife said. Morbid obesity is a contributing factor to development of lymphedema. Once a swelling has occurred, avoiding any stress on that body part is essential for preventing recurrences. Patients who have had lymphedema should not have a blood pressure cuff wrapped around the affected limb, or have injections or blood draws, Thiadens said. Go to the opposite arm or the leg. Although there is no cure, controlling the swelling is important. Swelling can become permanent and cause irreversible limb distortions. In addition, other skin conditions can develop, including cellulitis. Plus, the body's defenses are impaired. One of Dr. Fife's patients, for instance, reads meters for the gas company. While tramping through backyards all day, he is bitten by mosquitoes and fire ants, and those bites often lead to infections and hospitalizations. Treatment for lymphedema is a gentle massaging technique, called manual lymphatic drainage, which encourages lymph flow. Once a limb is reduced to near-normal size, efforts switch to compression bandages and garments to keep the swelling down. Although lymph flow maps, complete with roadblocks, have not been available for years -- an earlier mapping technique had been painful and dangerous and was abandoned -- promising research is under way at Baylor College of Medicine, Houston. Fluorescent dye is injected just under the skin, picked up by the lymphatics and transported throughout the system, said Eva M. Sevick-Muraca, PhD, professor of radiology at Baylor and principal investigator for the study. Its path is illuminated by shining near-infrared light on the skin. The light can penetrate several centimeters of tissue. The technique, developed with funds from the American Cancer Society and the National Institutes of Health, has been tested in a phase I trial with normal subjects because, "We don't even know what normal lymph flow looks like," Dr. Sevick-Muraca said. Researchers are beginning to test the system on lymphedema patients, specifically attempting to determine if lymph flow is enhanced by massage. "We image before, during and after the massage and see if the lymph is being pushed into the correct nodal basin," she said. A new drug target for preventing lymphedema disease has been discovered by a team of researchers, according to a new study published recently in the prestigious medical Journal of Clinical Investigation. The study has established that a previously known hormone secreted by all body cells and related to cardiovascular disease, may be critical in the development of the lymphedema cancer disease. The idea is, according to the new study, to target this hormone, called adrenomedullin. The lymphedema cancer disease is a potentially severe disease that causes painful swelling in arms and legs. Experts estimate that the lymphedema disease affects more than 1000 million people worldwide. Kathleen M. Caron, PhD., from the Department of Cell and Molecular Physiology and The Department of Genetics, The University of North Carolina, Chapel Hill, NC. (USA), led the study along with colleagues from both departments at UNC. They believe, according to the study, that have discovered the basis for therapies that will prevent cancer cells to travel through the lymph system preventing then the spreading of the cancer to other parts of the human body. The hormone Adrenomedullin is involved in a variety of human body functions. For example it is responsible for regulating blood vessel opening and promote the growth of new blood vessels. It helps control metabolism, antibacterial issues and nerve signaling. Caron and colleagues have discovered a new function for adrenomodullin. This small peptide is related to the normal development of the lymphatic system, which is an relevant part of the human body's immune system. The lymphatic system is formed by a myriad of tiny-networked tubes and nodes that transport a fluid called lymph. These tubes resemble blood vessels and run throughout the human body. Its function is catch up immune cells that have leach out from cells and get them back were they belong. Caron and her team of colleagues took mice and genetically manipulated until they lacked completely of adrenomodullin. In these mice the developed lymphangiogenesis, that is the swelling on the lymph nodes, known to cause lymphedema. The only treatment available today for lymphedema is to using low-compression stockings and garments, and massage. But these are not of too much help. In this new study researchers have described three new targets, adrenomedullin and two of its partners in the cell, which could offer hope for lymphedema sufferers since they could be the basis for the pharmaceutical treatment for lymphedema. The authors believe that by increasing adrenomedullin, the lymph sacs will proliferate and take up more fluid. This could be the basis for a new treatment for lymphedema and also be helpful preventing the spread of cancer since cancers spreads sometimes through the lymphatic system Source: Caron et al. . 2007. Adrenomedullin signaling is necessary for murine lymphatic vascular de HEALTH & SCIENCE Lymphedema no longer rare, still underdiagnosed Climbing rates of obesity may be adding to the burdens of the lymphatic system and boosting the number of cases of lymphedema. By Susan J. Landers, AMNews staff. Dec. 3, 2007. -------------------------------------------------------------------------------- Washington -- Trained in family practice medicine, Caroline Fife, MD, didn't know what she was getting into when she decided to begin treating people with lymphedema. She was operating a wound clinic at Memorial Hermann-Texas Medical Center in Houston and was receiving calls from people seeking relief for their swollen limbs. They seemed to have nowhere else to go. So she thought, "How hard can it be? I know a lot about leg swelling." "Never say that," she cautioned. About nine years ago, she hired a part-time therapist for the clinic. Within a year she had eight therapists. "Patients came out of the woodwork." She's been treating patients with lymphedema ever since, and she's had to reach out to others to learn how best to do so. "I had one lecture on the lymphatic system in medical school. [Lymphedema] seemed so rare I thought I would never need to know about it." "It's an ignored field of medicine," said Saskia Thiadens, RN, the executive director of the National Lymphedema Network, based in Oakland, Calif., which she founded 20 years ago. "I would say that of the majority of patients who go to see their primary care physicians, the chances that he or she will be diagnosed are pretty slim." Many patients are misdiagnosed for years, said Andrea Cheville, MD, associate professor of physical medicine and rehabilitation at the Mayo Clinic in Rochester, Minn. When diagnosing a patient with a swollen leg, for example, physicians tend to think, "Is it the heart? Is there a blood clot? Is there a tumor in the abdomen? Often patients get an echocardiogram. They will get an ultrasound of their leg and a CT scan of the belly. If those are negative, many times they are told, 'Well, this is nothing that is going to kill you. Aren't you glad? Good-bye.' " Women treated for breast cancer have a greater chance of having lymphedema than does the general population. Yet it's not so unusual to see patients, both men and women, with swollen limbs caused by a slowdown in the lymphatic system, which serves as an extensive drainage network to maintain the proper body fluid levels and defend against infections. The numbers of people affected by the condition are difficult to come by. Estimates range from 35% to 45% of women treated for breast cancer -- a large number in itself considering that about 2.4 million women alive today have had breast cancer, according to the Centers for Disease Control and Prevention. This population is more commonly affected, since lymph nodes may be removed during treatment, thus slowing the entire system. The lymphedema network has had a patient questionnaire on its Web site since 2001. Respondents are about equally divided as to whether they have primary lymphedema, which is congenital; or secondary, which seems to be due to a trauma, such as surgery. But even that distinction has blurred as researchers are beginning to understand that everyone's lymph system is not created equal, Dr. Fife said. One person may have a fantastic drainage system that can continue to function well despite a huge assault, such as a radical mastectomy. Another person's system may be less robust and be disrupted by a minor injury. Regardless, any slowdown can lead to the pooling of lymph and its cargo of protein molecules, salts, glucose, urea and other substances. The system carries several liters of fluid a day. An obstruction could result in tremendous amounts of fluid building in the body. Another consequence of obesity The rise in obesity is also contributing to the numbers of lymphedema patients. Ten years ago Dr. Fife didn't have any patients who weighed 500 pounds. Now, 2% or more of her patients are at this weight or heavier. Why morbid obesity leads to lymphedema is unknown, but one theory is that fat may block the system. "So as everyone gets fatter, we have more lymphedema," Dr. Fife said. Morbid obesity is a contributing factor to development of lymphedema. Once a swelling has occurred, avoiding any stress on that body part is essential for preventing recurrences. Patients who have had lymphedema should not have a blood pressure cuff wrapped around the affected limb, or have injections or blood draws, Thiadens said. Go to the opposite arm or the leg. Although there is no cure, controlling the swelling is important. Swelling can become permanent and cause irreversible limb distortions. In addition, other skin conditions can develop, including cellulitis. Plus, the body's defenses are impaired. One of Dr. Fife's patients, for instance, reads meters for the gas company. While tramping through backyards all day, he is bitten by mosquitoes and fire ants, and those bites often lead to infections and hospitalizations. Treatment for lymphedema is a gentle massaging technique, called manual lymphatic drainage, which encourages lymph flow. Once a limb is reduced to near-normal size, efforts switch to compression bandages and garments to keep the swelling down. Although lymph flow maps, complete with roadblocks, have not been available for years -- an earlier mapping technique had been painful and dangerous and was abandoned -- promising research is under way at Baylor College of Medicine, Houston. Fluorescent dye is injected just under the skin, picked up by the lymphatics and transported throughout the system, said Eva M. Sevick-Muraca, PhD, professor of radiology at Baylor and principal investigator for the study. Its path is illuminated by shining near-infrared light on the skin. The light can penetrate several centimeters of tissue. The technique, developed with funds from the American Cancer Society and the National Institutes of Health, has been tested in a phase I trial with normal subjects because, "We don't even know what normal lymph flow looks like," Dr. Sevick-Muraca said. Researchers are beginning to test the system on lymphedema patients, specifically attempting to determine if lymph flow is enhanced by massage. "We image before, during and after the massage and see if the lymph is being pushed into the correct nodal basin," she said. -------------------------------------------------------------------------------- Certain factors can lead to the development of lymphedema and may provide alerts to the cause of swelling in the arms, legs or other body parts. No diagnostic tests are available, but risk factors include: Breast cancer, if the patient received radiation therapy or had lymph nodes removed. Radiation therapy to the underarm area after surgical removal of the lymph nodes. Having a larger number of lymph nodes removed increases risk. Surgical removal of the lymph nodes in the underarm, groin or pelvic region. Radiation therapy to the underarm, groin, pelvic or neck regions. Scar tissue in the lymphatic ducts or veins and under the collarbones, caused by surgery or radiation therapy. Cancer that has spread to lymph nodes in the neck, chest, underarm, pelvis or abdomen. Tumors growing in the pelvis or abdomen that involve or put pressure on the lymphatic vessels and/or the large lymphatic duct in the chest and block drainage. Having an inadequate diet or being overweight may delay recovery and increase the risk for lymphedema. Source: National Cancer Institute With nationwide coverage of a potential surgical “cure” for diabetes, Pittsburgh pharmacist and naturopathic physician, Darrell Misak, recommends education and lifestyle change before what he called “drastic and irresponsible measures.” “I believe people need to be aware that there are short and long term consequences of mini-gastric bypass surgery, even the risk of death,” stated Dr. Misak, who counsels his patients about a natural lifestyle, which he claims promotes general health and longevity. A cursory view of the media headlines on the newly proposed surgical cure for diabetes reveals stories about a pregnant woman losing her fetus, post surgery complications with abdominal pain from adhesions or scar tissue inside the body, lymphedema or swelling due to altered lymphatic circulation, and even death in 4.6% of patients or about 1 in 20 people according to the journal Nature. These are significant concerns and risks for anybody considering this procedure and Dr. Misak believes “this is only the tip of the ice burg as the associated nutrient mal-absorption has the potential to lead to multiple chronic illnesses based on genetic predisposition and dietary nutrient intake.” On the other side of the story, according to Dr. Misak medical literature review shows multiple studies with positive results from a healthy lifestyle that includes a high fiber, low glycemic or sugar diet along with regular exercise, which suggest to prevent or in some cases reverse diabetes and cardiovascular risk factors. He stated that “your lifestyle is a choice and the consequences of that lifestyle are clear in the research,” and he showed considerable disappointment with his perception of the public taking responsibility for their health. He reported seeing multiple patients reverse their diabetes and cardiovascular risks through this approach and added that “nutritional research has given us multiple supportive options to enhance the process.” Either way you look at this issue, it seems to come down to the choices you make along with being informed of potential consequences. Both choices require personal commitment and apparently accepting the responsibility that goes along with that choice. Study Examines Imaging Procedures for Diagnosing Blood Clots in the Lung (Ivanhoe Newswire) – Pulmonary embolism (blood clot in lung vessels) is a common, serious and sometimes deadly condition that is also difficult to diagnose. It’s responsible for 5-10% of all deaths in the United States each year. For 30 years the V/Q (ventilation-perfusion) lung scan has been the chief, non-invasive method of detecting these clots. But now a new study indicates that another test that wasn’t thought to be sensitive enough may actually be a better diagnostic tool. The other test uses computed tomographic pulmonary angiography (CTPA). David R. Anderson, M.D., of Dalhousie University, Halifax, Nova Scotia, Canada and colleagues did a comparison of V/Q scanning and CTPA methods. 1,417 patients considered likely to have acute pulmonary embolism (deep vein thrombosis) were studied at 4 Canadian and one U.S. tertiary care center between May 2001 and April 2005. They were randomized with 716 undergoing V/Q scanning and 701 having CPTA. Preliminary testing for some of the original group did not indicate the presence of a clot or inflammation and those people were given follow-ups for 3 months. The rest were evaluated using one of the two tests. Of the group that had CTPA, 133 (19.2%) were diagnosed with pulmonary embolism or deep vein thrombosis in the initial evaluation period. 101 (14.2%) in the V/Q scan group had a similar diagnosis. The 5% difference in that initial diagnostic period was considered significant. Further results showed that of those who had been considered free of clots initially, only 2 of 561 (0.4%) CTPA patients developed venous thromboembolism in follow-ups as opposed to 6 of 611 patients (1.0%). “The results of our study are reassuring given previous reports of relatively low sensitivity of CTPA for the diagnosis of pulmonary embolism,” the authors write. They go on to say they did not expect to find that CTPA would result in a significant increase in diagnoses. The authors conclude that further research is needed to confirm the clinical importance of some of the emboli found by CPTA in order to decide which patients need anti-coagulant therapy. This article was reported by Ivanhoe.com SOURCE: JAMA Dec. 19, 2007 ---------------------------------- New Findings About Dangerous Cancer Protein (Ivanhoe Newswire) – Researchers are one step closer to understanding why one of the most commonly activated proteins in cancer is so dangerous. A new report from the University of Pennsylvania and Johns Hopkins University finds the Myc protein can stop the production of at least 13 microsRNAs – small pieces of nucleic acid that help control which genes are turned on and off. The study also finds in several cases, re-introducing repressed miRNAs into Myc-containing cancer cells suppressed tumor growth in mice – this means it is possible that a gene-therapy approach could be effective in treating some cancers. Researchers analyzed more than 300 miRNAs in lymphoma cells of humans and mice. They had previously found Myc could turn on one particular group of growth-promoting miRNAs in lymphoma cells. In the cells with high amounts of Myc protein, researchers found big changes in the quantities of at least 13 miRNAs. When researchers took a closer look at the DNA of the lymphoma cells, they found Myc was directly attaching to the DNA at the miRNA genes. “This study expands our understanding of how Myc acts as such a potent cancer-promoting protein,” lead researcher Joshua Mendell, Johns Hopkins University, was quoted as saying. “We already knew that it can directly regulate thousands of genes. Through its repertoire of miRNAs, Myc likely influences the expression of thousands of additional genes. Activation of Myc therefore profoundly changes the program of genes that are expressed in cancer cells.” Researchers also reintroduced several repressed miRNAs into mouse lymphomas with high levels of Myc. When they measured the effect on the progression of lymphoma they found at least five of the miRNAs could stop cancer from growing. Mendell says RNA-based therapies have had some success in animals and it is possible to find a wide range of miRNAs that can stop cancers in their tracks. This article was reported by Ivanhoe.com, which offers Medical Alerts by e-mail every day of the week. To subscribe, click on: http://www.ivanhoe.com/newsalert/. SOURCE: Nature Genetics published online Dec. 2007 MIT Works Towards Engineered Blood Vessels (Ivanhoe Newswire) – MIT scientists are excited about the big step they’ve taken towards being able to transplant tiny engineered blood vessels into tissues such as the kidneys, liver, heart or any other organ that requires large amounts of vascular tissue. The paper is posted this month in an online issue of Advanced Materials. One of the authors, Robert Langer, an MIT Institute Professor, said, “It provides a new way to create nano-based systems with what we hope will provide a novel way to someday engineer tissues in the human body.” The work focuses on vascular tissue that includes capillaries, the tiniest blood vessels that are an important part of the circulatory system. The secret to controlling the cells’ development into tube-like structures is growing them on a surface with nano-scale patterning. “The cells can sense (the patterns),” said Christopher Bettinger, MIT graduate student and lead author. “They end up elongated in the direction of those grooves.” The cells, known as endothelial progenitor cells (EPCs), not only elongate in the direction of the grooves, but also align themselves along the grooves. That results in a multicellular structure with defined edges also called a band structure. “Using the patterned surface takes the guesswork out of the current process of tissue engineer which involves mixing cell types with different growth factors and hoping that a useful type of tissue is produced,” said Bettinger. The next step is to implant capillary tubes grown in the lab into tissues of living animals and try to integrate them. SOURCE: Advanced Materials Online Edition Dec. 2007 Another ‘Smart’ Cancer Drug Can Have Toxic Effects on the Heart (Ivanhoe Newswire) -- Sunitinib, one of the new cancer ‘smart’ drugs is showing a risk for heart failure, heart attack, and hypertension in patients with a cancer called gastrointestinal stromal tumor (GIST). The so-called ‘smart drugs’ are tyrosine kinase inhibitors that target specific signaling molecules inside cancer cells that aid in its spread. A study on another targeted ‘smart’ therapy, imitinib, was reported last year in Nature Medicine, to be associated with heart failure in patients with chronic myelogenous leukemia. Researchers at Children’s Hospital in Boston, Dana-Farber Cancer Institute (Boston) and Thomas Jefferson University(Philadelphia), in a collaborative study, examined cardiac toxicity and sunitinib. This new ‘retrospective analysis’ was lead by Ming Hui Chen, M.D., MMS, a cardiologist at Children’s. In a phase I/II trial at Dana-Farber, 75 patients with imatinib-resistant GIST, who were on multiple cycles of sunitinib were studied. 6 of them (8%) developed symptoms consistent with moderate to severe congestive heart failure and 2 had heart attacks. In all, 8 patients (11%) had some kind of cardio vascular event while taking FDA approved or lower doses of sunitinib. Patients with preexisting coronary artery disease were more likely to develop problems. 19% of the 36 people who were taking the FDA approved dose showed decreases in the left ventricle’s ability to pump blood. 47% developed hypertension. And though hypertension is a common side effect of cancer drugs, the number of patients affected and degree of increase in systolic blood pressure of those taking sunitinib was notable, said Chen. The sunitinib study highlights potential concerns about multi targeted cancer drugs especially in children. These kinds of side effects are especially important to manage in order for children to survive the cancer in good health well into adulthood. “Early identification of cardiac side effects is an important part of keeping patients on life saving cancer therapy over the long term,” says Chen. For the patients in this study, the cardiac dysfunction and hypertension were usually medically manageable. Above all, they were most often able to resume sunitinib therapy after the addition of cardiac medications and/or dose adjustments. SOURCE: The Lancet Dec. 15, 1007 http://www.dailynewstribune.com/homepage/x121490362 Wednesday December 26, 2007 Divine diet helps man get life back by praying off the pounds by Charlotte Ferrell Smith Daily Mail staff MAN - At 295 pounds, Louie Grimmett is a shadow of his former 600-pound self. Divine diet helps man get life back by praying off the pounds Louie Grimmett holds up a pair of pants he wore when he weighed 600 pounds.Using the power of prayer, he has lost more than 300 pounds and his wife, Barbara, has shed more than 60 pounds. Louie prayed for guidance and strength and then did his part to eat .. The 47-year-old Logan County man did not have surgery, join a gym, or enroll in a weight-loss program. He prayed the pounds away. Click here for video of Louie Grimmett talking about how he prayed the pounds away "I was a big boy," Grimmett said. "I used to ride a four-wheeler. It was all I could do to get out to the driveway to get to the four-wheeler." Unable to walk more than a few steps, the cycle was the only way he could get around on his own. He could not fit behind the wheel of a car and depended on his wife to drive him. He ordered clothes off the Internet because it was impossible to find pants with a 72-inch waist and shirts in size 7X in stores. As the weight ballooned, his health deflated. Around this time last year, Grimmett was hospitalized with congestive heart failure and suffered Lymphedema as his swollen legs wept fluid. He was treated with antibiotics and diuretics and told if he did not lose weight that he would die. Severely depressed and nearly immobile, Grimmett began to pray. "I said 'Lord, I can't do this," Grimmett said. "I wasn't living. I was taking up space. I didn't know what to pray for. I just knew I needed help. I was at my lowest point. Sometimes you have to hit bottom before you look up." Grimmett did janitorial and maintenance work at Logan General Hospital until he became disabled from a back injury in 1998. That is when his eating began to spin out of control and he packed on the pounds. He and wife, Barbara, tried to count the number of calories he once consumed in a day but gave up at 12,000. A typical breakfast once included four fried eggs, an entire can of biscuits, a mound of fried potatoes, gravy, and four pieces of sausage. There was no separating lunch, dinner and snacks because eating was an ongoing process throughout the day. He would consume cookies, cakes, candy bars, chips, entire rolls of bologna, and packages of crackers washed down with milk. He drank a dozen sugar-laden sodas a day. He also loved take-out fried fare. Because he could not fit in a booth, he could only eat in restaurants with sturdy chairs. Without any nutritional knowledge, Grimmett asked God to help him change. "I did my part," he said. He began researching nutrition on his computer, learned to read food labels, and began to exercise. At first, he could only stand for a minute or so to strengthen his back. Then he began walking, adding a few steps as he could. As his walking increased and he felt better, he burned additional calories by washing cars and cutting grass for neighbors. He now drives himself to the store, diligently reads food labels, does his own cooking, and walks two to four miles every day. He eats 1,500 calories a day as he consumes a diet rich in fruits and vegetables instead of fats. Ground turkey is used for everything from sandwiches to lasagna. He highly recommends I Can't Believe It's Not Butter. He never feels hungry and enjoys his meals more than ever. He now wears a 2X shirt and jeans with a 46- to 48-inch waist. He weighs himself once every two weeks at a local recycling center where he knows the scales are accurate. As his wife has changed her eating habits and joined the walks, she has shed 63 pounds. Aside from their sizes, their grocery bill has dwindled from $900 to $500 a month for a family of three. Louie and Barbara are the parents of 18-year-old Amanda, who lives with them. Barbara also has two grown children from a previous marriage. Tammy Crosby, 37, and Michael Crosby, 34, both live in North Carolina. The couple said their entire lives have changed. They had a garden over the summer. He recently went hunting with his buddies. And Louie names as his greatest accomplishment the ability to stand and sing at the Greenville Freewill Baptist Tabernacle. They hope to take a beach vacation this year. And Louie would love to fly and be on a show, such as Oprah. "I've never been on a plane," he said. "I couldn't walk through the terminal or fit in the seats. Now I'd love to get on one." However, he wonders if television is ready to air a faith-based plan. With a consistent weight loss and excellent reports regarding blood pressure and cholesterol, Grimmett said his doctor has told him to keep praying. He has considered a 250-pound goal weight for his 6-foot-2-inch frame but will leave that in the Lord's hands as he does his part to stick to what he calls a lifestyle change and not a diet. He said if he had to give his health plan a name, it would be the Jesus Bypass. "I trust in Jesus and bypass the rest of it," he said. "I trust in the Lord and let him take control. This ol' boy prays every day. There is no way I could repay him. Every day I thank him and ask for help." THANJAVUR: Dr. Sinnamohideen Jamal, retired professor of plastic surgery, Thanjavur Medical College Hospital, has been awarded the “Lifetime Achievement Award” by the International Society of Lymphology. The award was presented to him at the 21st International Congress of Lymphology at Shanghai in China on September 26. He is the first recipient of the award. A pioneer in lymphology in India, Dr. Jamal has vast experience in filarial lymph edema and is one of the top surgeons in the field. Committed to treating filarial patients, he has attended to more than 50,000 patients. He developed Nodo-Venous shunt operation for the treatment of filarial elephantiasis in 1970 and has performed thousands of surgeries till date with 90 per cent success rate. He graduated from the Madurai Medical College in 1960 with a gold medal for surgery. He passed the FRCS Glasgow and Edinburgh in 1964 and passed the plastic surgery board examination at Americal College of Plastic Surgeons in 1967. After returning to India in 1967, he started the plastic surgery unit at Thanjavur Medical College Hospital and elevated it to train M.Ch plastic surgery. He was also responsible for setting up the filarial clinical research ward with 10 beds at the hospital. The World Health Organisation held its 12th scientific working group meeting on filariasis at Thanjavur Medical College Hospital in 1985. He was instrumental in bringing together lymphologists and WHO filariasis scientists together. In 1981, Dr. Jamal conducted a double blind trial on coumarin for filarial patients with Prof. John Casley Smith, University of Adelaide, Australia, and research on filarial fever with Prof. W.L. Olszewski, plastic and reconstructive surgeon, Polish Acade of Sciences, Warsaw, Poland, all of them funded by WHO. The surgeons of Thanjavur congratulated Dr. Jamal for his achievements in lymphology and winning the highest award. It may also help prevent the spread of cancer, according to a team from the University of North Carolina at Chapel Hill School of Medicine. Adrenomedullin, which is secreted by cells throughout the body, is known to play a role in cardiovascular disease and other cell functions. In a new study, the UNC group found that adrenomedullin also plays an important role in the formation of the lymphatic system in mice. They said it may be possible to develop drugs that target this hormone in order to help the more than 100 million people worldwide who suffer from lymphedema. The condition occurs when the lymphatic system fails to work properly. In rare cases, it is genetic, but millions suffer lymphedema due to parasitic infections or as the aftermath of cancer therapies. Currently, the only treatments for lymphedema include massage and the use of low-compression stockings and other garments. But these aren't much help, the UNC researchers said. "Our research also may lead to therapies to prevent cancer cells from traveling through these lymphatic vessels to infiltrate other parts of the body," senior study author Kathleen M. Caron, assistant professor of cell and molecular physiology and genetics, said in a prepared statement. The study is published in the Dec. 20 issue of the Journal of Clinical Investigation. More information The Society for Vascular Surgery has more about lymphedema. Interstitial magnetic resonance lymphography: is it a new method for the diagnosis of lymphedema? Int Angiol. 2007 De Dimakakos E, Koureas A, Koutoulidis V, Skiadas V, Katsenis K, Arkadopoulos N, Gouliamos A, Vlachos L. Vascular Unit, 2nd Department of Surgery, University of Athens edimakakos@yahoo. gr. AIM: The aim of this study was to evaluate the method of interstitial magnetic resonance lymphography (MRL) as an examination for the depiction of the lymphatic system in humans in comparison with the method of direct X-ray lymphography. METHODS: We studied 6 persons, 2 volunteers and 4 patients with clinical suspicion of lymphedema in lower extremities. We administered subcutaneous gadobutrol for the MRL with a volume of 5 mL composed of 4.5 mL of Gadobutrol mixed with 0.5 mL of lidocaine hydrochloride and after 7 days lipiodol in the lymph vessel for the X-ray direct lymphography (in 3 patients) in order to compare the findings of the two METHODS: We then followed up all individuals for 7 days for any possible side effect of the contrast agents. RESULTS: Using MRL, we depicted the lymphatic system (lymph vessels and inguinal lymph nodes) of volunteers in 60 min. Moreover, in patients we depicted several abnormalities of the lymphatic system including decreased number of lymph vessels, lymphocele and ectatic lymph vessels. X-ray direct lymphography confirmed the findings of the MRL in all cases. No side effects were observed. CONCLUSION: In our pilot study, Gadobutrol seems to be a good contrast agent for the painless depiction of the lymphatic system in humans through interstitial MRL. More extensive studies are needed in order to establish the efficacy and the dosage of Gadobutrol. PMID: 18091705 [PubMed - in process] What AM I? AM Is A Regulator Of Vascular System Functionality ScienceDaily (Dec. 21, 2007) — The two vascular systems in mammals develop sequentially during embryonic life. The blood vascular system, which is essential for the delivery of oxygen and nutrients to the tissues, develops first. This is followed by the lymphatic vascular system that returns extracellular fluid and proteins back to the blood vascular system from the spaces between the tissues. -------------------------------------------------------------------------------- New data reported in two studies in the Journal of Clinical Investigation has identified signaling by a peptide known as AM in the development of both the blood and lymphatic vascular systems in mice. How the two groups observe similar mouse phenotypes but one concludes they are due to lymphatic vascular system defects and the other to blood vascular defects is discussed in an accompanying commentary by Mark Kahn from the University of Pennsylvania, Philadelphia. Kathleen Caron and colleagues at the University of North Carolina, Chapel Hill, showed that mice lacking AM or either one of the two components of its receptor (Calcrl and RAMP2) died mid-gestation after developing interstitial lymphedema without hemorrhage. Detailed analysis indicated a defect in these mice in lymphatic vascular development, and in vitro experiments demonstrated that AM signaling through Calcrl/RAMP2 drives the proliferation of lymphatic endothelial cells. The authors therefore suggested, "that lack of lymphatic proliferative signals during lymphangiogenesis results in smaller, lower-capacity jugular lymphatic vessels that are unable to accommodate the normal uptake of extravasated fluid and thus exacerbates massive interstitial edema." Similarly, Takayuki Shindo and colleagues from the Shinshu University Graduate School of Medicine, Japan, established that mice lacking RAMP2 died mid-gestation due to severe edema and hemorrhage. However, they observed that the arterial walls of these mice were abnormally thin and their typical structure was severely disrupted. Furthermore, overexpression of RAMP2 in endothelial cells enhanced their ability to form blood capillaries in vitro. The authors therefore concluded that, "RAMP2 is a key determinant of the effects of AM on the vasculature and is essential for angiogenesis and vascular integrity in mice." Article: Adrenomedullin signaling is necessary for murine lymphatic vascular development. Journal of Clinical Investigation. December 20, 2007. Adapted from materials provided by Journal of Clinical Investigation. Need to cite this story in your essay, paper, or report? Use one of the following formats: APA MLA Journal of Clinical Investigation (2007, December 21). What AM I? AM Is A Regulator Of Vascular System Functionality. ScienceDaily. Retrieved December 22, 2007, from http://www. sciencedaily.com /releases/2007/12/071220173855.htm Related Stories Cancer. 2007 Dec 17 [Epub ahead of print] Links Manipulative therapy of secondary lymphedema in the presence of locoregional tumors.Pinell XA, Kirkpatrick SH, Hawkins K, Mondry TE, Johnstone PA. Radiation Oncology Department, Emory University School of Medicine, Atlanta, Georgia. BACKGROUND.: Complete decongestive therapy (CDT), including manual lymphatic drainage (MLD) is a manipulative intervention of documented benefit to patients with lymphedema (LE). Although the role of CDT for LE is well described, to the authors' knowledge there are no data regarding its efficacy for patients with LE due to tumor masses in the draining anatomic bed. Traditionally, LE therapists are wary of providing therapy to such patients with 'malignant' LE for fear of exacerbating the underlying cancer, and that the obstruction will render therapy less effective. In the current study, the authors' experience providing CDT for such patients is discussed. METHODS.: Cancer survivors with LE were referred to therapists at 2 Atlanta-area clinics. CDT consists of treatment (Phase 1) and maintenance phases (Phase 2). During Phase 1, the patient undergoes manipulative therapy and bandaging daily until the LE reduction plateaus; at that point, Phase 2 (self-care) begins. At the beginning and end of Phase 1, LE is quantified and differences in girth volume calculated. The results for patients completing Phase 1 therapy for LE in the presence of locoregional masses were compared with results for patients with LE in the absence of such disease. Both volume reduction of the affected limb and number of treatments to plateau were analyzed. RESULTS.: Between January 2004, and March 2007, LE of 82 limbs in 72 patients was treated with CDT and Phase 1 was completed. The median number of treatments to plateau was 12 (range, 4-23 treatments); the median limb volume reduction was 22% (range, -23 to 164%). Nineteen limbs (16 patients) with associated chest wall/axillary or pelvic/inguinal tumors had nonsignificant difference in LE reduction (P = .75) in the presence of significantly more sessions to attain plateau (P = . 0016) compared with 63 limbs in 56 patients without such masses. CONCLUSIONS.: Patients with LE may obtain relief with CDT regardless of whether they have locoregional disease contributing to their symptoms. However, it will likely take longer to achieve that effect. Manipulative therapy of LE should not be withheld because of persistent or recurrent disease in the draining anatomic bed. Cancer 2008. (c) 2007 American Cancer Society. PMID: 18085587 [PubMed - as supplied by publisher] Int Angiol. 2007 Dec;26(4):367-71. ----------------------------------------- Interstitial magnetic resonance lymphography: is it a new method for the diagnosis of lymphedema? Dimakakos E, Koureas A, Koutoulidis V, Skiadas V, Katsenis K, Arkadopoulos N, Gouliamos A, Vlachos L. Vascular Unit, 2nd Department of Surgery, University of Athens . AIM: The aim of this study was to evaluate the method of interstitial magnetic resonance lymphography (MRL) as an examination for the depiction of the lymphatic system in humans in comparison with the method of direct X-ray lymphography. METHODS: We studied 6 persons, 2 volunteers and 4 patients with clinical suspicion of lymphedema in lower extremities. We administered subcutaneous gadobutrol for the MRL with a volume of 5 mL composed of 4.5 mL of Gadobutrol mixed with 0.5 mL of lidocaine hydrochloride and after 7 days lipiodol in the lymph vessel for the X-ray direct lymphography (in 3 patients) in order to compare the findings of the two METHODS: We then followed up all individuals for 7 days for any possible side effect of the contrast agents. RESULTS: Using MRL, we depicted the lymphatic system (lymph vessels and inguinal lymph nodes) of volunteers in 60 min. Moreover, in patients we depicted several abnormalities of the lymphatic system including decreased number of lymph vessels, lymphocele and ectatic lymph vessels. X-ray direct lymphography confirmed the findings of the MRL in all cases. No side effects were observed. CONCLUSION: In our pilot study, Gadobutrol seems to be a good contrast agent for the painless depiction of the lymphatic system in humans through interstitial MRL. More extensive studies are needed in order to establish the efficacy and the dosage of Gadobutrol. PMID: 18091705 [PubMed - in process] ----------------------------------- Ultrasound Q. 2007 Dec;23(4):255-68. Links Imaging and estimation of tissue elasticity by ultrasound.Garra BS. John P. and Kathryn H. Tampas Green & Gold Professor of Radiology, Department of Radiology, University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT. Ultrasound (US) elasticity imaging is an extension of the ancient art of palpation and of earlier US methods for viewing tissue stiffness such as echopalpation. Elasticity images consist of either an image of strain in response to force or an image of estimated elastic modulus. There are 3 main types of US elasticity imaging: elastography that tracks tissue movement during compression to obtain an estimate of strain, sonoelastography that uses color Doppler to generate an image of tissue movement in response to external vibrations, and tracking of shear wave propagation through tissue to obtain the elastic modulus. Other modalities may be used for elasticity imaging, the most powerful being magnetic resonance elastography. With 4 commercial US scanners already offering elastography and more to follow, US- based methods may be the most widely used for the near future.Elasticity imaging is possible for nearly every tissue. Breast mass elastography has potential for enhancing the specificity of US and mammography for cancer detection. Lesions in the thyroid, prostate gland, pancreas, and lymph nodes have been successfully imaged using elastography. Evaluation of diffuse disease including cirrhosis and transplant rejection is also possible using both imaging and nonimaging methods. Vascular imaging including myocardium, blood vessel wall, plaque, and venous thrombi has also shown great potential. Elasticity imaging may also be important in assessing the progress of ablation therapy. Recent work in assessing porous materials using elastography suggests that the technique may be useful in monitoring the severity of lymphedema. PMID: 18090836 [PubMed - in process] --------- Oregon Massage & Lymphedema Clinic opens in Masonic building By Barbara Adams The Estacada News, Dec 19, 2007 Oregon Massage & Lymphedema Clinic, 366 South Broadway Suite 210, is now open in the second level of the old Masonic building. Massage therapist Tamara Nielson offers a wide variety of massage techniques for overall health. Barbara Adams / Estacada News When Tamara Nielson puts her hands on a patient’s shoulders, she moves with experience–as a massage therapist who has suffered pain and found a natural, soothing way to work through it and heal. Nielson, 46, developed lymphedema after being treated for cancer in 1994. She was raising five children and working as a paralegal when her legs began swelling. “The doctors told me to go home, sit in a chair and put up my feet for the rest of my life. I was 33,” she said. But Nielson led an active life and did not accept the advice. So she went on a quest to find a diagnosis and treatment. She searched medical journals at the library, and through her work learned about lymphedema, which is “a chronic swelling of protein fluids in your tissues,” Nielson said. “Because, when they remove lymph nodes or give you radiation, your lymph nodes can no longer draw fluid out of a limb.” She found a clinic in Ballard, Wash., that treats lymphedema. “A form of massage therapy is how you treat it–that’s how they treat it in Europe as part of your after-cancer care,” she said. Now she is a licensed massage therapist specializing in lymphedema, chronic pain, and working with cancer patients. She recently opened Oregon Massage & Lymphedema Clinic in the Masonic building, 366 South Broadway, Suite 210. But massage isn’t just for people suffering from chronic pain; massage is a natural and pleasant way to take care of your body. As Nielson begins her career as a massage therapist, she’s also constantly learning and educating herself on the many forms of massage and the wide variety of ways it can be used. Helping mothers form deep relationships with their babies is another area Nielson is interested in. It’s called baby massage–Nielson will work with the mother to show her how to massage her baby, and how it helps increase the mother-baby bond. Massage also can break the cycle of pain for people who suffer from chronic pain, Nielson said. For individuals who’s work involves trauma, such as firefighters and police officers, massage can aid in recovery. Nielson is offering a half-price special for first visits, and for those who purchase two massages up front will receive their third massage for free. She’s also networking with a variety of health insurance companies. To make an appointment, or to learn more about Oregon Massage & Lymphedema Clinic, call 503-318- 6799. ------ 12 Million New Cancer Cases Worldwide in 2007 (Ivanhoe Newswire) – By the end of the year it is predicted there will be more than 12 million new cancer cases and 7.6 million cancer deaths worldwide – that’s about 20,000 cancer deaths a day. The estimates come from a new American Cancer Society report based on data from the International Agency for Research on Cancer. The report also estimates 5.4 million of those cancers and 2.9 million deaths will be in economically developed countries, while 6.7 million case and 4.7 million deaths will be in economically developing countries. The research shows the three most commonly diagnosed cancers in men in developed countries are prostate, lung, and colorectal cancer; in women they are breast, colorectal, and lung cancer. But in developing countries the three most commonly diagnosed cancers in men are lung, stomach, and liver cancer; and in women they are cancers of the breast, cervix uteri, and stomach. Cancers of the stomach, liver, and cervix are related to infection in these countries. About 15-percent of all cancers around the world are infection-related with a three times higher percentage in developing countries than in developed ones – 26 percent versus 8 percent. “The burden of cancer is increasing in developing countries as deaths from infectious diseases and childhood mortality decline and more people live to older ages when cancer most frequently occurs,” study co-author Ahmedin Jemal, Ph.D., American Cancer Society, was quoted as saying. “This cancer burden is also increasing as people in the developing countries adopt western lifestyles such as cigarette smoking, higher consumption of saturated fat and calorie-dense foods, and reduced physical activity.” In both developed and developing countries, the report shows the three most common cancer sites are also the three leading causes of deaths from cancer. This article was reported by Ivanhoe.com SOURCE: Global Cancer Facts & Figures, 2007 ------------------------------------------------------------------------- APRIL 2008 LYMPHEDEMA IN THE NEWS http://news.monstersandcritics.com/health/news/article_1397615. php/Caution_advised_while_doing_sports_after_breast_cancer_operation Health News Caution advised while doing sports after breast cancer operation Mar 31, 2008, 3:08 GMT published on the web April 1, 2008 Bonn - Women who have had breast cancer surgery should avoid rapid backward arm movements while doing fitness because it could badly strain the scar tissue, the German cancer assistance centre in Bonn said. Asian sports such as Tai Chi and yoga and activities such as Nordic walking are more suitable for women who have had breast cancer surgery, the centre said. However, Nordic walkers should be careful to let the sticks go back loosely and not to set them down toward the back, otherwise, the strain on their wound could be too much and it could cause lymphedema. Any exercise that causes pain should be immediately ceased. After breast cancer therapy, pursuing the right sport can counteract shortened muscles, the centre said. Physical activity also can strengthen self confidence, which often suffers in women who undergo breast cancer operations. A long road home Posted By Daniel Williams Kim McColl and her husband Dale Neil used to spend six-months each winter in Florida, from November to April. Then in December 2006 McColl discovered lumps under her arm that she had never noticed before. McColl says she always valued the Canadian health care system but now she is more appreciative of what we have here because of the tribulations she experienced in Florida. The day that she discovered the lumps she tried to make an appointment at a primary care practitioner she had visited in the past. She was refused after explaining her situation and was told the office would not accept cash paying patients. Even though she was there the previous year and had paid with the couple’s insurance policy. McColl suspects that the particular clinic she went to that day only accepts insurance from one company. Fortunately McColl was able to locate a second general practitioner who was willing to take cash. The doctor got her in to Manatee Memorial Hospital in Bradenton, Florida where she was administered a diagnostic mammogram and an ultrasound. The tests found nothing, which McColl later learned could have been caused because the cancer had metastasized. “At the time I did not realize the gravity of the situation,” said McColl thinking like many who have a cancer scare, that it will probably end up being nothing. McColl’s insurance policy covered her for emergency procedures only, the tests at approximately $2000 each were paid out of pocket. The doctor in Florida recommended that she have a fine needle biopsy next but with the medical costs adding up and the possibility of more tests McColl and her husband decided to cut short their Florida trip and return to Napanee. Prior to returning Neil called their family doctor in Napanee to set up an appointment, the family doctor told them that 80 per cent of lumps can be drained. McColl saw her doctor within days of returning in February of 2007 and had the fine needle biopsy at Lennox & Addington County General Hospital the next day. For the next month McColl was submitted to a barrage of tests, “CATscan, MRI, bone scan, endoscopy, colonoscopy they were trying to find the source of the cancer,” recalls McColl, everything happened very quickly. “This was an education we did not want,” says McColl, “it was discovered that the cancer was without a primary source.” On March 27 McColl had 12 lymph nodes removed and and a prophylactic mastectomy. Chemotherapy began for McColl in May but she only made it through the first five treatments, skipping the final treatment because she says it would have finished her. “My body rejected it,” says McColl, “I have an honorary degree in throwing up.” The next complication came in the form of lymphedema or swelling of the limbs caused by a blockage in the lymphatic system. The swelling meant that McColl could not raise her arm above her head so they could localize the radiation therapy. During the summer and fall of 2006 McColl underwent physiotherapy and massage therapy to control the lymphedema. Finally in November of 2007 McColl began the first of 25 radiation treatments that lasted through December. McColl began herceptin treatments in February which will last for a year. The treatments are administered every three weeks in Kingston. A volunteer driver from the Canadian Cancer Society picks her up for her treatment, a service McColl is grateful for. “The Cancer Society has been an invaluable resource,” says McColl, “I have had many different drivers some of whom are cancer survivors.” McColl describes her medical journey as a 26-month ordeal, she still has 10 months of herceptin treatments but is very optimistic about the road to recovery. “I am still on the road, but the main thing is that I am on the road,” says McColl, “all this effort will not go to waste.” McColl plans on attending the wedding of her nephew this summer and maybe down the road heading back to Florida for a holiday. Article ID# 970413 Body Talk: A Time To Heal WEARING STRETCHY BLACK PANTS TO YOGA can be anxiety- producing enough. Wearing a wig is even tougher. And Karen Soltes, director of the therapeutic yoga program at Circle Yoga (3838 Northampton St. NW, 202-686-1104), found that women with breast cancer were uneasy about attending classes even if they really wanted to start — or restart — their practice. So, this Friday, Circle Yoga is launching "Yoga for Breast Cancer Recovery," a six-workshop series (10: 30 a.m.-12 p.m.; the series runs through May 16; price depends on how many classes one attends). "We needed to find a way to make it comfortable," she says. Each session is 90 minutes, but a third of the time will be devoted to relaxation — restorative yoga and yoga nidra, a kind of meditation. "There's a lot of anxiety and tension in the body, understandably, when you have this illness," Soltes adds. In terms of the physical practice, Soltes plans to focus on chest opening and stretching exercises to counteract the effects of radiation. And while other yoga classes may include a great deal of weight- bearing exercises with the arms, they'll be shying away from those poses to limit the risk for lymphedema. http://www.readexpress.com/read_freeride/2008/04/body_talk_a_time_to_heal.php Dr. Chester Plotkin, 82, started the UH Lymphedema Center Saturday, April 05, 2008Wally GuentherPlain Dealer Reporter Beachwood - Dr. Chester Plotkin, 82, founder and director of the Lymphedema Center at University Hos pitals, died Tuesday at the Montefiore Hospice in Beachwood. The Lymphe dema Center, which he estab lished in 1993, became the first hospital-based program in the country. It served as a model for other nationwide clinics. The Beachwood resident retired from private practice in 1997 at the University Suburban Health Center on Green Road in South Euclid. He had been a member of Cleveland Physicians Inc. for 41 years. Although he retired from private practice, Plotkin continued working with the Lymphedema Center until 2004. The program emphasized lymphatic drainage massage that was mainly practiced in Europe until the 1980s, his family said. Plotkin often was invited nationwide to speak about his experiences and findings at medical meetings, college medical schools, hospitals that wanted to institute their own lymphedema clinics, and massage therapy groups. In 1996, he was the guest speaker at the Sir Michael Sobel House, Churchill Hospital, in Oxford, England. Plotkin served as an associate clinical professor at the Case Western Reserve University College of Medicine for 40 years. He taught physical diagnosis and clinical medicine. He was a medical consultant to the Social Security Administration's Court of Appeals for several years. Plotkin had been a volunteer at the Free Clinic in Cleveland. He also volunteered at the Court Community Services for 10 years. In that capacity, he helped assign to various jobs people who had been arrested and ordered to perform community services. When he lived in Shaker Heights, he helped organize the Lomond Association in the early 1960s, and served as the first chairman of the neighborhood association. Plotkin was born in the Bronx. He served in the Army during World War II with a military police unit in England and France. After the service, he graduated from New York University, and received his medical degree from the State University of New York Downstate College of Medicine. Plotkin and his wife, JoAnn, had been married 56 years. http://www.cleveland.com/news/plaindealer/index.ssf?/base/news-1/1207384415226400.xml&coll=2 Breast cancer patients find it helps to move Treatment side effects subside through dance by Meghan Tierney | Staff Writer Brian Lewis/The Gazette Sultana Begum (left) of Rockville practices the Lebed Method, taught by Vicki Ralph, an occupational therapist with Adventist Rehabilitation Hospital of Maryland. At Adventist Rehabilitation Hospital of Maryland, women suffering from chronic pain are moving toward healthier bodies and minds with the help of bubbles, boas and bands of yellow stretchy rubber. More News Amid the violence, a lesson Elrich questions Weast meeting with unions Man charged with drowning his children made prior threats Burtonsville Dutch Market to move to Laurel Damascus Rotary Club folds after five decades The Rockville hospital, Montgomery General Hospital in Olney and Baltimore Washington Medical Center in Glen Burnie are the three hospitals in the state to offer classes in the Lebed Method, a light dance-inspired physical therapy regimen. The therapy is used by those whose movements are limited by lymphedema, a chronic and incurable condition common among breast cancer patients that causes swelling in the limbs and elsewhere in the body. The classes have also become something of a social phenomenon in places such as Washington, where they are offered in 65 different hospitals, community centers and churches, according to Focus on Healing Inc., the non-profit that owns the rights to the therapy. ‘‘It brings fun and silliness. It makes people forget about their fears and concerns for an hour a week,” said occupational therapist Vicki Ralph, a certified Lebed instructor who recommends that her lymphedema patients attend Adventist classes to supplement regular treatments, which involve massage and compression of the affected limbs. Attendance at the weekly class has more than doubled since she began teaching it in the fall, and the five original students remain among the 12 currently enrolled. Participants use props to aid them in light stretching and gentle movements, such as raising and lowering a feather boa and blowing soap bubbles to help with breathing. The exercises can be done sitting or standing, and can be beneficial for people with chronic fatigue, multiple sclerosis, arthritis or other conditions that make movement difficult, Ralph said.‘‘It’s activity, but it’s not too strenuous,” said Susie Sabatano, 36, of Silver Spring, who was diagnosed with breast cancer when she was 28 and developed lymphedema a year later. She found out about the class last fall from Ralph, an acquaintance she met through church. ‘‘It’s not like an aerobics class where you’re trying to get your heart rate up,” she said. Exercise is recommended for people with lymphedema, a condition in which the lymphatic fluids that help the body fight infection build up in the limbs or elsewhere, because it moves accumulated fluid out of swollen areas, according to Ralph. However, physical activity can be difficult for those with severe swelling. ‘‘It puts you in a good mood and gives you energy that you didn’t have before,” said LaQuita Hunteman, 66, of Germantown, who was unable to lift her left arm above her ahead until she began the exercises. She has worn a custom-made compression bandage extending from her hand to her elbow 24 hours a day, seven days a week for the last six years to reduce the swelling. Hunteman, a breast cancer survivor, developed lymphedema after she had 26 lymph nodes removed in 2001. Breast cancer often first spreads to the lymph nodes near the armpits, according to the nonprofit breastcancer.org. The Lebed Method was developed in 2000 by Sherry Lebed Davis, a professional dancer who was diagnosed with breast cancer in 1996. The Adventist classes, which also serve as a kind of support group, feature music such as ‘‘(You Make Me Feel Like) A Natural Woman” and ‘‘I Believe I Can Fly” and plenty of water breaks for socializing. ‘‘You start talking about your cancer and then you start talking about where your family lives,” said Hunteman, who exercises at home and plays the piano for an hour a day to keep her fingers moving. Ralph agreed. ‘‘Some people don’t connect with a support group,” she said. ‘‘This is more upbeat.” http://www.gazette.net/stories/040208/olnenew53622_32360.shtml ------- MHMC Breast Care Clinic focuses on Lymphedema Saturday April 12, 2008 http://www.reporter-times.com/?module=displaystory&story_id=98513&format=html Called the "Stepchild of Medicine," lymphedema has long been ignored by the medical community as a condition that cannot be improved. However, residents have medical professionals in the Morgan County medical community who are aware that lymphedema is a condition that will, in many cases, improve with treatment from a skilled professional. Lymphedema is a common debilitating condition in which excess fluid, called lymph, collects in tissues and causes swelling (edema) in them. This often happens after lymph vessels or lymph nodes in the axilla (armpit) or groin are removed by surgery or damaged by radiation, impairing the normal drainage of lymphatic fluid. Lymphedema may also be due to a mass, such as a tumor, pressing on the lymphatic vessels. Jeanette Dow, OT, CLT, of Morgan Hospital & Medical Center (MHMC), has worked in this medical community for more than 12 years. In addition, she has been practicing as an Occupational Therapist (OT) for almost 26 years. Coincidentally, Dow noticed that her training as an OT specializing in Upper Extremity Rehabilitation left her unprepared for treating breast cancer patients with lymphedema. "The standard practice was to use techniques that were effective for edema management, not Lymphedema," said Dow. "If we don't use complete decongestive therapy, which targets removing the excess plasma proteins from the tissue, we will continuously see a recurrence of the lymphedema fluid and at some point the development of scar-like changes in the tissue of the involved extremity that are not reversible." Dow researched for the most advanced training available in the United States and completed her certification course in 1999. She continued to advance her training through many continuing education courses over the next seven to eight years. In 2007, when MHMC's Regional Cancer Center opened its doors to an expanded service line by adding the Breast Care Clinic, she recognized that as the Cancer Center's breast cancer population continued to grow, so would the need for specialty care of patients developing lymphedema. Dr. Robert Goulet Jr., Medical Director of the Breast Care Clinic, said he is well aware of the benefits of having this kind of therapy. "In my experience, lymphedema is one of the most dreaded complications of breast cancer care," he said. "A therapist with special training in a variety of treatment techniques and genuine concern for this patient population can make the difference between a lifetime of pain and limited function versus a survival free of the constant reminder of their underlying disease." One of the interesting facts about lymphedema, a condition of swelling of a limb or other body area, is that it may not surface until months or years following surgery. Some individuals may awaken, surprised to find their arm swollen. "This swelling might have occurred because the patient did an activity that put a larger than usual fluid load on the lymphatics, such as an injury/trauma, sunburn, airplane ride or unaccustomed activity," said Dow. "Patients should receive education regarding triggers like these and take precautions to avoid them." Dow also brings to the table a good source of information regarding lifestyle modifications as well as occupational performance guidelines to assist those individuals wanting to return to work following breast cancer treatment. According to Dow, there are life changes after breast cancer. "We need to recognize that as medicine continues to improve, cancer survivorship improves as well," she said. "The interval of time in which complications may develop or the duration that symptoms may persist has increased substantially. Many women adopt significant lifestyle changes as a result of their cancer experience that may impact things like exercise, travel, and career choices; all of which may impact their risk of lymphedema. Most of these changes represent progress toward recovery and we encourage our patients to embrace these changes knowing that by observing certain precautions or following a treatment plan developed by a trained specialist, complications can be avoided or minimized." "After all of the doctor visits; after the surgery; after chemotherapy; after radiation therapy; the dust will begin to settle," said Dow. "The key to the long-term treatment of patients with breast cancer in the future is recognizing that with evolving advances in therapy most women will move beyond the life and death struggle they are initially faced with to an outlook focused on survivorship. Concerns for overall quality of life and symptom management must be recognized." Dow has surveyed the patient population serviced by the Breast Care Center at MHMC and has found a strong interest in a survivorship program to meet their needs. An organizational meeting was held March 10 to measure interest and future direction of a program. Due to the sign of support from local residents, a second survivorship meeting has been scheduled for 6:30 p.m. Monday in the CBAC Room at MHMC. For further information, call 765-349-6533. ================================================== Buddy Check 12: Lymphedema Posted: April 12, 2008 04:25 PM EDT Buddy Check 12: Lymphedema By: Christy Hendricks CAPE GIRARDEAU, Mo. - Breast cancer affects one in eight women in a lifetime. Not only do patients have to deal with treatment of the cancer, other health problems can develop from the treatment. Patients who have mastectomies often develop lymphedema. It happens many times after lymph nodes are removed during surgery and fluid builds up in the arm. While there's no cure for lyphedema there is treatment. "After I finished with all the surgery and all the chemo and everything that took all of my time and energy, I noticed that my arm continued to hurt," said Connie Eichhorn. She was diagnosed with breast cancer two years ago. Eichhorn says after 23 lymph nodes were removed from her arm during a mastectomy, she could barely buckle her seat belt and couldn't sleep through the night. After hearing about lymphedema through a support group, she sought treatment from physical therapist Paula Stout. "The treatment of choice for lymphedema is manual lymph drainage. It's not massage. It's a treatment by which we stimulate the lymph vessels to reroute the fluid around that area that's been removed," said Stout. "Like the very first treatment I went home and I think I slept all night which I hadn't done in probably six months," Eichhorn said. Connie receives the manual lymph drainage treatment every week. She also wears a compression sleeve several hours a day to reduce swelling. "Lymphedema is aggravating and it takes a lot of time and it's painful, but compared to the other things that I went through in that year, probably, it's really a much easier thing to deal with," Eichhorn said. Stout says anyone who's had lymph nodes removed probably have a little bit of lymphedema. If left untreated, it could cause infections and hardening of the skin. --------------------------------------- What is lymphedema? Primary lymphedema is caused by a malformation of the lymphatic system. Secondary lymphedema is often caused by surgery removal of lymph nodes, injury, scarring, or radiation therapy. Many breast cancer patients develop lymphedema. Symptoms: Swelling, pain, joint immobility, feeling of heaviness, repeated infections, skin thickening Treatment: Manual lymph drainage - manual treatment technique which improves the activity of the lymph vessels and re-routes the lymph flow around the area of blockage. Compresson therapy - special compression garments are applied to the arm or limb to reduce swelling. Skin and nail care - helps prevent bacterial and fungal growth. Use a low pH lotion to maintain moisture and reduce the chance of an infection. Therapeutic exercise - exercises done while wearing the compression garments to promote the flow of lymph and improve range of motion. ---------------------------------------------------------------------------- Illness inspires trainee therapist The Yomiuri Shimbun Sawako Anada wants to become a therapist so that she can help cancer patients suffering from bloated arms and legs--symptoms of lymphedema, an aftereffect of the disease that she also suffered. In April, Anada, 34, started attending a vocational school in Tokyo specializing in lymphedema therapy. Anada,who ran a livestock meat-processing business in Iwaizumicho, Iwate Prefecture, experienced relief after receiving a special massage from a lymphedema therapist. This prompted her to attend classes to learn how to provide mental and physical care for cancer patients. She hopes one day to return to Iwate Prefecture to work as a lymphedema therapist. Anada was told by her doctor in October 2002 that she had cervical cancer and might only live for six months if she did not undergo surgery. At the time she was busy with her work and raising a child, but nonetheless successfully underwent the life-saving surgery. However, when she left the hospital she had a bloated right leg--a typical symptom of lymphedema. Lymphedema is an aftereffect of surgery to remove lymph nodes and causes limbs to swell when lymph fluid accumulates under the skin. While it is said that more than 100,000 people nationwide suffer from the condition, a silver-bullet treatment has yet to be discovered. Anada resumed her meat-processing business, which meant she was kept standing for hours packing sausages and other products into boxes. One day, she noticed her right leg had swollen by more than 10 centimeters. Besides the disfigurement, lymphedema causes mental anguish, and patients tend to become lethargic. Until this spring, there also were financial burdens associated with tackling the condition. Short-stretch compression bandages and other products that dealt with the symptoms were not covered by insurance. Usually, lymphedema therapists provide a combination of four kinds of care--skin care, body massage, properly applying compression bandages and showing patients how to exercise. Mental care also plays a large part in the treatment. Lymphedema therapists are in short supply in Iwate Prefecture, and only a few hospitals specialize in offering proper lymphedema treatment. Anada's physical and emotional pain was exacerbated by menopausal symptoms and worries over her cancer reappearing. In 2005, however, Anada established a group of gynecologic cancer patients in the Miyako district in eastern Iwate Prefecture. The group's name, Rankyu, comes from the combination of the two Japanese words for "womb" and "ovary." As part of the group's activities, Anada's bloated leg was massaged by a therapist. "The therapist's hands felt so warm. She relaxed my mind and body, which was quite amazing," Anada said. Since then, Anada has been receiving massages several times a year, with the result that her right leg has, more or less, stopped swelling. As five years have passed since her surgery, she decided to attend school to learn how to provide physical and mental relief for cancer patients. She will study for three years to become a therapist, and aims to obtain state licenses for acupuncture, moxibustion, acupressure and massage, as well as qualifications in lymphedema treatment and mental care for cancer patients, which she feels is overlooked. Anada, who has received a great deal of support from her family and friends, said, "I want to discover new possibilities for myself." --------------------------------------------------------------------------------------- SOURCE: Presbyterian Hospital of Dallas Apr 11, 2008 12:00 ETHyperbaric Chamber at Presbyterian Hospital of Dallas Reaches Milestone, Stands at Forefront of 'Atmospheric' Medicine DALLAS, TX--(Marketwire - April 11, 2008) - When the Hyperbaric Medicine Unit at Presbyterian Hospital of Dallas opened 15 years ago, it was one of the only units of its kind in the region. Originally used to treat decompression illness in SCUBA divers and carbon monoxide poisoning, the science of hyperbaric medicine slowly expanded as researchers theorized it could treat other ailments. As the role of hyperbaric medicine has expanded over the years, so has the unit at Presbyterian Hospital. The team of specialized-trained doctors and nurses recently completed their 50,000th treatment, making it one of the busiest hyperbaric programs in the Southwest. "We knew the science was strong for treating acute cases of the Bends and carbon monoxide poisoning, but theories on how well it would impact wound-healing and other diseases were still being investigated 15 years ago," medical director Dr. Jeffrey Stone said. "Through the years, studies have proven time and again that hyperbaric medicine can be an important part of a team-approach to treating complex medical cases." The 1,100-cubic-foot compression chamber uses compressed air at simulated depths of up to six atmospheres to treat patients with chronic non-healing wounds, diabetic foot wounds, bone infections, radiation soft-tissue injuries, and failing skin graphs. Most patients breathe 100 % oxygen while being treated at pressure equivalent to two times normal atmospheric pressure, giving them 10 times more oxygen than sea-level air. The gas levels in the patients' blood and organs undergo all the same physiological changes experienced when deep-sea diving. During normal healing, cells proliferate and divide, releasing growth factors. New blood vessels are created, a collagen matrix is formed, and remodeling occurs. Certain medical conditions alter this course and limit healing. Demand for hyperbaric medicine has increased as diabetes has skyrocketed nationally. Non-healing wounds are a common side-effect of diabetes. "Thousands of diabetic patients undergo surgical amputation every year as a result of non-healing wounds," Dr. Stone said. "These amputees face a long, costly rehabilitation, and permanently reduced mobility and independence. Hyperbaric treatments are an important tool in treating diabetic wounds before it's too late." Other conditions can also lead to the development of non-healing wounds, including peripheral vascular disease, arterial or venous ulcers, traumatic injury, complications following surgery, rheumatoid arthritis, congestive heart failure, lymphedema and other conditions which compromise circulation. The hyperbaric program is a division of Presbyterian's Institute for Exercise and Environmental Medicine, which is a joint collaboration with UT Southwestern Medical Center. http://www.marketwire.com/mw/release.do?id=842925 ====================================================================== ============ Cancer Resource Center helps 300+ in first year 04/17/08 The Cancer Resource Center at Gordon Hospital recently celebrated its first birthday with a party complete with birthday cake and refreshments. “The first year has gone extremely well,” said JoAnn Silvers, nurse navigator at the Cancer Resource Center. “We’ve seen 300 people that have come into the center, and that is not including visitors to the nutritionist, the Image Recovery Boutique or for Lymphedema Therapy.” Silvers adds that in the past year, the center has held several events and screenings to promote early detection of cancer that were well received by the public. In addition, she receives many comments about the convenience of the Image Recovery Boutique, a shop that sells wigs, bras and supplies often needed by cancer patients. For Silvers, helping people is one of the most rewarding parts of the job. “Many of our past clients still come back to visit, even if it is just for a few moments,” she said. “We are happy to hear when they are finished with their treatments and have gone back to work.” Most recently the center has begun hosting the monthly meetings of the Cancer Survivor Group and offering a free Fitness Class for Cancer Patients and Survivors. The Cancer Survivor Group holds monthly meetings the first Tuesday of each month from 6:30 to 7:30 p. m. The fitness class is intended for cancer patients and survivors to help them with their healing process. For more information about the activities at the Cancer Resource Center, call 706-879-4746. http://news.mywebpal.com/news_tool_v2.cfm? pnpID=722&NewsID=895231&CategoryID=3388&show=localnews&om=0 ====================================================================== =============== Researchers identify genes responsible for drug resistance in breast cancer SAN DIEGO — Seven genes that may play a role in resistance to tamoxifen have been identified by researchers from Erasmus Medical Center in Rotterdam. These genes, some of which are new, could provide therapeutic targets for individualized breast cancer treatment or prevention of drug resistance, according to one of the researchers who presented the findings at the 2008 Annual Meeting of the American Association of Cancer Research. “We have investigated the principal causes of tamoxifen resistance by performing genome-wide functional genetic screening,” said Lambert Dorssers, PhD, a cell biologist at the department of pathology at Erasmus. “We established that these ‘Breast Cancer Anti-estrogen Resistance’ genes have a role in clinical breast cancer. The results have shown that the majority of genes are indeed associated with clinical tamoxifen resistance and tumor aggressiveness.” Dorssers presented information about the seven BCAR genes that cause the tamoxifen-resistant phenotype: AKT1, AKT2, BCAR1, BCAR3, EGFR, GRB7 and TRERF1. After identifying these genes, Dorssers and colleagues then further studied 561 estrogen receptor- positive primary breast cancers for tumor aggressiveness and tamoxifen resistance. They identified three genes — AKT2, EGFR and TRERF1 — as having an association with metastasis- free survival, the primary endpoint for tumor aggressiveness. In a separate analysis of breast tumor samples from recurrent patients treated with tamoxifen, the researchers found five genes associated with progression-free survival, depending on the level of expression: BCAR3, ERBB2, GRB7, TLE3 and TRERF1. Moving forward, the researchers are examining how these genes function to pinpoint possible targets for treatment of breast cancer. – by Leah Lawrence More than 50% of women who are diagnosed with breast cancer express the estrogen receptor and of those approximately 50% respond to treatment. Why do the other 50% not respond? That is the question. Why do women who express the estrogen receptor not respond to hormonal therapies? Why does essentially every woman who gets hormonal therapy who lives long enough eventually become resistant to hormonal therapy? This is a huge problem. Unfortunately, when patients with breast cancer or almost any other solid tumor recur, the prognosis is very bleak in terms of long-term survival. The importance of study is enormous. – William N. Hait, MD, PhD Immediate Past President, AACR For more information: Dorssers LCJ. #1582. Presented at: 2008 Annual Meeting of the American Association for Cancer Research; April 12-16, 2008; San Diego. http://www.hemonctoday.com/article.aspx?rID=27666 ---------------------------------------------------------------------------------- COX-2 manifestation in atypia may indicate breast cancer risk Print Email Discuss in our forum Cyclooxygenase-2 enzyme expression could be a biomarker in women with atypia that suggests an increased risk of breast cancer, according to data recently published in the Journal of the National Cancer Institute. Researchers from the University of Michigan, the Mayo Clinic in Rochester, Minn. and the University of Helsinki, assessed the expression of COX-2 in tissue samples of 235 women with atypia. After a 15- year average follow-up, researchers reported that 17% of the women developed breast cancer. COX-2 expression was moderate in 30% and strong in 14% of the 235 samples. Compared with controls, the risk for developing breast cancer increased as the COX-2 expression increased (P=.07). Over-expression of COX-2 was significantly associated with older age when biopsied (>45 years, P=. 01), type of atypia (ductal or lobular, P<.001) and the amount of foci of atypia in the biopsy (P=.02). – by Paul Burress J Natl Cancer Inst. 2008;100:421-427. COX-2 is a longstanding focus of clinical and laboratory research in breast cancer. This inducible enzyme is over expressed in a variety of cancers, including in-situ and invasive malignancies of the breast. In addition, it is a very targetable enzyme, using both narrow agents (ie, celecoxib) and broader ones (ie, aspirin). There are multiple hypothesized causes for COX-2 over-expression in breast cancer but its precise role in pathogenesis is not clear. In this study, researchers explored the expression of COX-2 in pre- malignant lesions. They focused on atypical hyperplasia, a relatively common benign finding, and they noted that COX-2 expression, detected by immunohistochemistry staining, was associated with the risk that breast cancer would subsequently develop. If confirmed, this might allow investigators to identify a subset of women for the development of a chemoprevention strategy using COX inhibitors. – Clifford Hudis, M.D. Chief, Breast Cancer Medicine Service Memorial Sloan-Kettering Cancer Center http://www.hemonctoday.com/article.aspx?rID=27351 BMI linked to overall survival in locally advanced breast cancer In women with locally advanced breast cancer, prognosis is worse among those with high BMI, compared with patients who are normal or underweight. Researchers from University of Texas M.D. Anderson Cancer Center in Houston and Dubai Hospital in United Arab Emirates analyzed data from 602 patients with locally advanced breast cancer who were treated in prospective clinical trials. Patients were divided into three groups based on BMI: =24.9, normal/underweight; 25.0 to 29.9, overweight; =30, obese. Eighty-two percent of patients had non-inflammatory locally advanced breast cancer; 18% had inflammatory locally advanced breast cancer. Compared with overweight and normal/underweight groups, those in the obese category had a higher incidence of inflammatory breast cancer (P=.01). Compared with the normal/underweight population, overall survival and recurrence-free survival rates were worse for those in the obese or overweight categories who had locally advanced breast cancer (P=. 001). The incidence of visceral recurrence was also higher among the overweight and obese groups. – by Stacey L. Adams Clin Cancer Res. 2008;14:1718-1725. This article is important because we are hoping to use any and all information available to help us understand the risks that women with breast cancer face. In other words, we want to make sure that we recognize all of the information that might be valuable in helping to understand how to take care of women with breast cancer. In this instance, we have been informed that women who have a bad prognosis with breast cancer at the time of initial diagnosis will actually have a worse prognosis if they have a higher BMI. This information, therefore, helps us begin to categorize women within a conventional high-risk group — to categorize these women into relatively higher and relatively lower-risk groups with respect to their prognosis. This study does not offer us a means to treat those women differently, but what it can do is suggest to us that if we recognize that there is a particular group of women at higher risk — women with those types of cancer who also have higher BMI — then in the future, we might be able to study that group of women specifically and look for better ways to treat them as a ‘high, high’ risk subset. We do this often in cancer medicine; we try to distinguish, even within a bad disease, those people whose disease is worse because those people in particular would benefit from having better therapies devised for them. This study, in and of itself, is interesting intellectually, but it will not lead anywhere unless researchers now take these women who have been defined as ‘high, high’ risk based on high BMI and try to do something for them. That is why any study like this is done, really, it is not just the intellectual exercise but to help us understand who needs more help and then to begin to figure out ways to get them that help. In medicine, we talk all the time to our patients about the value of maintaining a healthy weight. We know, for example, that the risk for diabetes is reduced if you maintain a healthy weight; we know that risk for cardiovascular disease, stroke, heart attack and high blood pressure will be reduced if you maintain a healthy weight. We believe that there are cancer risks that can be reduced by maintaining a healthy weight, and here is an example of that. There is a reasonably good foundation in this report to be able to say to women, ‘it is valuable to maintain a healthy weight because if you ever are so unfortunate as to develop breast cancer, by having a healthy weight at that time, you are going to make your prognosis better.’ So, I think this adds to the body of evidence that we need to make women aware that maintaining a healthy weight as a lifetime wellness strategy is a good thing to shoot for. I think the messages women get from medical professionals about maintaining a healthy weight are pretty widely disseminated in our culture and our medical care, but every opportunity we have to re-emphasize that and expand women’s understanding of that is worthwhile. So here is another instance in which it has been made clear that maintaining healthy body weight will be advantageous. This adds to the chorus calling for maintaining healthy body weight and it has a particular focus because it is a very important women’s health issue that a lot of women worry about. – Donald W. Northfelt, MD Associate Professor of Medicine, Mayo Clinic, Scottsdale, Ariz. http://www.hemonctoday.com/article.aspx?rID=27265 MAKO Surgical Corp. http://www.makosurgicalcorp.com Eight Glasses of Water: Evidence all wet (Ivanhoe Newswire) -- It’s recommended most people drink eight glasses of eight ounces of water a day. But a new study finds there isn’t much research to support this recommendation. Drinking enough water is touted to be helpful for everything from clearing toxins and keeping organs healthy to warding off weight gain and improving skin tone. But does the research back these claims? Researchers from the University of Pennsylvania found there is a definite lack of research to support or deny these claims. Study authors reviewed published clinical studies that focused on drinking water. They found there is solid evidence that people in hot, dry climates as well as athletes and those with certain diseases have an increased need for water. However, they report the average, healthy individual does not benefit from drinking eight glasses of water a day. Researchers say it’s not even clear where this recommendation came from. Researchers say the studies revealed increased water consumption does not improve kidney function or other organ function. They found there is no research to back the theory that drinking water will make people feel full and curb their appetite. They say there are no studies showing a clinical benefit to one’s skin from drinking water. There is also no solid evidence that drinking water can reduce headaches due to water deprivation. Researchers say what they found instead was a lack of evidence for or against drinking eight glasses of water a day. SOURCE: Journal of the American Society of Nephrology, published online April 2, 2008 ANOTHER INTERESTING ITEM: FDA Deadlines may Hurt Patient Safety (Ivanhoe Newswire) -- Congressionally mandated deadlines may be causing the U.S. Food and Drug Administration (FDA) to rush drugs to market before they are really ready. That’s the key finding from Harvard researchers who reviewed the data on FDA drug approvals. Results showed drugs that were approved right before the deadline were two to three times more likely to be pulled from the shelves over time than drugs approved at a more leisurely pace, and two to seven times more likely to end up needing special “black box warnings” alerting patients to safety issues. These drugs were also two to seven times more likely to be discontinued by manufacturers on a voluntary basis because the demand for them had declined. They were twice as likely to experience a change in manufacturer. The authors explain deadlines were first established for the FDA approval process in 1992, when Congress passed a law saying the agency had to either approve 90 percent of new drug candidates within 12 months or face a drop in funding. The rule was strengthened to 10 months in 2002 and renewed in 2007. Researchers say the bottom line is the FDA is under pressure to approve drugs prior to the deadline, and that could spell trouble for patients. “We found that, while these deadlines speed up the approval process, many drugs are approved right up against the deadline, which might lead to unintended consequences with regard to drug safety,” study author Daniel Carpenter, Ph.D., was quoted as saying. “This suggests that drug safety might improve under an FDA approval protocol that is more flexible and less driven by deadline pressures and more by stable growth in FDA resources.” SOURCE: The New England Journal of Medicine, 2008;358:1354-1361 http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=18500 NOT LYMPHEDEMA BUT INTERESTING SINCE WE'RE SUPPOSED TO DRINK ALOT OF WATER........ Local minister dealing with wife's illness Submitted Photo Carrie and David Sparks have been married for 42 years, a union that has remained strong even though she has been receiving treatment at a facility in Ohio for more than a year due to a severe stroke. Published: Sunday, April 27, 2008 9:47 PM CDT Tom Joyce Staff Reporter David Sparks now knows the way from Mount Airy to Toledo, Ohio, almost by heart. That's not because Sparks is a long-distance trucker or a traveling salesman whose route encompasses the Buckeye State. Instead, he pastors Flat Rock Pentecostal Holiness Church, and the 500-mile trips he regularly makes to the Toledo area result from his wife, Carrie, being housed there for more than a year after a major stroke. “Just two years ago, I would have never dreamed I would be traveling 500 miles up the road to be with my Miss America,” Sparks said. “That's what I call her.” At first, Sparks, who has been with Flat Rock Pentecostal Holiness Church for 14 years, made the journey each week to be by his wife's side, while also juggling his duties as pastor. But due to “pure exhaustion” and the expense involved, he has had to stretch that out to every other week, or more frequently as the need arises. When asked how many miles he has driven over that time, Sparks replied, “probably 52,000, is what I estimated.” The local pastor admits that the strain of being so far away from his wife of 42 years, not to mention her serious medical condition itself, occasionally has been hard to handle. “At times, I have felt like, why me, Lord?” he said. “But as time goes on, those thoughts pass on by more than they did. Instead of ‘why me?' I think, ‘why not me?'” When he gets down in the dumps over the situation, Sparks said he reminds himself that “it's not about me - it's much bigger than me. “If the shoe were on the other foot,” he added, “my wife would be just wonderful.” Problems snowballed in 2006 Sparks remembers the date of Oct. 18, 2006, well. On that day, Carrie Sparks - a mother of two who sustained a series of mini-strokes in the late 1990s while in her 50s - suffered a serious stroke. She initially was a patient at Forsyth Memorial Hospital in Winston-Salem, before spending time at a rehabilitation facility in Greensboro and later Blue Ridge Nursing Center in Stuart, Va. Then, in January 2007, the local woman suffered another setback when her kidneys failed completely, which has required dialysis treatments three days a week for four hours at a time. “She'll be on dialysis the rest of her life,” her husband said. Also during that winter, a federal judge in Greensboro declared Carrie Sparks legally blind. “At that point, it became necessary to find a long-term care facility that could deal with Carrie's health problems,” her husband recalled. In addition to the vision and other difficulties, including being unable to walk, she was afflicted by diabetes and lymphedema, a condition involving a breakdown of the lymph system in which fluid builds up throughout the system. Such a facility also had to be within close proximity of a dialysis center. An Internet search revealed two locations in the United States where Carrie Sparks' various physical needs could be met - one in Roanoke, Va., and the other in Gibsonburg, Ohio, about 22 miles from Toledo. Naturally, the facility in Roanoke was the first choice, “but they had a long waiting list,” Sparks said. So the decision was made to have his wife treated at Windsor Lane Healthcare Center in Ohio, while also adding her name to the list in Roanoke. “They have really done her good - it's a world-class facility,” Sparks said of the Gibsonburg center that serves patients from across America. “We feel blessed for her to be there.” Carrie Sparks was admitted to the Ohio center on Easter Sunday, March 23, 2007. Then began the regular trips back and forth to Ohio by her husband, who said that he sometimes does not have a choice about his travel plans. Since Sparks has power of attorney for his wife, he must be present for doctor consultations and similar situations. “That stroke left her unable to communicate well, so I have to communicate for her,” the veteran pastor said. The stroke also impaired her memory, so Carrie Sparks, who recently has experienced heart difficulties as well, would have difficulty remembering what the doctors say. She can talk, but her oral skills have been affected by the severe stroke to the point that she is not able to describe objects, or sometimes identifies them by the wrong names. Yet, Carrie Sparks has managed to make it clear that she is comfortable and satisfied with her care. “She has really settled in well to the facility,” the pastor said. The Sparks family also includes the couple's son, Chris; their daughter, Sherry Tipton, and her husband, Darrell; and the Tiptons' young children, Timothy and Tiffany. The grandchildren have been on some of the trips to Ohio. “That's the best medicine she gets all week, is when they show up in her room,” Sparks said. “She is happy - that has meant so much to me and the family,” he added. “The Lord has given her contentment and maybe patience. I don't know what else. But whatever it takes, the Lord has given it to her.” Ordeal brings blessings Sometimes, good does come from bad things, and David Sparks says that in his case, he has been strengthened and encouraged by the support from his congregation at Flat Rock Pentecostal Holiness. “This church has really pulled together,” he said. “They have distinguished themselves, and I am so immensely proud of my wonderful congregation.” A retired minister friend, the Rev. Deward Scott, has delivered sermons in Sparks' place when he has had to be in Ohio. “He's very dependable, and a great, great friend,” Sparks said. “I just can't say enough about Deward Scott.” Meanwhile, two couples at the church, Haywood and Alyene Young and Buster and Sharon Davis, were recruited for those occasions when the pastor ministers to congregation members who are hospitalized for surgery or other crises. “They eagerly accepted my request,” Sparks said. “They go in with the patient and family until the surgery is over, just like I would do if I was here.” The pastor also said that people in the church will call him on his cell phone to keep him company during the long journeys to Ohio, which involve driving on Interstate 77 almost to Cleveland, then heading west on the Ohio Turnpike. “They'll call me all the way up the road.” Buster Davis once talked to Sparks for such a lengthy time during one trip that Sparks said it was if he had picked up a hitchhiker along the way. Davis later told Sparks' children about their father's experience with his “hitchhiker,” which “flabbergasted” them until they heard the full story. “So it was kind of neat,” the Flat Rock pastor said. In praising the support from his congregation, Sparks said he “is grateful for the way the church has rallied together in this highly unusual chapter in the life of this family, and the life of the Flat Rock Pentecostal Holiness Church.” Among other blessings emerging during the ordeal have been friends he has met in Ohio. “There are great people everywhere,” Sparks said. The local resident said he can identify with the situation of a well-known Bible figure, Job, who was faced with all kinds of hardships. But the key was how Job dealt with them. “Job responded in such a marvelous way,” said Sparks, who hopes to also “respond in a way that will glorify the Lord.” This includes possibly serving as an example to others undergoing a similar crisis, so they can forge ahead with life. Sparks agrees that in the course of his wife's illness he has found strength within himself that he never knew was there. “It just constantly amazes me.” http://www.mtairynews.com/articles/2008/04/28/news/local_news/local04.txt Contact: Wendy Lau 212-845-4272 Russo Partners, LLC Preoperative assessment of cancer patients enables early diagnosis, treatment of lymphedema NIH, National Naval Medical Center, George Mason University study published in journal Cancer demonstrates importance of physicians' shift to baseline measures and ongoing 'surveillance' model for successful management of common, debilitating condition BETHESDA, Md., April 30, 2008 – The preoperative assessment of breast cancer patients for subclinical lymphedema enables clinicians to establish a baseline, which serves to enable the early diagnosis and successful treatment of the debilitating condition, according to data from a five-year study published this week in the online edition of the journal Cancer (http://www3.interscience.wiley.com/cgi- bin/abstract/118821880/ABSTRACT). In a study conducted by the National Institutes of Health (NIH) and the National Naval Medical Center, in collaboration with faculty and students from the University of Michigan-Flint and George Mason University, researchers measured the upper limb volume of 196 newly diagnosed breast cancer patients from 2001 to 2006 to establish a baseline prior to surgery. At designated postoperative intervals, the researchers took repeated measurements as part of a “surveillance” model to monitor for possible impairments related to breast cancer treatment--such as lymphedema--as opposed to treating therapy- related problems after they occur. Using the surveillance approach, the investigators demonstrated that a short trial of compression garments effectively treated subclinical lymphedema when it was detected early. Forty-three, or 22 percent, of the 196 breast cancer patients in the study developed subclinical lymphedema, as defined by a change in limb volume of >75cc; and all subjects showed a significant mean volume reduction to very near their pre-surgical “normal” state. All subjects were able to maintain this level for an average of 4.8 months, and none of the patients demonstrated progression of the condition in the follow-up period. Steven Schonholz, M.D., a breast surgeon and medical director of the Breast Cancer Center at Mercy Medical Center in Springfield, Mass., added: "The problem with lymphedema is that there hasn’t been an easy way to detect the condition before it is apparent to the doctor and patient. Today there are new, non-invasive methods that have enabled me to identify the condition and begin treatment long before the patient is aware of a problem. If patients aren't treated at the earliest possible indication of lymphedema, it is less likely to be effectively treated, and the condition may require life-long costly treatment and, more importantly, have an enormous impact on a woman's self-esteem, function and quality of life." While there is no standard tool used to assess the condition, physicians have relied on tape measures and water displacement to track changes in limb circumference and size as well as on patients to report changes in upper extremity mobility. Several diagnostic tools are able to accurately track minute changes in extracellular fluid to allow for the earliest possible detection. These include bioimpedance spectroscopy devices, which use an electrical signal to assess fluid changes in the body. "Optimal management of lymphedema requires diagnostic tools that are sensitive to subclinical changes in tissue," said Dr. Schonholz, who uses an FDA-cleared low frequency bioimpedance device developed by ImpediMed Inc. in his practice. ### About Lymphedema Lymphedema is a condition that can cause significant swelling of the upper and lower extremities due to the build-up of excess lymph fluid. This can occur when the lymphatic system, which is responsible for draining excess fluid from the body and is a key component of the immune system, is damaged or altered. In breast cancer patients, this can occur after surgery, such as removal or biopsy of the lymph nodes, and/or radiation therapy. It is estimated that 6 percent to 40 percent of patients with breast cancer develop lymphedema, and that it often occurs within the first two years after surgery. For some cancer survivors and others at risk, a low level lymphedema can occur 10 years to 15 years following the initial primary treatment and develop into a condition that has a serious impact on overall health and quality of life. Ann Dermatol Venereol. 2008 Apr;135(4):299-303. Epub 2008 [Intravascular B-cell lymphoma with febrile inflammatory lymphoedema of the lower limbs and lower back.] [Article in French] Pallure V, Dandurand M, Stoebner PE, Habib F, Colonna G, Meunier L. Service de dermatologie, groupe hospitalo-universitaire Carémeau, rue du Professeur-Robert-Debré, 30900 Nîmes, France. BACKGROUND: Intravascular lymphomas are diffuse large-cell lymphomas belonging to a group of high-grade non-Hodgkin's lymphomas and are generally of phenotype B. They are rare and carry a severe prognosis. Clinical polymorphism is dominated by neurological and cutaneous involvement. PATIENTS AND METHODS: We report the case of an 80-year-old woman with cutaneous intravascular B-cell lymphoma as revealed by an isolated episode of febrile bilateral inflammatory lymphoedema. Following combined chemotherapy with rituximab and mini-CHOP (cyclophosphamide, adriamycin, oncovin and prednisone), complete remission was obtained rapidly, with no relapse at two years. DISCUSSION: Diagnosis of these tumours is rendered difficult by the clinical polymorphism and multifocal nature of lymphocytic proliferations. In the present case, diagnosis was based on histology results since presentation of the disease in the form of bilateral inflammatory oedema of the lower limbs is not sufficient to establish lymphoma. Combined rituximab and polychemotherapy comprising a CHOP regimen appears to yield the best results. PMID: 18420078 [PubMed - as supplied by publisher] ELLENSBURG – Marian Reichelt of Snohomish is no stranger to fishing, she just never has done it quite like she did Saturday on the Upper Yakima River. She’s fished lakes and streams for salmon and steelhead alongside her husband in the Lake Chelan area, but she’s never fly fished with 11 other women, all breast cancer survivors, many of whom would never think to step into a rocking drift boat on a chilly, unseasonable spring day. Yet the women did just that. Twelve of them, all patients of Northwest Hospital in north Seattle, along with selected hospital staff and local fishing guides, sought the wily trout in nine boats most of the day Saturday. The Puget Sound-area women were given the fly-fishing experience free as part of a twice-a-year outing that’s into its fourth year thanks to Northwest Hospital and, this year, due to generous donations from doctors and specialists. “It’s something I’d always wanted to try,” said Reichelt, 50, as she got ready to leave the Yakima River Fly Shop in downtown Cle Elum Saturday morning with her guide for the trip to the push off point. “It’s been on the top of my list of things to do for quite a while.” Reichelt, for quite a while, has been occupied, to say the least. For the past four years she’s been on journey of survival that’s included a mastectomy, repeated rounds of what she called “aggressive chemotherapy” and radiation treatment. “I’m doing some added treatment, but I can say I’m cancer free right now,” Reichelt said. “When I look at it all, I believe it’s made me a stronger person.” Therapy Using fly-fishing as physical therapy for strengthening is part of the goal of the outings that were started by Dr. Sandra Vermeulen, a radiation oncologist at Northwest Hospital. The physical work of casting a fly with rod in hand exercises the arm and shoulder in such a way that it steers the women away from a common side effect of breast cancer treatment. The side effect is lymphedema, a painful swelling in the arms and upper body that can lead to permanent loss of mobility. About one in five women who’ve had breast cancer will get lymphedema, but exercise is one way to prevent it or lessen its impact. Vermeulen said she’s been an avid fly-fisher for many years, and the Upper Yakima is one of her favorite spots. “All of these women have had surgery and some very hard treatment,” Vermeulen said Saturday before heading on to the river. “These are some pretty tough ladies; they’ve been through a lot.” She said in addition to the therapy, the beautiful, riverside scenery, the friendship of other women and the excitement of fishing helps the women “refocus their lives. They see that life can still be great out there.” Local help With the support of Northwest Hospital, Vermeulen started the biannual trips with the help of local fishing guide Charles Cooper of Cle Elum and Yakima River Fly Shop owner/guide Jim Gallagher. The two men help organize the trip’s logistics, and each travels to Seattle the week before the trips and gives a five-hour fly-fishing lesson to a portion of the women. The men each bring a drift boat along to their lesson and drag it on to the grass at the Seattle hospital’s campus. The women get a feel for what being in a small boat is all about while fly-casting at the same time. Cooper said women ranging from 30 years old to nearly 70 have been on the trips. Nine fishing guides accompanied the women. “These ladies have just survived probably the most traumatic experience of their life,” Cooper said Saturday. “For me, I want to give them a great adventure, and I want them to enjoy the camaraderie of other survivors.” He said assisting the women is personal for him: his mother is a breast cancer survivor. For Jim Gallagher, it’s personal, too. Before heading to the river Saturday morning, he said his mother died from breast cancer. “I grew up in a fly-fishing family; all of us fished together,” Gallagher said as his voice softened. “My entire life has been involved with fly-fishing.” Sisterhood Reichelt said she jumped at the chance to fly-fish with a guide when her doctor offered her the invitation. “It’s really a neat experience on the river, especially with these other women who have an experience in common,” Reichelt said. “You could say we’re a band of survivors, a sisterhood. If you haven’t gone through cancer treatment you can’t really understand what one really goes through. It’s so hard to explain. “We’ve all faced the same situation. I guess we’re all in the same boat, so to speak. We’ve been through the whole thing and made it back.” A stitch in time brings relief PATRICE ST. GERMAIN patrices@thespectrum.com ST. GEORGE - Sewing machines whirred as members of the American Sewing Guild put together "anti- ouch pouches" at the local Bernina store on Friday. The pouches are pillows that hang from the shoulder and fit snuggly under the arm to provide a cushion and keep the arm away from the body after breast surgery or during radiation treatment. The pillows will be inclu-ded in post-mastectomy care kits given to patients at Dixie Regional Medical Center. "The pillows are something very simple but it has great importance for our post-mastectomy patients," Lorraine Moe said. Moe is an occupational therapist and certified lymphedema therapist working in the Dixie Regional Medical Center rehab services center. She said a lot of times after mastectomy surgery, patients have edema - fluids caused by the surgery - and have drains in place, which cause pain and tenderness in the area around and under the arm. The pillow prevents friction against the tender area and Moe said not only does it help reduce the pain, but it comforts the patient. "Because a drain can be there several days, up to a couple of weeks, the pillow is more of a sense of comfort knowing that the area is not rubbing," Moe said. Moe said for post-mastectomy patients, even something as simple as vibration from sitting in a car may cause pain in the surgical area. Ruthann Adams said the local sewing group is made up of members of the St. George Neighborhood Branch of the Las Vegas Sewing Guild, which is part of the American Sewing Guild. Frequently, the group gets together to make items such as the anti-ouch pillows as projects to help members in the community. As a breast cancer survivor, Adams knows how important the pillow can be. The pillow was designed by Deon Maas, a breast cancer survivor and member of the American Sewing Guild. Komen awards local grants From submitted reports Three Baxter Regional Medical Center programs have received grants from the Susan G. Komen for the Cure Arkansas Affiliate totaling nearly $113,000. The Mobile Mammography Unit (MMU) received $105,080, the Lymphedema Outreach Program received $4,050 and the Tell Your Mom, Save a Life Program received $3,679. Mobile Mammography Unit The Komen grant is the primary source of funding for the MMU that makes mammograms convenient and affordable. Housing the mammography equipment in an RV-type vehicle makes it possible to take this lifesaving screening to various locations throughout Baxter, Marion and surrounding counties. The MMU also offers bone density testing. Most of the approximately 11,000 patients served by the MMU since BRMC first began this outreach in 2001 have said they probably would not undergo regular checks were it not for the MMU. Many said they would probably never get a mammogram without the MMU. Last year, the MMU did 2,769 screenings. To schedule the unit, call (870) 508-2666. Lymphedema Outreach The Lymphedema Outreach Program, started four years ago by physical therapist Reneé Barnes, is entirely funded by the Komen grant. Lymphedema is a condition that causes swelling in the trunk and extremities. It is common following breast cancer and related treatments. Grant money is used to purchase compression garments to help control the symptoms and complications of lymphedema. Barnes also produced a video — "Management of the Lymphedematous Extremity" — for distribution to survivors as a tool to reinforce their management techniques at home. The grant money also has provided education and certification in lymphedema therapy for an additional therapist. The BRMC Rehabilitation Services Department now has three staff members — Barnes; Jason Smith and Arlette Michalak — who are certified in the treatment of lymphedema. A new facet of treatment was recently added to the outreach program as therapists were trained in the use of the "Lebed Method" of lymphedema therapy. This method incorporates dance movement and therapeutic exercise to help lymphedema sufferers. Tell Your Mom, Save a Life The Tell Your Mom, Save a Life initiative takes breast-cancer awareness and education to junior and senior girls in area schools. They are encouraged to share this information with their mothers and other female relatives. Nearly all the girls reached by the program indicated by survey that they would pass along the information. As part of the program, the girls learn when and how to do a breast self-exam (BSE). The outreach also stresses the importance of mammograms for women age 40 and older. Each girl receives a packet of information about breast cancer, BSE and mammograms. They learn about the BRMC MMU and the Susan G. Komen Race for the Cure. During the 2007-08 school year, BRMC Women's Health Education Center Coordinator Angi Nix presented the program to 15 schools and handed out 730 packets of information. Komen for the Cure This year, Komen for the Cure Arkansas Affiliate handed out checks to 28 Arkansas organizations. Grants awarded totaled more than $1.2 million. "We are thrilled that our grant program continues to grow after 14 years," said Arkansas Affiliate Executive Director Sherrye McBryde. "This year we awarded $1,205,221 to 28 very worthwhile breast cancer projects around the state." The Komen Arkansas Affiliate first awarded grants totaling $78,700 in 1994. "The support that Arkansans provide to Komen for the Cure through the Race for the Cure and other events continues to grow with each year," McBryde said. "It is because of that support that we are able to offer grants to worthy organizations dedicated to the fight against breast cancer." Komen for the Cure was established as the Komen Foundation in 1982 by Nancy Brinker to honor the memory of her sister, Susan G. Komen, who died from breast cancer at the age of 36. Komen for the Cure has raised nearly $600 million for the fight against breast cancer. 1002 Nature Methods - 5, 431 - 437 (2008) Published online: 20 April 2008; | doi:10.1038/nmeth.1205 Modeling lymphangiogenesis in a three-dimensional culture system Françoise Bruyère1, Laurence Melen-Lamalle1, Silvia Blacher1, Guy Roland1, Marc Thiry2, Lieve Moons3, Francis Frankenne1, Peter Carmeliet4, 5, Kari Alitalo6, Claude Libert7, 8, Jonathan P Sleeman9, 10, Jean-Michel Foidart1, 11 & Agnès Noël1 1 Laboratory of Tumor and Developmental Biology, Groupe Interdisciplinaire de Génoprotéomique Appliqué–Cancer, University of Liège, Avenue de l'Hôpital 3, B-4000 Liège, Belgium. 2 Laboratory of Cell and Tissue Biology, University of Liege, rue de Pitteurs 20, B-4020, Liège, Belgium. 3 Laboratory of Neural Circuit Development and Regeneration, Zoological Institute, Katholieke Universiteit Leuven, Naamsestraat 61, B-3000 Leuven, Belgium. 4 Department for Transgene Technology and Gene Therapy, Vlaams Instituut voor Biotechnologie, Onderwijs en Navorsing building I, Herestraat 49, B-3000 Leuven, Belgium. 5 Center for Transgene Technology and Gene Therapy, Katholieke Universiteit Leuven, Naamsestraat 61, B-3000 Leuven, Belgium. 6 Molecular Cancer Biology Program, Ludwig Institute for Cancer Research, Biomedicum Helsinki, Haartman Institute, P.O. Box 63 (Haartmaninkatu 8), FI-00014 University of Helsinki, Finland. 7 Department for Molecular Biomedical Research, Universiteit Gent Vlaams Instituut voor Biotechnologie, Technologiepark 927, B-9052 Gent, Belgium. 8 Department of Molecular Biology, Ghent University, Technologiepark Zwijnaarde 927, B-9052 Ghent, Belgium. 9 Forschungszentrum Karlsruhe, Institut fur Toxikologie und Genetik, Postfach 3640, D-76021 Karlsruhe, Germany. 10 Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68135 Mannheim, Germany. 11 Department of Gynecology, Centre Hospitalier Universitaire, Blvd. du 12ème de Ligne, B-4000 Liège, Belgium. Correspondence should be addressed to Agnès Noël agnes.noel@ulg.ac.be A lack of appropriate in vitro models of three-dimensional lymph vessel growth hampers the study of lymphangiogenesis. We developed a lymphatic ring assay—a potent, reproducible and quantifiable three- dimensional culture system for lymphatic endothelial cells that reproduces spreading of endothelial cells from a pre-existing vessel, cell proliferation, migration and differentiation into capillaries. In the assay, mouse thoracic duct fragments are embedded in a collagen gel, leading to the formation of lumen- containing lymphatic capillaries, which we assessed by electron microscopy and immunostaining. We developed a computerized method to quantify the lymphatic network. By applying this model to gene- deficient mice, we found evidence for involvement of the matrix metalloproteinase, MMP-2, in lymphangiogenesis. The lymphatic ring assay bridges the gap between two-dimensional in vitro models and in vivo models of lymphangiogenesis, can be used to exploit the potential of existing transgenic mouse models, and rapidly identify regulators of lymphangiogenesis. Nature Methods - 5, 439 - 445 (2008) Published online: 6 April 2008; | doi:10.1038/nmeth.1198 Spheroid-based engineering of a human vasculature in mice Abdullah Alajati1, 2, 3, 6, 7, Anna M Laib1, 7, Holger Weber2, 6, 7, Anja M Boos1, 2, Arne Bartol1, Kristian Ikenberg2, Thomas Korff2, 6, Hanswalter Zentgraf4, Cynthia Obodozie2, 6, Ralph Graeser5, Sven Christian1, 2, Günter Finkenzeller3, G Björn Stark3, Mélanie Héroult1, 2 & Hellmut G Augustin1, 2 1 Joint Research Division Vascular Biology of the Medical Faculty Mannheim (CBTM), University of Heidelberg, Ludolph-Krehl-Str. 11-14, D-68167 Mannheim, Germany, and the German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, D-69120 Heidelberg, Germany. 2 Department of Vascular Biology and Angiogenesis Research, Tumor Biology Center, Breisacher Str. 117, D-79108 Freiburg, Germany. 3 Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Hugstetter Str. 55, D-79106 Freiburg, Germany. 4 Electron Microscopy Group, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany. 5 ProQinase GmbH, Breisacher Str. 117, D-79108 Freiburg, Germany. 6 Present addresses: Friedrich-Miescher Institute, Maulbeerstrasse 66, CH-4058 Basel, Switzerland (A. A.); ProQinase GmbH, Breisacher Str. 117, D-79108 Freiburg, Germany (H.W., C.O.); Department of Physiology, University of Heidelberg, Im Neuenheimer Feld 581, D-69120 Heidelberg, Germany (T.K.). 7 These authors contributed equally to this study. Correspondence should be addressed to Hellmut G Augustin augustin@angiogenese.de The complexity of the angiogenic cascade limits cellular approaches to studying angiogenic endothelial cells (ECs). In turn, in vivo assays do not allow the analysis of the distinct cellular behavior of ECs during angiogenesis. Here we show that ECs can be grafted as spheroids into a matrix to give rise to a complex three-dimensional network of human neovessels in mice. The grafted vasculature matures and is connected to the mouse circulation. The assay is highly versatile and facilitates numerous applications including studies of the effects of different cytokines on angiogenesis. Modifications make it possible to study human lymphangiogenic processes in vivo. EC spheroids can also be coimplanted with other cell types for tissue engineering purposes. April 2008: Preventing and Treating Arm Lymphedema Key Questions from this Conference “Is there any 100%-positive way to prevent lymphedema?” Answer. “I'm wondering what exercises can help prevent lymphedema? Can I lift weights at all on the affected arm, even just 5 lbs?” Answer. “How can I tell the difference between the swelling in my arm and breast from radiation (I am 2 months out of treatment) and the signs of lymphedema?” Answer. “Is it safe to get a manicure if you have arm lymphedema?” Answer. The guest speakers for this conference were Kathryn Schmitz, Ph.D., M.P.H., F.A.C.S.M. and Nicole Stout Gergich, M.P.T. C.L.T.-L.A.N.A. The moderator was Jennifer Sabol, M.D., F.A.S.C. Kathryn Schmitz, Ph.D., M.P.H., F.A.C.S.M. is assistant professor in the division of clinical epidemiology at the University of Pennsylvania and adjunct associate professor in the division of epidemiology at the University of Minnesota. She leads a number of research studies, including a study examining physical activity and lymphedema in breast cancer survivors. Dr. Schmitz has won multiple awards from the American Heart Association, including the Jeremiah Stamler Award for New Investigators and the Trudy Bush Fellowship for Cardiovascular Research in Women's Health. Nicole Stout Gergich, M.P.T., C.L.T.-L.A.N.A. is a physical therapist and lymphedema specialist at the Breast Care Center at the National Naval Medical Center. She is also the president of the oncology section of the American Physical Therapy Association, and has previously served on the Medical Advisory Board and research committee for the National Lymphedema Network. Ms. Stout Gergich has lectured internationally on the topics of lymphedema and cancer rehabilitation. Areas of specialization within the lymphedema population include head and neck, breast reconstruction, stage III management, and wound care. Jennifer Sabol, M.D., F.A.C.S. is a breast surgeon who directs the newly developed Breast Care Center at Lankenau Hospital in Wynnewood, Pa. For the past 9 years, Dr. Sabol has held an appointment at Jefferson Medical College as a clinical assistant professor of surgery. Among her many interests, Dr. Sabol spearheads several research initiatives to advance the care for women with breast cancer and improve methods of breast cancer detection and treatment. She has appeared on CNN to discuss breast cancer-related issues and is a frequent lecturer. Dr. Sabol is also a member of the breastcancer.org Professional Advisory Board. breastcancer.org: Welcome! Thanks for joining our special breastcancer.org Ask-the-Expert Online Conference: Preventing and Treating Arm Lymphedema. As much as possible, we'll answer those questions that cover the topics most of you are interested in. We'll be answering only questions that relate to this month's topic from participants in this live, online conference, as well as questions from members of the breastcancer.org community who couldn't join us tonight. Lymphedema reversible if treated early? Question from Constance: Is arm lymphedema always reversible if treated early? Answers: Nicole Gergich: I think at any stage of lymphedema there's an element of reversibility. We can soften the tissue and we can decongest the limb, especially at the early stages. Dr. Jennifer Sabol: If I can make a comment, as a surgeon I usually tell patents that lymphedema is kind of like blowing up a latex balloon: the more you allow it to stretch out, the harder it is to get back to its original shape. That's why we try very hard to educate patients to look for signs of lymphedema so that we can start treatment early and hopefully get back to the original form of the arm as quickly as possible. Dr. Kathryn Schmitz: I don't know whether the person asking this question intended this thought to come up, but there is a possibility that with the answers that are being given, depending on how they're taken, some women may blame themselves for lymphedema – “Gee, why didn't I do something earlier?” I think there are probably women for whom it's inevitable that their arm is going to enlarge. There are women who, for reasons that are unknown, never do develop lymphedema even if they've had the same treatment. I want to be cautious in saying that it is always preventable, or that we can do a better job with it in every single case when caught early. However, I think that there is ample evidence at this time in the scientific literature that early detection and early treatment are clearly associated with a better outcome and a better clinical course, and that it is less likely if detected early and treated early that lymphedema will become severe. Even with that, there are some women for whom it's completely inevitable that they're going to have a large arm. I don't want anyone reading this thinking that they are to blame for it. -------------------------------------------------------------------------------- What to do for swelling caused by bandaging? Question from PS: Do you have any suggestion for treating hand lymphedema when bandaging and sleeve/glove seem to make it swell more? Answer: Nicole Gergich: That is a complicated situation, as there are so many issues that surround a complicated hand. It can range from the quality of the bandaging that's done, the size of the hand, and the compression class of the garment being used. Many times bandaging and garments become an exercise in strategy and what works for one patient isn't going to work for another. I think just sampling different garments, different bandage strategies, or different alternatives in mechanisms of compression may help. I have thousands of strategies in mind, but I think it's impossible in a conference situation like this to give very specific strategies. There are some good resources for follow-up with bandage strategies or garment strategies. Many of the custom garment companies have advice on constructing garments that could be helpful. Or collaborating with other therapists, if you have a network with other therapists you work with, passing ideas back and forth of what's been helpful, innovative strategies that you can share with one another. -------------------------------------------------------------------------------- Guaranteed way to prevent lymphedema? Question from Doris: Is there any 100%-positive way to prevent lymphedema? Answers: Nicole Gergich: I think the more appropriate way of looking at lymphedema is looking at it in terms of risk reduction. I think that we familiarize ourselves and our patients with how they can reduce their risk of first developing lymphedema. But secondly, if they have lymphedema, how they can reduce their risk of seeing that condition advance? There are excellent evidence based guidelines that have been offered by the National Lymphedema Network, that focus on reducing risk through skin care, prevention of infection, and just taking care of the arm with activity. Dr. Jennifer Sabol: We get a lot of questions from other primary care providers about when it's safe to do things like blood pressure, putting IVs in someone's arm, etc., and there are some perceptions that if the arm hasn't swelled after 1 or 2 years, that it's safe to do these normal medical procedures. I think a lot of patients would like to know your opinion on that. Nicole Gergich: Again, if we look at the literature, it is surprisingly scant in these areas. Venipuncture is one thing; actually dropping an IV is another thing; glucose-monitoring finger sticks is another thing. So 3 forms of skin puncture, just as an example. We don't have the evidence to say one is safer or more detrimental than the other. We do advocate for their patients to keep their skin integrity maintained, so it stands to reason we'd avoid those things on an affected or at-risk limb to avoid an infection. Again, it's a mechanism of risk reduction. However, what we need to understand to answer Dr. Sabol's question is that once the lymphatics have been damaged or removed, they never regrow, so that patient remains at risk for life. So I don't think that we can say that in a period of time that it is safe for us to undertake activities that we know may increase the patient's risk. -------------------------------------------------------------------------------- Swelling worsens without sleeve? Question from Karen: If you have LE and don't wear a compression sleeve 24/7, will your swelling irreversibly worsen over time? Answers: Dr. Kathryn Schmitz: I think it needs to be known that there is at least one therapist out there who's very popular with patients who think asking women to wear compression garments all the time is an unacceptable state of affairs and that more frequent massage-based drainage can do the same thing as wearing a sleeve, perhaps in combination with pumping. I can also say that opinion, from my experience, does appear to be outlying, that most lymphedema therapists recommend the regular use of compression garments. The question of how many hours a day is truly an individual clinical decision. Nicole Gergich: I would add that, if we look at some of the historical work in the literature (I refer specifically to the Casley-Smiths) that lymphedema will progress over time if it's not managed appropriately. So I agree with Dr. Schmitz that it comes down to an individual clinical decision about what is appropriate treatment. Compression garments have been shown to be very effective to maintain limb volume. -------------------------------------------------------------------------------- Still okay to ride exercise bike? Question from Carol: Before several of my lymph nodes were removed due to breast cancer, I used to ride a stationary bike for exercise. Can I still ride it now or will it be too much exercise for my surgical arm? Answers: Dr. Kathryn Schmitz: The answer is you should absolutely ride your stationary bicycle, and it will not be too much for your affected arm. In fact, I would submit, and I hope that Jennifer and Nicole will agree with me – if it's controversial I suppose they'll tell me – that the risk of inactivity poses greater long-term health risks than the risks of being active. I think that there is evidence that weight gain and obesity are associated with worsening of lymphedema. And there is evidence that exercise is effective in avoiding weight gain. Therefore, aerobic exercise in particular may be quite useful in risk management and attenuating worsening of lymphedema. Dr. Jennifer Sabol: I think it's fair to say we all agree 100%. -------------------------------------------------------------------------------- Exercises to prevent lymphedema? Weights okay? Question from Marianne: I'm wondering what exercises can help prevent lymphedema? Can I lift weights at all on the affected arm, even just 5 lbs? Answers: Dr. Kathryn Schmitz: The answer would be yes. You can lift 5 pounds, you can lift 15 pounds, you can lift 100 pounds. The issue is not what you can lift; it's gradually increasing the capacity of the affected limb. You want to increase the amount that you lift gradually enough that the affected limbs have a chance to communicate through symptoms that you've done too much. So if you start by lifting 1 pound and you feel fine, then the next session you try to lift 1-1/2 pounds or 2 pounds and you feel fine after that, and the next time you increase again by 1/2 pound or 1 pound increments. As long as your limb is not changing in any negative way, there is no need for an upper limit on the amount that you can lift. But you do need to build your capacity gradually. I'll use an analogy here: after someone has a heart attack you certainly don't ask them to go out and run a marathon the next week. But there is ample evidence that individuals who have had heart attacks can and indeed do train and successfully complete marathons. They start in cardiac rehabilitation programs and gradually build up capacity of their damaged heart so that they are capable of running faster and longer than the average person. This would hold true for the lymph system as well. Nicole Gergich: I feel very strongly that women who have been given the advice that they should "never lift more than 5 pounds for the rest of their life" should take that advice and throw it out the window. I truly believe that every exercise program is to be individualized. Every patient has the ability to do whatever activity they choose, whatever it is – rock climbing, dragon boat racing – as long as they choose an appropriate mechanism to train and monitor their limb. Dr. Kathryn Schmitz: I will add one thing: something women with lymphedema can't afford to do versus women not at risk can afford to do is to injure the arm due to overactivity. So women who have lymphedema do have to be smart that if they walk away from exercise for some period of time, they must back off and rebuild the limb. Muscle is a “use it or lose it” tissue. So if you stop training because you're taking care of your sick mother or you're busy at work, like any other woman wearing many hats and meeting other needs, you need to be aware of the breaks between exercise sessions and not overextend the limbs after a break. That is key. -------------------------------------------------------------------------------- Breast lymphedema possible? Question from Amy: Does lymphedema only occur in the arm or can it be in the breast as well? Answers: Nicole Gergich: Absolutely! Not only can it be in the breast as well, it can be exclusively in the breast and chest wall, even if it does not appear in the arm. So we need to recognize that breast edema and chest wall edema exist and should be treated. Dr. Jennifer Sabol: As a surgeon, I probably see it more acutely than most and have a more difficult time getting other physicians to acknowledge that there is such an entity as lymphedema of the breast which is actually quite uncomfortable for some patients as well as alarming, because it is difficult to ask for treatment for swollen breasts. I think maybe you can comment on how you manage patients like this. Nicole Gergich: I would say, first of all, recognition is part of the key. I believe anecdotally that I am seeing more frequency of breast and chest wall swelling – lymphedema, if you will – now with the sentinel node biopsy, as we are removing the direct drainage pathway out of the breast. Unfortunately, it is going far underrecognized. Treatment for breast and chest wall lymphedema is analogous to the way we would treat the arm, meaning that the patients would require lymphatic drainage, compression, therapy, exercise, and skin care. Many of these patients will require custom fit or near-custom compression bras. Dr. Kathryn Schmitz: I would say this is an international problem. I was at the Australasian Lymphology Association meeting in Perth in March, and this issue of seeing more breast edema was a theme there. It seems to me that the compression garments and treatments available are not as advanced as they are for arm edema, the compression garments in particular. Nicole Gergich: I would agree with that to an extent. I think there are excellent compression bras that exist. I agree with you that we are as not highly evolved in this area in recognition, treatment, and management as we are with the arms. Dr. Jennifer Sabol: I would add one note of hope, and it is sort of anecdotal. I think this is one of the few times that lymphedema does have a tendency to regress. It's probably due to the acute injury of the radiation therapy. Breast edema does tend to go down over time, though it may not disappear. It is a very slow resolution of the edema and it's almost never complete. I generally tell patients to expect a very slow, ongoing improvement, even over 2 to 3 years after their radiation therapy, until they reach a stable plateau. I'd be curious if you two have found the same sort of better overall prognosis for the breast edema. Nicole Gergich: I typically treat breast lymphedema; I wouldn't expect it to spontaneously resolve itself. I think there is a large cohort out there where we see swelling not only in the breast, but the lateral chest wall and posteriorly in the scapular area, swelling that persists and is identifiably asymmetrical. We cannot expect it to spontaneously decongest in all of our patients. -------------------------------------------------------------------------------- How common is lymphedema from radiation? Question from JJ: What percent of patients who receive radiation treatment to the underarm node region develop lymphedema? Answer: Nicole Gergich: I don't know if we can give an exact percent, but we would assume that if the patient is getting radiation to their underarm that they have positive lymph nodes and have probably had more removed, so their risk according to current research could be as high as 48%. I emphasize the “could be” – it could be as high as 48%. -------------------------------------------------------------------------------- Risk of lymphedema from flying? Question from EMcK: Is it advisable for all patients to wear a sleeve when flying? What if only one or two lymph nodes were removed? Is there a difference between short and long flights? Answer: Nicole Gergich: Again, I think making a blanket statement like “all” or “every” to our patients does not serve them well. I do believe that there is ample anecdotal evidence that there is a shift in fluid when people are exposed to a decreased air pressure for a long period of time. My feet swell when I go to Los Angeles on a flight. So I think everyone's body will respond to that pressure differently. If a patient is to have a compression sleeve for an airplane flight, the garment should be well-fit by a trained therapist, and the patient should be familiar with how to properly wear the garment. -------------------------------------------------------------------------------- How to tell normal swelling from lymphedema? Question from Lyd: How can I tell the difference between the swelling in my arm and breast from radiation (I am 2 months out of treatment) and the signs of lymphedema? Answers: Nicole Gergich: I would say the hallmark sign of lymphedema is an asymmetrical swelling in the tissue that persists over time. We also need to understand that skin changes and tissue changes related to radiation can persist for a long period of time. In fact, inflammation is high in that tissue for up to a minimum of 4 months, and longer term changes can happen for up to 5 years. So to tell the difference in the early stages I agree is difficult, and there's not a specific percent of difference we would say is accurate. But the question I would ask is does the swelling change over time? Do you see the swelling in your arm or breast change from week to week or day to day? Month to month even? Is it gradually improving over time? If it is, I'd say it's related more so to the radiation. Dr. Jennifer Sabol: I tend to agree. I think it's very difficult to decide what is simply treatment radiation change and going to get better. Traditionally, we think of radiation swelling as being within the radiated field, meaning the breast; however, treatment's effect can also impact the lymphatics as they come out of the arm, and during radiation treatment some patients may experience more arm swelling. Again, these changes do subside slowly over time. I think while it's impossible to specifically treat lymphedema during radiation (and Nicole may have a comment about that), symptoms that persist after treatment should be managed aggressively. Nicole Gergich: I think we can certainly treat someone during radiation therapy, although it becomes very difficult. I think the program, though, becomes slightly modified depending on how the tissue is responding to radiation. Certainly, we can stimulate the lymphatic system in its proximal and central and healthy areas, but we would tend to avoid massaging over the radiated field. So it does limit the treatment to some degree. Compression would also be limited during radiation treatment as we need to protect tissue. I think we need to remember that the lymphatics in the underarm drain the tissue of breasts, the chest wall, and the arm on the same side. So even if we don't directly damage the arm or the underarm with radiation, there still can be damage done that impacts the drainage of that entire quadrant. -------------------------------------------------------------------------------- Manicures safe with arm lymphedema? Question from Website Question: Is it safe to get a manicure if you have arm lymphedema? Answer: Nicole Gergich: Absolutely! As long as it's done in a safe manner, and by that I mean protecting the skin integrity. Again, we advise people not to have their cuticles cut and just simply push them back. It's a safe mechanism by which you can protect the skin. I've had patients who take their own sterile supplies to have their manicures done, because they feel more comfortable that way. There's never a never and never an always, that's what I like to say. I think that's very true when you deal with lymphedema. -------------------------------------------------------------------------------- Okay to practice yoga after nodes removed? Question from JSD: I have had 25 lymph nodes removed and radiation to the area. I do yoga regularly (inversions supporting the body with arms and feet, push-ups, etc.). Is this something I should continue if I was doing it during treatment and after? Is it dangerous to continue this? Answers: Dr. Kathryn Schmitz: It's perfectly safe, keep going. Nicole Gergich: And good for you for doing inversions. Dr. Kathryn Schmitz: In general, I think it is important to have women learn to increase the load on the affected limb GRADUALLY. That means that you do positions such as downward dog for a moment the first time, and then increase time over weeks/months, using the same approach with other inverted or upper body intensive poses. -------------------------------------------------------------------------------- Why so few lymphedema therapists? Question from Maire: Why are there so few lymphedema therapists? Is there a standard of care that should inform patients about getting evaluated early on? Answers: Dr. Kathryn Schmitz: There is actually something this audience should know about. There's a difficulty in this field, like nutritionists and exercise trainers, in that there is no current regulation of who calls themselves a lymphedema therapist and who does not. In response to this, the National Lymphedema Network, www. lymphnet.org, has published a physicians’ paper that is easily downloaded on the adequate training of lymphedema therapists. Further, the schools that fulfill those requirements publish their lists of students who have completed and are certified. Unfortunately, that's the best we've got in the United States. I can tell you, they're way beyond us in Australia. Nicole Gergich: And many of the European countries as well. Dr. Jennifer Sabol: I think part of that is there are issues with reimbursement. It's a shame we're not particularly good at reimbursing for lymphedema care in this country. It becomes hard to find therapists who feel passionately about this and want to be well trained. -------------------------------------------------------------------------------- Shoulder bags okay to wear? Question from Rose-5: Is it okay to wear a shoulder strap handbag on the affected arm? Also, would activities such as painting walls cause damage or be detrimental? Answer: Dr. Kathryn Schmitz: This question comes back to the issue of overuse and understanding what overuse is for you individually. If your shoulder bag requires more of your limb than it can handle and your arm feels tired and stressed after wearing it, it's too much. Get a smaller bag. If your limb feels okay, it's fine. If your maximal capacity of the affected limb is a 10 and any activity – not just carrying a shoulder bag – requires 9.5 out of 10, that's probably too much. So rather than say you can never carry that bag again, go do some exercise so that your capacity becomes a 15 and carrying a bag that requires 9.5 isn't such a big deal any more. -------------------------------------------------------------------------------- Exercises for lymphedema? Wear compression garment forever? Question from Kay: I developed lymphedema in my left arm and my left breast (trunk area). Are there any exercises that I should be doing on a regular basis? Do I need to wear my Belisse compression bra for the rest of my life, as well as the arm sleeve? What precautions do I need to be aware of? Thank you and God bless! Answer: Nicole Gergich: I think the precautions have been well outlined up to this point, as far as precaution with activity and exercise, lifting, etc. Indeed, there's no restriction; you just need to be cautious about completing those activities to the best of your abilities. As far as wearing compression garments for the rest of one's life, I think that is different for every patient. You will probably need some degree of compression on the chest wall. It's hard to say if that's every day, all day, and the same goes for the arm sleeve. I think everyone is different and as we learn our limbs, we learn our breasts also, and how much compression we need to maintain the swelling to a degree that's comfortable for us. -------------------------------------------------------------------------------- Exercises to cure lymphedema? Question from SWoods: Are there exercises that one can do to make lymphedema go away? Answers: Dr. Kathryn Schmitz: No. Nicole Gergich: No, but I would say when exercises are done in the context of a complete decongestive therapy program, they can maximize limb decongestion. Once we have lymphedema, it never goes away. That is vital for people to understand. -------------------------------------------------------------------------------- Research on drugs to increase lymph flow? Question from Gabriela: Is there any research being done to develop pharmaceutical solutions (i.e. drugs) to increasing lymphatic flow? Answers: Dr. Kathryn Schmitz: I am aware of research that is likely at least a decade away. It is at the point of early discovery of targets that could lead to the development of a drug. Dr. Jennifer Sabol: I don't know of any in the present right now. I know several compounds have been used in the past anecdotally, and none have proven to be either effective or necessarily safe, even. -------------------------------------------------------------------------------- Okay to ignore fluid build-up on elbow? Question from Dane: There is always a little bit of build up of fluid on my arm, around the elbow area. This has been present for over 5 years. It does not worry me, so am I correct in ignoring it? Answers: Nicole Gergich: No! Dr. Kathryn Schmitz: This is one of those questions that I worry about, because we don't want anyone reading this or looking at the transcript to walk away freaked out unnecessarily. That said, Nicole's No! is well taken. We've known for a long time that early intervention and management is effective at preventing or attenuating worsening of lymphedema. At the very least, monitoring that limb is worth pursuing. Nicole Gergich: Your arm is telling you a story right now. It is telling you that there is a fluid congestion; it is telling you that it is likely related to lymphatic overload. Even though it hasn't progressed, it doesn't mean there's not still a risk, especially for infection. It may not bother you and it may not ever get worse, but because it exists and it's there, it's your limb telling you already that it's a little bit too stressed. You have to heed that little bit of a warning, so just keep an eye on it. -------------------------------------------------------------------------------- Does computer work affect lymphedema? Question from Georgia: I use the computer for 99% of my work day. Will this affect my arm? Answers: Dr. Jennifer Sabol: It's sort of like using a computer and the development of carpal tunnel – some people will develop carpal tunnel but some people will not. Only time and trial and error will tell you if you're going to develop lymphedema in that situation. I think my only suggestion would be to make sure your work station is ergonometrically (physically safely) positioned – the seating and desktop area. Nicole Gergich: Again, if you are someone who's been using their computer for 99% of your work day for years and years, your arm is probably in tune with that level of activity. -------------------------------------------------------------------------------- Shaving and lymphedema risk? Question from Ruth: What about shaving? I really hate the electric razor! Answer: Nicole Gergich: This just goes back to skin care. The less opportunity we give for bacteria to enter our skin with nicks and cuts from shaving, the less exposed we are and potentially the healthier the limb will be. Again, that's not to say nicks and cuts don't happen, and bugs will certainly bite. So if these small punctures to the skin do happen, we take care of them with antibiotic ointment and prevent them from becoming infected. -------------------------------------------------------------------------------- How to participate in lymphedema research? Question from Sue K956: How can one participate in a research project for lymphedema? Answer: Dr. Kathryn Schmitz: I would direct you to www.oncolink.org. That's a fantastic resource for finding about research being done in survivors and patients. I am in the process of trying to disseminate the results of a large study about exercise and lymphedema. It's difficult. -------------------------------------------------------------------------------- Compression sleeves and flying increase lymphedema risk? Question from MELB: My therapist says if you've never had lymphedema, wearing a compression sleeve on a plane will actually increase the risk of developing lymphedema. She says there is already compression in the plane, and adding even more compression with a sleeve will be way too much on a compromised arm. Is there formal study evidence showing anything to support either side of the flight controversy? Answer: Dr. Kathryn Schmitz: Yes, I can answer this. I love it when you go to a conference and you hear something and can tell someone about it. Sandi Hayes in Australia has done a small study, and she's planning on repeating it larger. She asked people to get measured before and after an airplane flight, and she found no effect. She's planning on repeating on a trans-Pacific flight from Sydney to San Francisco to confirm cross- continent flights. I will also comment that I think the reality – given that lymphedema garments are not often covered by third party payers, need to be fitted individually, and need to be replaced every 6 months – of burdening a woman who does not currently have lymphedema with a non-covered visit to a lymphedema therapist and the several hundred dollars for a garment every 6 months, is overkill. I'll also say that in light of this, it's clear from my interaction with women that they take this advice and translate it into putting on poorly fitting compression garments or off-the-shelf Ace bandages, which indeed could do more harm than good. -------------------------------------------------------------------------------- How to respond to lymphedema emergencies? Question from Kris: Thanks so much for sharing your expertise with us tonight. Can you talk a bit about lymphedema emergencies and how/when to respond? Answers: Nicole Gergich: Great question! Dr. Kathryn Schmitz: There was a woman advocate survivor with lymphedema at the conference in Australia who regularly developed cellulitis and finds herself talking to doctors to try to get a prescription for antibiotics in remote areas of Australia. It's a difficult situation for her. Her response has been to have a script for antibiotics on her person at all times. That's one issue: having cellulitis and needing antibiotics immediately. I think it's inexcusable for physicians not to have that available to their patients if they have recurring cellulitis. Nicole Gergich: I think we should define what an infection looks like for those who have never had one: rapid exacerbation of swelling in their arm, redness to the tissue, it will be warm to the touch, and it's typically painful. If a patient's limb or chest wall exhibits these signs they should proceed directly to get medical attention, because a cellulitic infection can first of all bring on lymphedema in someone who's never had lymphedema before. And secondly, it will spread very rapidly as the protein-rich fluid is a culture for bacteria. So I agree with Dr. Schmitz’s comments – patients need to recognize and respond quickly. If they're familiar with infections, if they've had recurrent infections, they should have access to antibiotics. Because Murphy's Law is that Friday night, 10pm, the redness and pain starts in their limb and having access to antibiotics prevents them the trip to the emergency room. It enables them to treat without having a seriously exacerbating situation. Dr. Jennifer Sabol: One thing I would add is that, while sometimes you can get a pink tinge to a swollen limb, patients that have true cellulitis generally feel overall ill. They have a general sense of fever, chills, aches – much like they have the flu and the onset is fairly rapid. I agree it's never at a convenient time. So I encourage a lot of my patients if they're traveling outside of the area to simply fill a prescription and take it with them if they've had recurring episodes. -------------------------------------------------------------------------------- Good news for lymphedema patients? Question from MsMadelyn: Reading this could leave someone facing lymphedema (or its possibility) feeling a little hopeless and helpless. So is there any good news about improvements in the future through research or improved methods? Answers: Dr. Kathryn Schmitz: There's already been good news. The first good news is that we're no longer ripping all the underarm nodes out of women. There was a time, less than 10 years ago, when it was common to remove all of the nodes under the arm, and the rate of lymphedema was higher. So already, we've cut the rate of lymphedema in half or more by the introduction of sentinel lymph node surgery. There has been a lot of recent research that will clarify that women do not need to be as restricted as previously thought in their activities if they have lymphedema. Nicole Gergich: We're also training more and more therapists every year to become more specialized in lymphedema management, and those therapists are telling the world the fact that there is treatment available for lymphedema. A decade ago we used to tell women they had to live with lymphedema, and we have novel interventions today. Dr. Jennifer Sabol: I have to say from a surgery standpoint, I've seen dramatic decreases again with the rate of lymphedema thanks to sentinel node biopsies. But one of the best improvements I've seen is the acknowledgment by the physical therapists we're using that it's not a question of trying to limit someone's activity so this doesn't happen. I now see more therapists asking their patients what they want to do in their life, such as water-skiing or climbing a mountain, and then finding innovative ways to help them get there. -------------------------------------------------------------------------------- ------------------------ breastcancer.org: Thanks for being with us this evening. We hope the support and information you've gotten here tonight will help you discuss some of these issues with your doctor and make the best choices for YOU. We also look forward to hearing from you at future Ask- the-Expert Online Conferences right here at breastcancer.org. --------------------------------------------------------------------------------------------------------- -- Feet Hurt? Stop Wearing Shoes Need a little mercy for your sole? Khaled Desouki "Everyone who wears shoes walks wrong," says Adam Sternbergh, who wrote about shoes and human feet for New York magazine. AFP/Getty Images The Bryant Park Project, April 22, 2008 · It took 4 million years of evolution to perfect the foot, and humans have been wrecking that perfection with every step since they first donned shoes, New York magazine's Adam Sternbergh says. "Everyone who wears shoes walks wrong," he says, echoing the headline of his recent article, "You Walk Wrong." Sternbergh calls the ubiquity of footwear a "conspiracy of idiocy." He points out the probability that at no point did any shoemaker say, "Let's design something that works with your foot." In the Middle Ages, for example, people began wearing shoes with higher heels to avoid stepping in other people's excrement. Today, high heels are considered sexy. Whatever their reasons for wearing the shoes they wear, people don't usually consider whether a shoe actually works with their foot, he says. The human foot works pretty well on its own, Sternbergh says, and it doesn't need a lifetime of help from shoes. He explains the basic illogic of footwear by comparing the concept to a perpetual cast. "Imagine if someone put a cast on your arm when you were 3 years old and you never took it off," he says. "Your arm would stop working. That's kind of what's happened with our feet." Sternbergh cites a 1940s study of barefoot rickshaw drivers in India. Scientists found that the drivers had unusually healthy feet. Sternbergh says subsequent evidence supports the conclusion that feet don't need shoes. Why are shoes on virtually every foot, then? Sternbergh says the rationale that most urban and suburban people use is that the ground is hard and our feet need the cushioning of footwear. "But in many places in the world, the ground is quite hard," he says. "[Our ancestors] were able to absorb the shock." Sternbergh concedes that in most settings, some form of foot covering makes sense. "I'm not going to convince anyone to walk barefoot," he says, acknowledging that he continues to wear shoes as a bulwark against glass, grime and gross things. He may still wear shoes, but Sternbergh has switched to a model from England called the Vivo Barefoot from the Clark shoe family. Galahad Clark, son of the inventor of the Wallabee — a particularly successful, if traditional, shoe — helped develop the Vivo Barefoot. Sternbergh says the shoe is basically a slipper with a Kevlar sole, to prevent puncturing. "They kill your heels," he says. "A traditional shoe advocate would say you need to switch back to sneakers that have a big cushiony heel." But a barefoot-walking advocate would say, "You're walking wrong," Sternbergh says. He asked Clark for advice or instruction, but Clark said walking in the shoe is instinctual. "You'll find that your walk starts to change," Sternbergh says. "You land on your heel, but it's a much softer landing. ... A traditional shoe with a lot of cushioning is designed to allow you to walk with the bad habits that you have because you've been wearing shoes all your life." For those who cling to their typical footwear, Sternbergh is sympathetic. "Shoes perpetuate shoes," he says, referring to the cycle of coddled feet forever needing high-tech --------------------------------------------------------------- MAY 2008 LYMPHEDEMA IN THE NEWS Lymphedema treatments There may be no cure for lymphedema, but Stacea Boss, a physical therapist at the Lymphedema Clinic at Reading Hospital, said there are effective treatments. "Once you have it, you always have it," Boss said. "It’s going to be an inconvenience, but you can reach a point where you need to just maintain the treatment." Boss said the incidence of lymphedema has been well-researched in breast cancer patients (where it usually affects an arm), but there aren’t as good stats for other types of cancer. For breast cancer the incidence of this side effect is somewhere between 20 and 30 percent, Boss said. Because it isn’t as well documented in gynecological or groin cancers (where it usually affects the abdomen and legs), Boss said some of those patients are surprised when it happens. "They are shocked," Boss said. "Breast cancer survivors have really taken it on their shoulders to make sure people understand more about it, but that hasn’t happened with other cancers." Boss said treatment is effective for all affected limbs, although lymphedema in the legs can be more difficult to control. ---------------------------------------------------------------------------------------------- Cancer Centers of North Carolina Receives Prestigious Accreditation RALEIGH, N.C., May 14 /PRNewswire/ -- Cancer Centers of North Carolina's diagnostic imaging service has been awarded a three-year term of accreditation as the result of a recent survey by the American College of Radiology (ACR). Radiation oncologists Dr. John F. Reilly and Dr. K. Kolby Sidhu lead the practice's radiation oncology program, which provides patients with state-of-the-art diagnostic and therapeutic radiology services, including Computed Tomography (CT) and Intensity Modulated Radiation Therapy (IMRT). "We are thrilled to receive the ACR's accreditation because it signals to the community that our patients and our future patients receive unparalleled, cutting-edge cancer care services. This reflects our commitment to excellence and is a significant validation from our national peers and colleagues," said Dr. Reilly. Radiation oncology is the medical use of ionizing radiation as part of cancer treatment to eradicate cancer cells. Physicians can use it as primary therapy, but it is also frequently combined with surgery, chemotherapy and/or hormone therapy. Computed Tomography (CT) scanning is the use of radiation to accurately visualize and evaluate cancerous tumors anywhere in the body. The ACR, headquartered in Reston, Va., awards accreditation to facilities for the achievement of high practice standards after a peer-review evaluation of the practice. Nationally board-certified physicians and medical physicists who are experts in the field conduct the evaluations. They assess the qualifications of the personnel and the adequacy of facility equipment. The surveyors report their findings to the ACR's Committee on Accreditation, which subsequently provides the practice with a comprehensive report. The ACR is a national organization serving more than 32,000 diagnostic and interventional radiologists, radiation oncologists and nuclear medicine and medical physicists with programs focusing on the practice of medical imaging and radiation oncology and the delivery of comprehensive health care services. About Cancer Centers of North Carolina Cancer Centers of North Carolina (CCNC) has been providing comprehensive cancer care and hematology services in the Greater Triangle area since 1979. Beginning as a single physician practice, originally named Raleigh Hematology Oncology, CCNC has grown to include a physician staff of 14 medical oncologists, two radiation oncologists, and the area's only head and neck surgical oncologist. The practice, which now offers services in five locations throughout the area, provides advanced, state-of-the-art diagnostic and therapeutic services, including administration of chemotherapy, biologic and targeted therapies, Computed Tomography (CT), Intensity Modulated Radiation Therapy (IMRT), laboratory and pharmacy services, and an extensive clinical trials program connecting patients to leading cancer investigators around the country. Services are provided in the context of a pleasant, convenient, community-based outpatient setting, where the focus is on patients and their families. CCNC brings the best of medical science and cancer care support services together in one organization, offering nutrition counseling, lymphedema services, physical therapy consultation and fitness programs, social services, stress management, support groups, social services and financial counseling. Practice sites are located in Raleigh, Northern Wake County, Cary, Clayton and Dunn. For information, call (919)-781-7070 or visit SOURCE Cancer Centers of North Carolina "Because of gravity you are more likely to swell," Boss said. She also said even well-managed cases can flare up when patients have been on their feet for a long time, or in the summertime. "Heat takes a toll," she said. "And some patients I have treated and done beautifully will flare." Flares are one problem, but infection is actually a more serious complication of lymphedema as the affected limb can easily become infected due to the skin and tissue being compromised by the swelling. In addition the lymph fluid contains toxins that should be flushed by the lymphatic system but instead are pooling in the tissue. While quality-of-life issues are difficult, an infection in a swollen limb can be life-threatening, so management is essential. Boss said she also suggests her clients drink lots of water and try to maintain a low-salt diet in addition to the wrapping and massage. She also suggests yoga, breathing exercises and range-of-motion exercises. Acupuncture can offer some relief to patients who research to make sure the practitioner uses sterile equipment in a sterile environment. "Exercise and yoga enhance the pumping mechanism in the body to help move the fluid," she said. "We encourage them to do it throughout the day." While there is no cure for lymphedema, Boss said researchers are working on ways to perform surgeries and radiation with less damage to the lymphatic system. "They are trying to find ways to minimize the damage," she said. 5/13/2008 Living with lymphedema The side effect of her cancer treatment has left Barbara Starr’s leg swollen to the point where neither her clothes nor her shoes fit. There’s no cure for the disorder, but the Hamburg-area woman is trying to make the best of a bad situation. By Tracy Rasmussen Reading Eagle Correspondent Barbara Starr’s cancer may be cured, but the fight for the quality of her life continues. The surgeries and radiation that destroyed the cancers in her uterus and bladder took the healthy cells of her lymphatic system too, leaving her with a leg so swollen neither her clothes nor her shoes fit. And there is no cure. Lymphedema is a side effect of cancer surgery that occurs when the lymphatic system is compromised either through the removal of lymph nodes or through radiation. While it is generally more common after breast cancer treatment, it’s also a side effect of gynecological surgeries, where the lymph nodes in the groin are affected. "When I came out of my surgery everyone commented on how healthy and strong I looked," said Starr, 67, of the Hamburg area, who also went through chemotherapy and radiation therapy in 2006. "The surgery was in February, and then I went through megadoses of radiation and chemotherapy until September." In the summer of 2007 Starr said she noticed that her right leg was beginning to swell. "I was getting acupuncture because of it and it went down," she said. "That spontaneously resolved." However late in the summer she took a vacation to Peru, which required a long plane ride. Unbeknownst to Starr, plane travel is often a trigger for lymphedema, stressing an already compromised lymphatic system. "When I got off the plane my left leg was swollen," Starr said. "And it’s never gone down since then." In fact her leg sometimes gets so swollen that the normally petite size 8 or 10 had to shop for plus sizes, just to get pants that would fit around her abdomen and leg. She still can’t wear the two pairs of shoes she had made for her in Peru and doubts she ever will. "Thank God for Crocs," she said. "They’re the only thing that I can wear." Physical therapy regimen Upon returning to the states, Starr was diagnosed with lymphedema and began a regimen of physical therapy that was designed to help her body drain the fluid that was accumulating in her leg. Because she had some lymph nodes removed and others damaged, the fluids and toxins that normally circulate through the body to be processed through the lymphatic system never get moving. Instead they pool, infuse the tissue and cause the swelling. Physical therapy uses a specific type of massage to push the fluid past the damaged portion of the system to a place where it can be circulated back into the lymphatic system. The massage is a gentle kneading that starts at Starr’s feet and works the fluids up to where it can hitch a ride through the healthy portion of the system. Once the leg has been flushed of fluid, it needs to be wrapped tightly to keep the swelling down. Yet no matter what she does, the swelling in Starr’s leg returns. "The bandages look like ace bandages but they don’t have any stretch in them," Starr said. "Every single toe is wrapped and (the therapist) would put pads at my ankles bone and around my calf and wrap over them. You can imagine how thick it is." After several months of that, Starr said it was clear the treatment was not enough. "None of that was really working for me," Starr said. "The swelling continued." Now she hooks herself up to a pump every night or when she’s relaxing and sleeps while it gently massages the fluid from her leg. "It’s finally allowed the fluid to pass for me," Starr said. "But it’s temporary. I have to do it every single day." Once she’s done with the machine she re-wraps her leg and gets on with her day. "The only time my leg is unwrapped is the time it takes to take a shower," she said. Starr knows there is no cure for the disorder, but she’s looking forward to using a new type of tight leg stocking that will do basically the same thing as the wrapping, but is easier to apply. But mostly, she’s working on accepting the way her life has changed over the past year and the way she can recover. Extraordinary attitude First, her attitude is extraordinary. She’s learned to cope and make the best of the situation, despite the challenges that keep coming. A few weeks ago her foot caught on the deck outside her home and she fell, breaking her wrist. "My foot is heavier now and I don’t walk the same way," she said. "It’s hard to bend my knee. I was wearing a new pair of shoes and I wasn’t used to them, so I fell." The purple cast on her arm makes it even more difficult to wrap her leg and get around, but she’s trying to make the best of it and is grateful for the health she enjoyed prior to cancer. Starr was always very active, she said. She’s a vegetarian who enjoys hiking and biking and being active. It’s that basic health, she said, that has allowed her to get as far as she has. She tries her best to have her good attitude cancel out her bad leg. "Gardening is difficult," she said, as an example. "So I do it when I can. I go out there and pick a couple of weeds. And I’m trying to get back into yoga. So it’s not the end. You just need to adjust." Starr’s way of adjusting is to try and give back to others. She’s working on starting a branch of the Wellness Community in the Hamburg area, and she’s hoping to be able to help others with the same affliction through yoga and massage. "I try to stay in the moment and live right now," she said. "My life is very different and I really feel my mortality now. But I want to give back, so I’m going to. And I’m hoping that some day there will be a miracle cure." ====================================================================== ==================== Faxton-St. Luke’s program receives grant -------------------------------------------------------------------------------- Observer-Dispatch Posted May 15, 2008 @ 11:10 AM -------------------------------------------------------------------------------- Faxton-St. Luke’s Healthcare announces the Lymphedema Treatment and Management Program at The Regional Rehabilitation Center has been awarded a $30,000 grant from the Central New York Affiliate of Susan G. Komen for the Cure. The grant will be used to help breast cancer survivors purchase necessities such as bandaging supplies, compression arm sleeves and gloves. The money will also be used towards educating the therapists who treat breast cancer and lymphedema with the most current and state-of the-art technology. For more information, please contact the Lymphedema Treatment and Management Program at (315) 624-5400. .. Tina Budde Applause to the Susan Komen for the Cure foundation. They have given so much to help not only cancer patients but lymphedema as well. There is hope for lymphedema patients. With all the research monies given out, we are seeing a mass explosion of possible treatment options for the future emerging such as lymph node transplants. Also there is technology, Impedimed has a machine that can detect stage 0 lymphedema, thus treating it before it becomes really noticeable. That can help primary lymphedema patients' children from ever developing full blown lymphedema with early intervention and change quality of lives for not only them but breast cancer survivors. http://health.groups.yahoo.com/group/lymphland/ Any lymphedema patients, feel free to join my support group. We keep up to date on all aspects of the condition. Sincerely, Tina Budde Lymphland International Lymphedema Online and Lymphland.com --------------------------------------------------------------------------------------- Routine Screening Of Breast Cancer Patients For Symptoms Of Sub-Clinical Lymphoedema Leads To Better Clinical Outcomes Main Category: Breast Cancer Article Date: 20 May 2008 - 4:00 PDT Get the Facts on Breast Cancer. Pictures, Symptoms and Treatments. MedicalHealthData.info Breast Cancer Photos Seek Out Causes, Symptoms, And Treatments For Breast Cancer. HealthWellnessGuides.info Breast cancer patients should undergo routine surveillance for sub-clinical lymphoedema, concludes a study published in Cancer. The study, which was conducted in the US, showed that compression garments introduced early in the course of lymphoedema can be used to effectively treat the sub clinical condition. Lymphoedema is an abnormal buildup of fluid, most often in the arms or legs; that occurs when lymph vessels or nodes have been damaged or removed. This occurs after breast cancer surgery or lymph node biopsy where removal of lymph nodes and vessels from under the arm changes the way lymph fluid flows. Breast cancer related lymphoedema is a chronic condition - estimated to affect 33 to 47 % of women following axillary lymph node dissection and 4 to 17 % after sentinel node biopsy. It is a progressive condition that diminishes a womanR! 17;s quality of life and contributes to impairment in the range of movements, loss of strength and limits every day activities, such as lifting and reaching. It has previously been reported that changes in interstitial tissue congestion occur before limb swelling becomes visible. Furthermore, it was suggested that earlier detection might result in fewer long term complications. Stout Gergich and colleagues, from the National Naval Medical Center ( Bethesda, Maryland, USA) set about investigating the efficacy of surveillance in patients with early stage breast cancer. The investigators hypothesized that on diagnosis of sub-clinical lymphoedema, a light grade compression garment worn daily would be sufficient to alleviate the problem. Between 2001 and 2006 all women with newly diagnosed unilateral early stage breast cancer (stage I- III) were screened by a physical therapist prior to surgery to determine eligibility. Patients were excluded from the study if they had a previous history of breast cancer, bilateral breast cancer or if they had suffered severe trauma or surgery to their upper limb. For the 196 women meeting the study criteria, limb volume was measured pre operatively and at three - month intervals following surgery using a Perometer. The Perometer is a sensitive and standardized device using infrared optoelectronic technology to detect and quantify limb volume changes. If the upper limb volume increased by greater than 3% compared with the preoperative volume, then a diagnosis of lymphoedema was made. Altogether 43 women were found to have lymphoedema and offered early intervention with a ready made 20 to 30 mmHg compression sleeve that was fitted by a physical therapist and worn for four weeks. Upon reduction of lymphoedema women were advised to wear the garment during periods of strenuous activity, if they experienced symptoms of heaviness or if they saw visible swelling. Results show that the average time to onset of lymphoedema symptoms was 6.9 months after the operation. The mean affected limb volume increase was 83 mL (±119 mL; 6.5% ± 9.9%) at lymphoedema onset (P = .005) compared with the baseline measurement prior to the operation. After intervention with the compression sleeve, a statistically significant mean 48 mL (±103 mL; 4.1% ± 8.8%) volume decrease was achieved (P < .0001). The mean duration of the intervention was 4.4 weeks (±2.9 weeks), with volume reduction maintained at the follow up of 4.8 months. While the standard of care for treating and managing clinically apparent lymphoedema is well established, write the authors, there is no standard for the treatment of early-stage, subclinical lymphoedema. "A new classification system is needed to recognize subclinical lymphoedema and encourage early intervention to diminish the negative functional, cosmetic, and psychosocial consequences of lymphoedema. On the basis of our findings, we believe that a more sensitive threshold for diagnosing lymphoedema is warranted and can be quantified by using optoelectronic imaging technologies," conclude the authors. Few clinical sites currently have access to optoelectronic measurement technology, concede the authors, but suggest that other assessment tools such as water displacement, bioelectrical impedance analysis, and circumferential girth measurements could all be used to diagnose sub clinical lymphoedema. Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Stout Gergich N L, Pfalzer L A, McGarvey C, Springer B, Gerber L H, Soballe P. Cancer (online 21 Apri1, 2008, DOI 10.1002/cncr.23494) Cancer Research Summaries are overviews of important cancer research findings that have been reported in leading cancer publications. The Cancer Research Summaries are provided by the Cancer Media Service (CMS) in collaboration with Nature Clinical Practice Oncology. All previous Cancer Research Summaries can be viewed here. This summary can be reproduced without permission. If reproduced please include the following acknowledgement: "This summary is provided by the European School of Oncology's Cancer Media Service." http://www.cancerworld.org/mediaservice ====================================================================== ============== Nurse Addresses Lymphedema In Breast Cancer Patients And Survivors Main Category: Breast Cancer Article Date: 18 May 2008 - 0:00 PDT Breast Cancer Treatments A poster session presented by The University of Texas M. D. Anderson Cancer Center at the Oncology Nurses Society 33rd Annual Congress, found that early nursing intervention and implementation of effective strategies can lead to a decrease in the incidence of lymphedema, better management of chronic lymphedema and improved quality of life in breast cancer patients. The literature review, led by Mattie J. Sennett McDowell, RN, BSN, a research nurse in the Department of Breast Medical Oncology at M. D. Anderson, examined 20 years of data about the prevention, management and care of upper extremity lymphedema (ULE), or lymphedema that occurs in the arms, in breast cancer patients. The goal of the review was to identify a comprehensive list of current evidenced- based strategies that nurses and hospitals can use in caring for their patients. "Women are living longer as breast cancer treatments get better, but at the same time, they face more devastating side effects like lymphedema," McDowell said. "So many women present with the symptoms, yet it is understudied and not well understood. More can to be done to proactively recognize and address lymphedema in breast cancer patients." ULE is an often a distressing and debilitating side effect of breast cancer treatment in which protein-rich fluid in the tissue of the arms accumulates and obstructs the lymph vessels. According to the National Lymphedema Network, approximately 15 to 20 percent of all breast cancer patients are affected by ULE. Its development can be triggered by breast cancer diagnostic procedures, radiation, surgery or environmental factors. It also can can occur immediately after treatment or many years down the road. ULE, which can make simple tasks such as picking up children, getting dressed or exercising painful, has a detrimental impact on the patient's quality of life. According to the literature, effective strategies to address lymphedema included early identification of at- risk patients through enhanced assessment techniques, monitoring, standardizing at-risk assessment tools and increased awareness of lymphedema through educational efforts of the health care team. The studies noted that increased awareness through educational forums, patient-nurse learning modules, and increasing the number of research studies focusing on ULE are vital in addressing this problem. McDowell, who is dedicated to the study, prevention and management of ULE after a breast cancer patient died from significant disease progression, complicated by advanced, unmanageable lymphedema, said, "This research is centered on what is important to the patient and their quality of life after treatment. Nurses are on the frontline and may hold the key in proactively preventing lymphedema in many patients by educating them about triggers and symptoms, continual and specific lymphedema assessments during each visit and pursuing research in this area." At M. D. Anderson, nurses and patient care teams have implemented several strategies to educate breast cancer patients about lymphedema and treat it aggressively. One such strategy is having a nurse and physician present information via discussion and prepared handouts before women undergo surgery. Additionally, all women are assessed for lymphedema during treatment and at follow-up visits. M. D. Anderson's multidisciplinary care team also offers comprehensive support and collaboration from prevention of the sequelae to advanced physical therapy for those with lymphedema. McDowell plans to develop further research studies examining the evidenced-based practices for ULE identified in this study, with the end-goal of developing a standard set of recommendations. More information on the causes and symptoms of lymphedema, risk reduction strategies and recommended treatment are provided online at M. D. Anderson's Rehabilitation Services Lymphedema homepage or by logging onto the National Lymphedema Network Web site. About M. D. Anderson The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 39 Comprehensive Cancer Centers designated by the National Cancer Institute. For five of the past eight years, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News and World Report. About Nursing at M. D. Anderson Nursing is a pillar in M. D. Anderson;s worldwide reputation for cancer care, research, education and prevention. Nearly 2500 professional nurses work in M. D. Anderson's clinics and hospital as direct care providers, research nurses, advanced practice nurses, case managers, educators and many other roles. M. D. Anderson is recognized internationally as a Magnet institution. University of Texas M. D. Anderson Cancer Center 1515 Holcombe Blvd., Box 229 Houston, TX 77030 United States ----------------------------------------------------------------------------------------- Our World: Survivor By MICHELLE CASSEL (Contact) 6:03 p.m., Sunday, May 18, 2008 MICHELLE CASSEL / Staff Maria Mason (left) kisses her mother Dolores Mason after they crossed the finish line at the Danskin Womens Triathlon in Orlando on Mother's Day May 11th. FYI: May 19, 2008 Calif. museum hosts China’s terra cotta warriors Local project to turn 'Cinderella' yard into example for future landscapes Share and Enjoy [?] There are many ways to die, Dolores Mason told her two grandchildren 12 years ago. You could get hit by a car. You could fall down a flight of stairs. But the breast cancer diagnosis Mason had just received? “I’m not going to die from this, you understand,” Mason told them. At age 66, Mason has now fought through her cancer, vertigo, obesity, depression, diabetes and lymphedema. Her health problems are ongoing, as is her will to overcome them. I met Mason in December on the ninth green of the Merrill Lynch Shootout, where she was working as a volunteer. She was eager to discuss an unusual birthday gift she had just received from her three children. Her children had hired a retired triathlon coach named Mary Ann Wallace to train her to race in the Danskin Women’s Triathlon at Walt Disney World on Mother’s Day. The triathlon is a sprint triathlon consisting of a .75-mile swim, 9-mile bike ride and 2-mile run through Disney’s Magic Kingdom. The event raises funds and helps bring awareness for breast cancer. Mason was incredulous. “I can’t do this, I’m too old!” she told her daughter Maria Mason, a triathlon trainer living in New York City. “Mom, you don’t have to worry about it. I trained a woman that was 55 and she finished. I know you can do it.” Maria told her mother. Later Maria would join the race to support her mother. “She’s always looking out for the rest of us,” said Maria, who finished right behind her mother in the May race. Mom at 971 out of a field of 1,165 and Maria at 972. “She doesn’t do anything that really makes her feel good about herself and this was something that I saw was a chance to do that.” For the next five months I followed Dolores, filming her push through the physical and emotional training Mary Ann had set forth. Wallace met with Mason twice a week at Lowdermilk Park to work on swimming, biking and running. On her days off, Mason would continue to train and do exercises assigned by Wallace. That meant roughly nine hours a week to prepare for the triathlon. I asked Dolores what kept her motivated. “I want to do it for all the people that have breast cancer or have had breast cancer,” she said. “I also want to do it for my children, my husband and myself. To prove to myself that I can do something.” http://www.naplesnews.com/news/2008/may/18/our-world-survivor/ -------- It seems like he changed after that shot' By JO CIAVAGLIA Bucks County Courier Times Like a good doctor's wife, Melissa Miller vaccinated her firstborn son, Sam. She wishes now she wasn't so good. Not long after Sam had his mumps-measles-rubella and other routine childhood shots, the toddler developed bad gastrointestinal problems, Miller said. He stopped talking, stopped making eye contact, he stopped being Sam. By the age of 2, the family finally learned what was wrong. Sam, now 8, had autism, a developmental disability that impairs a person's ability to communicate, socialize and form relationships. The autism diagnosis was upsetting enough. Then further medical tests revealed something more disturbing. Sam's blood had high levels of heavy metals, such as lead and mercury, which are found in vaccines. Could it be a coincidence? Miller doesn't think so. She isn't alone in her belief either, despite a lack of scientific proof linking childhood vaccines with autism and other health disorders. Today more than 10,000 people are expected to attend a vaccine safety rally in Washington, D.C. Celebrities such as actors Jenny McCarthy and Jim Carrey plan to attend. McCarthy has a 5-year-old son with autism. Miller, a Northampton resident, organized a charter bus, which was expected to leave early this morning with about 50 Bucks County residents headed for the “Green Our Vaccine” march in the nation's capital. The event is part of a campaign to convince Congress to re-enact legislation that would eliminate mercury and other toxins from vaccines and encourage national health agencies to reassess the childhood vaccine schedule. Organizers also want the government to extend the statute of limitations to allow all children affected by what they call vaccine-induced autism to file in the National Vaccine Injury Compensation program. Vaccine safety supporters contend that toxins used as vaccine preservatives contribute to brain disorders such as autism and Attention Deficit Disorder, and other chronic health conditions such as asthma and arthritis, which are increasingly diagnosed in children. In 2001, amid growing safety concerns, the vaccine additive Thimerosal, which contained mercury, was removed from all routine childhood vaccines, though some flu shots still contain it. Last month the United States Court of Federal Claims began hearings on whether Thimerosal caused children to develop autism. The court is considering whether the government should compensate the parents of roughly 4,800 children with autism. NO EVIDENCE Still, no credible scientific link between vaccines and autism has been found despite major government, academic and public health studies, and public health experts worry the anti-vaccine trend could lead to a re-emergence of illnesses such as measles and whooping cough. The medical community believes the dramatic increase in autism diagnosis over the last 20 years is related to earlier diagnosis, more comprehensive screening, better public awareness and a broader definition of the disorder. In the past, people with autism disorders were likely misdiagnosed as mentally retarded or emotionally disturbed, many doctors believe. The Centers for Disease Control and Prevention recommends that children age 6 and younger be vaccinated against 15 diseases, including meningitis for high-risk kids and an annual flu shot. The Bucks County Health Department's childhood vaccination program administers about 30 immunizations during that time span, said Barbara Schellhorn, supervisor of personal health. Parents are not required to have children immunized; Pennsylvania requires childhood vaccinations for school-age children, but parents can file for an exemption for moral, religious or philosophical reasons. Bucks hasn't seen any decline in immunizations; last year the department vaccinated more than 10,000 adults and children, Schellhorn said. This year all local schools reported their students were current with vaccines, she added. While Schellhorn understands parents' concerns, the anti-vaccine movement worries her as a public health advocate. “If you can prevent a disease, why wouldn't you?” AN OVERNIGHT CHANGE Debbie Gies put off vaccinating her then 13-month-old son Sam, after he was diagnosed with benign lymphedema, where excess fluid collects in tissue and causes swelling. But eventually she went against her gut reaction and took him for his routine diphtheria- tetanus-pertussis shot. That was in 1981, when vaccine safety was not something most people questioned. Hours later, Sam developed a fever, he started vomiting and screaming. The fever broke, but the next night it happened all over again. Soon after, Sam — who had been walking and started talking — avoided eye contact. He started crawling. He stopped talking. He became irritable. “I told my husband, it seems like he changed after that shot,” said Gies, a Bristol Township resident who is also attending the D.C. rally today. Sam, now 27, was later diagnosed with autism, and Gies refused to have him vaccinated again. Later, Gies had two more children, a daughter, who is now 25, and another son, Michael, 19. Neither was vaccinated. But Michael also has autism, though he is high functioning. Gies believes Sam would be more like Michael had she not vaccinated him. Gies insists she is not against vaccines, but she believes immunizations may aggravate underlying genetic disorders or compromised immune systems resulting in neurological damage. “I truly think the stronger ones are the ones who survive,” she said. DID YOU KNOW? Since 1990, the Vaccine Adverse Event Reporting System, a national database that collects reports of adverse post-vaccination events, has received more than 123,000 reports of bad reactions. In Bucks County, the number of school-age children with autism spectrum disorders more than tripled between 1999 and 2006, from 232 children to more than 700, according to state education statistics. Last year the Bucks County Health Department administered 480 mumps-measles-rubella vaccines, and the first four months of this year it administered 168. Jo Ciavaglia can be reached at 215 949-4181 June 4, 2008 6:54 AM ----------------------------------------------------------------------------- Scout leader's cancer struggle gives troop insight By Lori Gilbert Record Staff Writer June 05, 2008 6:00 AM When the members of Girl Scout Troop 2183 finish presenting the colors at Saturday's Relay for Life opening ceremonies at Weber Point Events Center, chances are good they won't leave once the flag is raised. Their appearance at the Stockton edition of the annual fundraising event for the American Cancer Society isn't a token moment of community service. It's personal. Their troop leader, Shiree Conklin, in addition to taking them on camp outs and helping them sell cookies, has introduced them to cancer. PREVIEW STOCKTON When: 9 a.m. Saturday through 9 a.m. Sunday Where: Weber Point Events Center Information: (800) 227-2345 LODI When: 10 a.m. Saturday through 10 a.m. Sunday Where: Lodi Grape Festival Grounds, 413 E. Lockeford St. Information: (800) 227-2345 Conklin and her best friend, Tina Robinson, started the troop three years ago. Conklin wanted to spend time with her daughter, Autumn, then 9, hoping to make up for time she'd missed during the previous two years as she was fighting cancer. When Kiana, one of her scouts, asked her why she had no breasts, Conklin, with the permission of Kiana's mom, told her. "I sat down with them in small groups, and explained I was really sick," Conklin said. "Having Autumn there was really good because she was able to put in little bits of stuff that made the girls understand a little more." Conklin didn't go into all the details of what it's like to be a 27-year-old single mother of two young children diagnosed with breast cancer. She couldn't completely convey the agony of a double mastectomy and the failure of reconstructive surgery that left her flat chested. Girls 5 to 13 can't grasp the magnitude of carrying the hereditary BRCA gene that attacks the female organs and led Conklin to also suffer cancer of the ovaries, cervix, uterus and liver. What she did teach her young scouts, though, is that while the median age of diagnosis for breast cancer was 61 years and only 1.9 percent of those diagnosed from 2001-05 were aged 20-34, according to the National Cancer Institute, it can happen to any woman. Conklin's own doctors didn't think it possible. When she felt a lump in her breast in 2003, her doctor dismissed it because of her age. Her gynecologist sent her for a mammogram, which technicians declined to conduct on a 27-year-old. A sonogram revealed more than a simple lump, and the mammogram was finally performed. "It was a pain trying to get them to actually take it serious," Conklin said. "The type of cancer I had was so aggressive that it would have killed me if I'd left it alone." She began a two-year ordeal of surgeries and chemotherapy that has left her with lymphedema, the swelling of her arms and legs that resulted from the removal of lymph nodes, nerve damage in her feet and fibromyalgia, which is chronic pain in her joints. She sometimes walks with crutches or a cane. Other times she uses a wheelchair. The toll is more than physical. "I lost practically all my friends," Conklin said. "I wasn't able to go to bars, to drink, to lay out by the pool. It's horrible in so many aspects. It's not just cancer. It's the drugs and, after the meds, the chronic pain from the different drugs they've pumped into your system. There's the headaches and the scars. There's so much residual. Even four, five years later, it's still lingering." All of that is what makes participating in Relay for Life vital to Conklin. "It's a time where you're accepted," Conklin said. "You don't have to pretend to be whole. You're not. You don't have to pretend to be something society expects you to be. You're around people who understand you, have been through what you've been through or are going through." This is the third Relay for Life in which Conklin will be part of the Pipe Dreamers team. The event features a survivors breakfast sponsored by the South Stockton Lions; live entertainment throughout, beginning with Seija Anderson singing the national anthem; and food and carnival game booths along with informational centers. Teams of people take turns walking the course during the 24-hour relay. This year's theme is "Celebrate, Remember and Fight Back," to honor the survivors, remember those who have been lost to the disease and to fight back during the other 364 days of the year. As in the past, she'll make her way around the Weber Point course on the first lap with fellow cancer survivors. "When you look around, you're in awe," Conklin said. "Everyone is there for, essentially, you. It means so much. Once you step on the track for the first lap with all the survivors and you're looking around, you're not alone. We have a strong community." The "community" has grown over the course of the relay, which is in its 11th year in Stockton. There are 63 teams, up from 47 last year, volunteer chairwoman Randie Chunn said. It's something Conklin anxiously awaits each year, and something she wanted to share with her Girl Scouts. "I guess it's selfish on my part," she said. "I wanted my girls to get involved in the relay because it means so much to me, and the girls mean so much to me. I wanted to combine the two. I really truly believe they're going to get a lot out of it in the long run." Contact Lori Gilbert at (209) 546-8284 ------------------------------------------------------------------------------ Cancer survivor's healing garden is ideal place to many By Dan Scanlan, My Mandarin Sun It's tucked a wning and decorated with flowers, plaques and big pink ribbons. Called a Healing Garden, it will be a private oasis of peace for breast cancer survivors shielded by a white fence and owned by a survivor herself. And at 2 p.m. Sunday, National Cancer Survivors Day, this quiet corner of flowers and wicker chairs was blessed by the Rev. Anthony Bonela, parochial vicar at St. Joseph's Catholic Church. The private garden is the brainchild of Cheryl Feeney, a cancer survivor herself over the past five years who also operates an online business that helps cancer survivors, plus has items on sale at local drug stores and gift shops. The idea was to give a breast cancer survivor some place closer to home to meet in support groups, most of which meet in the downtown area, she said. "There really isn't anything in Mandarin, so it is nice to have a respite, a quiet place where it is safe. This took a while to do, but I had a backyard with a lot of water and some floods, so it took a lot longer," she said. "It feels really great. It is something I thought about and was always on my mind, taking something from the beginning and giving birth to it." Bobbi de Cordova-Hanks, a three-time cancer survivor, breast cancer support group facilitator at the Women's Center of Jacksonville and founder of its Bosom Buddies program, said the new garden could become a very peaceful place for the people she works with daily. Survivors "have no place as beautiful." "That is wonderful to open her heart and her home to people on their cancer journey," she said. "Any place that can be serene and peaceful and a non-threatening environment can be a real plus for healing. Most of the time you are in a very sterile environment, seeing doctors in hospitals. Even support groups like ours meet in places of convenience that are not healing spaces." Feeney was diagnosed with breast cancer in 2000, when she was a tax accountant in Rhode Island. She underwent chemotherapy and radiation treatment. After therapy, she learned she could develop lymphedema, a painful swelling that typically affects the arms. It forced her to retire because carrying heavy audit cases could aggravate the condition. That's when she decided the plastic medical bracelet she got at the hospital wasn't too nice looking. She developed a collection of jewelry-designed medical bracelets, evolving into a collection of charms, brooch pins, lockets, pendants and gifts, designed to support individuals touched by breast cancer and other medical conditions. The idea for a garden-like gathering area arose when she moved to Jacksonville in late 2005. She continued selling her items online as well as at local boutiques and drug stores, with all after-tax profits going to the Healing Ribbons Fund at the Rhode Island Foundation. The philanthropic organization allows her to direct where she wants the money used in support of the fight against breast cancer and related diseases. But she also remembered how she wanted a quiet place to talk to someone when she learned of her diagnosis. "That is why I feel the way I do. When you hear that word [cancer] you wish you could call everyone. That is why my online group has been so good. But it is virtual," she said. "People are scared. They want to talk. Sometimes they don't want to be seen. But there are others who want to reach out and touch." The Healing Garden starts outside her townhome's white wooden fence, with a rock pathway leading to a garden arbor painted on the gate itself. Feeney asked local artists Sonya Cox, Louise Cruz and Leneke' to do the art work. Inside is a rocky path lined with flowering plants and pink paving stones, some with pink ribbons inlaid in them. The landscaping was done by Kathy Esfahan. Then around the corner lies a private corner with wicker chairs, surrounded by palm trees and flowers with a plaque that reads "If you dream, dream big ... it might come true." Feeney paid for all of it in stages. The final step was to have the gardens blessed, the artists and others who helped bring the garden alive joining her there Sunday, followed by a luncheon to celebrate it and National Cancer Survivors Day. As for use of the garden, Feeney said she will work with groups like Bosom Buddies and area hospitals to set up support group meetings. For more information on breast cancer survivor Cheryl Feeney's Healing Garden, call 288-6927. ---------------------------------------------------------------------- Another fight follows cancer Compression sleeves help lymphedema patients. By T.J. GREANEY of the Tribune’s staff Published Saturday, June 7, 2008 On Thursday, Joyce Wall proudly raised her swollen left arm and pointed to a bump. "See an elbow there? I feel a bump," she said with a smile. "We knew it was in there somewhere," said Vickie Parker, Wall’s occupational therapist. Though the ritual seems strange to an outsider, it’s business as usual for people in the Lymphedema Therapy Program on the second floor of Ellis Fischel Cancer Center. Wall, a resident of the Miller County town of Brumley, was driven this week by her husband to the cancer center because - after twice defeating breast cancer - lymphedema recently reappeared in her body, causing her arm to swell. A side effect of cancer treatment, lymphedema occurs in patients who have had lymph nodes removed in surgery or damaged by radiation therapy. The altered lymphatic system tends to retain fluid in certain spots, causing swelling. The condition can be particularly dangerous because the fluid is rich in a protein that feeds bacteria. An infection of the area - known as cellulitis - can travel through the bloodstream and can be fatal. So, for Wall, even the slightest decrease in swelling is cause for celebration. "Right now, after a couple of days of therapy, it is movable," Wall said, reaching to scratch her back with the arm that is twice its normal size. "Before I came in, it was so swollen, so big, so big, so big, that to reach here and scratch would have been impossible," she said. The Lymphedema Therapy Program also has reason to cheer. They recently received a $4,500 grant from not-for-profit Susan G. Komen For The Cure to help pay for supplies necessary to treat lymphedema. The grant fills a gap in coverage left by many insurers. Karen Wingert, a physical therapist at Ellis Fischel who also is an associate professor at the University of Missouri School of Health Professions, said the money is badly needed to pay for supplies for what is a lifelong condition. "What we tell people is that we can control it but we can’t cure it," Wingert said. "And that’s devastating to women who thought they just fought the battle of their life with cancer and won. It’s a constant reminder." Lymphedema is treated first with daily massage therapy and bandages wrapped tightly around the affected area. After several weeks of therapy, the swelling should decrease, but the patient must contain it by wearing a special elastic sleeve. The sleeves cost $200 to $500 each and must be replaced at least every six months for the rest of the patient’s life. Many insurers - including Medicaid and Medicare - won’t pay for the sleeves, and many patients can’t afford them. In past years, local advocates resorted to holding garage sales to pay for the sleeves. Still, some women went without a regular change of therapeutic sleeves. "Getting a grant is way better than having a garage sale," said Wingert. The stakes are high. Women like Wall who can’t afford the sleeves are in danger of having lymphedema return when the elastic on the medical sleeve wears out. "You have to go through very, very red tape in order to get any help paying for that stuff," said Wall, whose lymphedema came back after she went three years without replacing her sleeve. Advocates are happy about the grant but say it only covers a fraction of the need. They wish a lack of federal funding didn’t make it necessary. "There is a problem there," said Julie Peterson, a research nurse and facilitator for a local support group, the Mid-Missouri Lymphedema Network. Leading Surgeons at St. Mary's Medical Center Set New Standards for Surgical Procedures with Novadaq SPY(R) System SAN FRANCISCO - (Business Wire) St. Mary’s Medical Center (SMMC) is one of the first hospitals on the West Coast to routinely use the SPY® Intra-operative Imaging System (SPY or SPY System) in cardiothoracic procedures and plastic reconstructive surgeries. The SPY System is the only FDA- approved, intra-operative imaging system that provides real-time fluorescent images while the patient is in the operating room. SPY images enable surgeons to optimize surgeries, eliminate guesswork and potentially avoid post-operative complications including repeat surgical operations. The SPY System enables cardiac surgeons at St. Mary’s to simply and efficiently confirm proper placement of bypass grafts and visually assess their effectiveness during coronary artery bypass graft procedures. Similarly, physicians at SMMC’s Plastic Reconstructive Orthopedic Surgery Center performing reconstructive procedures use the SPY System to see the blood flow in co-joined vessels, micro-vasculature and related tissue perfusion in real-time. “We’re committed to adopting technology that allows us to provide the highest quality of cardiac care possible to our patients at St. Mary’s,” said Dr. Eddie Tang, cardiac surgeon at SMMC. “The SPY System enables us to immediately visually assess the blood flow in our bypass grafts, confirm that we have performed the best possible bypass procedure, and potentially improve immediate and long-term outcomes for the patient.” The SPY System combines the use of an infrared laser, high-speed imaging and a fluorescent imaging agent. The imaging agent, which is administered to patients intravenously during the procedure, emits light when stimulated by the infrared laser. During surgery, the imaging agent lights up in blood flowing through the circulatory system while the camera captures the live images. If the images indicate that a graft might not be functioning optimally, the surgeon can immediately make revisions in the operating room. Traditionally, surgeons have been forced to make an educated guess about whether bypass grafts, co- joined arteries or veins are functioning properly. Cardiac surgeons have only been able to get images of the heart and vessels after the patient’s chest is closed and the patient has been removed from the operating room. Likewise, surgeons performing plastic reconstructive procedures have not been able to easily perform real-time imaging in the operating room. Use of the SPY System may reduce the number of patients that must return to the operating room for the revision of improperly functioning or potentially misplaced grafts. According to Dr. Charles Lee, director of microsurgery at St. Mary’s Medical Center, “The SPY technology allows plastic surgeons to determine the blood supply to tissues we transplant to reconstruct the human body. Specifically, in breast reconstruction and lymphedema surgery, we use specific tissue types from the abdomen, buttocks or thighs, and with the SPY we can determine which parts of these tissues are best to use.” SMMC now joins other prestigious institutions utilizing the SPY System, including the Cleveland Clinic Foundation, Stanford University Medical Center and the Arizona Heart Institute. About St. Mary’s Medical Center Founded 150 years ago, St. Mary’s Medical Center is one of the first hospitals in San Francisco. It’s the home of several medical firsts including the nation’s first digital cardiac catheterization laboratory, the first balloon angioplasty for coronary artery disease and the first total hip replacement surgery. St. Mary's continues to adopt the latest advances in medical technology and practices with specialized centers for plastic reconstructive orthopedic surgery, and innovative cardiovascular, bariatric, oncologic and acute rehabilitation services. With more than 575 physicians and 1,100 employees, St. Mary's full-service acute care facility is committed to its mission to deliver compassionate, high quality, affordable health services to the communities it serves. St. Mary’s pioneering spirit endures and it is well poised to continue its tradition of providing health and healing for the San Francisco community. For more information, please call (415) 668-1000 Mortar Jamie Fishler, 415-772-9907 ext. 117 (Media) ------------------------------------------------------------------------------ SAN DIEGO, June 12 CA-BioimpendanceGuide SAN DIEGO, June 12 /PRNewswire/ -- Recent guidelines published by the Clinical Resource Efficiency Support Team (CREST) provide further support for the use of bioimpedance technology for the early assessment of lymphedema. The published guidelines for Northern Ireland titled "Guidelines for the Diagnosis, Assessment and Management of Lymphoedema" are the result of an expert panel including patients and healthcare professionals that reviewed the evidence for diagnosing, assessing and treating lymphedema. The guidelines support the need for a shift in treatment focus from a reactive approach to one focused on the early assessment and early intervention of the condition. Bioimpedance technology featuring high sensitivity and specificity support this approach. This surveillance method of diagnosis and treatment reflects recommendations recently published online in the journal Cancer, the official journal of the American Cancer Society. To view the published guidelines online, please visit http://www.crestni.org.uk/crest_guidelines_on_the_diagnosis__assessment_and_ma nagement_of_lymphoedema.pdf. (Due to the length of the link, please copy and paste into your browser.) About Lymphedema Lymphedema is a condition that can cause significant swelling of the upper and lower extremities due to the build-up of excess lymph fluid. This can occur when the lymphatic system, which is responsible for draining excess fluid from the body and is a key component of the immune system, is damaged or altered. In breast cancer patients, this can occur after surgery, such as removal or biopsy of the lymph nodes, and/or radiation therapy. It is estimated that 6 percent to 40 percent of patients with breast cancer develop lymphedema, and that it often occurs within the first two years after surgery. For some cancer survivors and others at risk, a low level lymphedema can occur 10 years to 15 years following the initial primary treatment and develop into a condition that has a serious impact on overall health and quality of life. For more information about lymphedema, visit http://www.nci.nih.gov/cancerinfo/pdq/supportivecare/lymphedema/patient/. About ImpediMed ImpediMed is the world leader in the development and distribution of medical devices employing Bioimpedence Spectroscopy (BIS) technologies for use in non-invasive screening and monitoring of human disorders and diseases. ImpediMed's primary product range consists of a number of medical devices that enable surgeons, oncologists and radiation oncologists to detect early onset secondary lymphedema in breast cancer survivors, before the onset of symptoms that are detectable using the most commonly used clinical technique, and before the condition becomes a matter of lifelong management and impairs the quality of life of the cancer survivor. ImpediMed has the only medical BIS device with FDA clearance in the United States for the clinical assessment by health care providers of secondary lymphedema of the arm. Contacts: Wendy Lau or David Schull Russo Partners LLC (212) 845-4272 SOURCE ImpediMed -------------------------------------------------------------------------------------- Fight cancer risk with exercise Study: physical activity helps reduce risk of cancer recurrence By Lindy Washburn MCT Published on: 06/12/08 HACKENSACK, N.J. — The standard weapons in the fight against cancer — surgery, chemotherapy and radiation — may soon be joined by something far simpler: exercise. New research shows that regular physical activity helps reduce the risk of recurrence of breast cancer and slows the advance of prostate cancer. In a few years, exercise will probably be prescribed regularly for cancer rehabilitation, said Melinda Irwin, an expert on cancer and exercise at Yale University School of Medicine. Personal trainers may join oncologists, surgeons and radiologists as members of the cancer-treatment team. Exercise will become a "targeted therapy, similar to chemotherapy or hormonal therapy," Irwin said Any regular physical activity — the equivalent of a 30-minute walk, five times a week — will do. "Don't think you have to work up a sweat or train for a marathon to benefit," Irwin said. Exercise offers many other advantages: It fights the fatigue caused by cancer treatment, calms anxiety and helps survivors feel better about themselves and their bodies. Some personal trainers now specialize in working with cancer patients and more will soon be certified through a program of the American College of Sports Medicine. The Ridgewood YMCA offers a 12- week strength-training and fitness program for cancer patients and survivors. There are 10 million cancer survivors in the United States, 22 percent of them women who have had breast cancer, 17 percent of them men who've had prostate cancer. Exercise makes sense for most of them — to live longer, avoid other health problems, and just feel better Heart attack patients are now routinely put on exercise plans. But workouts for cancer patients are neither prescribed by doctors nor covered by health insurance. "We're where cardiac rehab was 20 years ago," Irwin said. Once exercise was shown through research to prevent fatal heart attacks, 12 weeks of rehabilitation became the standard of care for most heart patients. In fact, many hospitals opened cardiac rehab centers. One day, that will probably happen with cancer patients. In the meantime, as a cancer survivor, I can't see a downside to starting now. It needn't cost anything — walking is free and you can work out at home. The hardest part is getting started and making time. But what stronger motivation can there be than avoiding another go-round with cancer? Besides, I feel so much better when I exercise. Lately, during a high-anxiety round of follow-up tests, my early-morning swim and gym sessions have kept me grounded. Even when I'm bruised from biopsies, a walk always restores me — especially when I have the company of my husband or a friend. Even with a low level of exercise, people benefit psychologically, said Rita Musanti, an oncology nurse- practitioner at the Cancer Institute of New Jersey who earned her doctorate studying exercise and cancer recovery. With so many cancer survivors in the community, she'd like to see informal networks created to encourage recovering cancer patients. I certainly cherished the encouragement from swimmers or gym members I'd known only by face who quietly introduced themselves and revealed their own stories of cancer recovery. There are a lot of us out there. We draw inspiration from each other. 'Out of that slump' Beth Wajts of Hillsdale joined the Ridgewood YMCA's free "Living Healthy, Living Strong" class in January after her second surgery for breast cancer, followed by chemotherapy and radiation. "I cannot believe the way I walked in, and the way I walked out," she said. "I never believed I would get out of that slump," Wajts said. "Now I feel incredible." One of her classmates, Joyce Murray of Hawthorne, had three surgeries in an eight-week period last summer, then chemotherapy with many complications. No amount of sleep could cure her fatigue, she said. After she started the twice-weekly program of resistance training and cardiac fitness, "I was surprised at the quick rebound," she said. "I really feel better." Recovering from cancer was her "job for the last year," she said, but at the program's conclusion, she was looking forward to getting back to work as a school nurse. Angelo Chiusano, 81, joined after 43 radiation treatments for prostate cancer and surgery for an aortic aneurysm. Thanks to the camaraderie in the weight room, "I've gained a new family," the Oakland resident said. "It's made such a difference in my feelings." After doing the weight-resistance circuit in the gym each session, he swam. "Then, when I go home, I walk a mile," he said. He's continued his workouts even though the program has ended. Researchers are working to understand how physical activity helps fight cancer. Their findings so far suggest that exercise: • Reduces blood levels of insulin, a substance in the body that causes cells to divide and grow more quickly. Women with high levels of insulin have a slightly higher risk of breast cancer and a much higher rate of recurrence and death. • Helps repair infection-fighting T-cells, restoring the immune system after it has been damaged by chemotherapy. • Reduces levels of circulating estrogen and testosterone, two hormones linked with breast, endometrial and prostate cancers. Even with medication to suppress estrogen production, some estrogen is stored in fat cells. Exercise may help by converting fat to muscle. • Prevents weight gain and promotes weight loss, important because obesity is associated with lower rates of survival for many forms of cancer. For women with breast cancer, obesity at the time of diagnosis, and weight gain afterwards, are associated with worse outcomes. The heavier and less active a person is, the more likely her cancer will return. Most of the scientific work so far has focused on women with breast cancer, simply because there are so many of us. But studies have also shown exercise has positive effects for survivors of colorectal and prostate cancers. Among men older than 65, three hours of vigorous activity a week was associated with a decline in death from prostate cancer. Exercise is now considered so beneficial that cancer experts are even encouraging patients to begin or resume exercise while treatment is under way. Workouts might need to be scaled back in intensity and pace, but "evidence strongly suggests that exercise is not only safe and feasible during cancer treatment, but that it can also improve physical functioning and some aspects of quality of life," according to the American Cancer Society. Lockey Maissoneuve, a 41-year-old personal trainer, went through two mastectomies and chemotherapy two years ago. She is now is training for a triathlon. "If you're in treatment, the first week or two you try to do anything, you need to take a nap," she said. "If there's a day you want to exercise, do it." Wearing a wig was uncomfortably hot in the gym, so she switched to a kerchief. With her immunity reduced by chemo, she wiped down the equipment before she used it. She is now certified to work with cancer patients. "The trainer is almost like your bodyguard," said Julie Percy, of Parisi Sports Club in Midland Park, who also specializes in work with cancer patients. "We maneuver you to the right equipment, give you a sense of security." When scar tissue forms after surgery, it limits flexibility. Percy helps women who've had mastectomies and underarm incisions restore the range of motion. Trainers have to be particularly attentive when someone has had surgery to remove lymph nodes. If the tiny valves in the vessels that transport lymph around the body fail, that can lead to lymphedema, a dreaded side effect of cancer surgery. The arm, for breast patients, or the leg, for prostate patients, becomes permanently swollen. "We watch the amount of weights they use," Percy said. She starts light and increases gradually. Women who have lymphedema, or a heightened risk of it, wear a compression sleeve. Extra energy Rita Scoccola, 43, of Wyckoff resumed exercising a year after she had a double mastectomy in 2000. She works out weekly with Percy and is in the best shape of her life. "There's always an awareness" of the ways her body has changed as a result of the surgery and reconstruction, Scoccola said, but her workouts, combined with healthful eating, have given her lots of energy. The path back from a cancer diagnosis varies for each person: We start at different levels of fitness, and go through treatments of varying severity. Feeling comfortable in my own body again, after the invasion of a terrible disease and then the medical procedures, restored much of my sense of health. It also helped me feel I could help myself, at least a little. Becoming active again, said Maissoneuve, helped her "realize that cancer is not a jail sentence. It's a big bump in the road. But you can find your new normal, and have a great life." ---------------------------------------------------------------------------- Tactile Systems Technology Announces Medical Advisory Board MINNEAPOLIS--(BUSINESS WIRE)--Tactile Systems Technology, which develops, manufactures and markets products to treat vascular disorders such as lymphedema, announced the formation of its first Medical Advisory Board. Initial members are Stanley Rockson, M.D., Professor of Lymphatic Research and Medicine, Stanford University School of Medicine; Harvey Mayrovitz, Professor of Physiology, College of Medical Sciences, Nova Southeastern University; and chair Kathleen Francis, M. D., Medical Director, St. Barnabas Lymphedema Treatment Center. “This board represents a cross section of well respected authorities on lymphedema,” said Gerald R. Mattys, Chief Executive Officer, Tactile Systems Technology. “We believe they will be instrumental in guiding our company as we increase the size of our direct sales force, fund larger clinical trials and expand into new clinical indications, such as the treatment of chronic wounds. In essence, they will help us gain consensus on how our Flexitouch system fits into the standard of care treatment continuum for lymphedema and venous disorders.” In 2008, Tactile Systems Technology raised $11.8 million to pursue opportunities for its Flexitouch system, which delivers therapy that simulates manual lymphatic drainage (MLD) through garments covering an individual’s limb and trunk. Preparing the trunk for lymphatic drainage is a unique feature of the Flexitouch system, which follows the principles of MLD as provided by therapists in clinical settings. Topics of conversation at the first board meeting, held May 15, included payer coverage criteria and clinical research initiatives. The board decided to move forward with two new clinical studies – one comparing pumps on the market today and a second to measure changes in edema of the trunk during therapy. In 2004, Rockson led a clinical trial that showed the Flexitouch may provide better maintenance edema control than self-administered massage in breast cancer-associated lymphedema. In 2007, Mayrovitz led a clinical study that compared pressures delivered by a competitive sequential compression device with those delivered by the Flexitouch. Francis, a practicing lymphedema physician and member of the National Lymphedema Network’s medical board, has counseled Tactile Systems Technology since early 2005. Lymphedema is the abnormal accumulation of lymph fluid in body tissues, typically in the dermis of the arms or legs due to blockage or inadequacy of lymph circulation. It is often the unintended consequence of cancer treatment. Approximately 25 percent of breast cancer survivors develop lymphedema within two years of treatment. In 2007, Tactile Systems Technology was named “Corporation of the Year” by the Lymphatic Research Foundation. For copies of the clinical studies, contact Mary Rausch at mrausch@tactilesystems.com. --------------------------------------------------------------------------------------------- J Am Acad Dermatol. 2008 Aug;59(2):324-31. May 29. Lower extremity lymphedema update: pathophysiology, diagnosis, and treatment guidelines. Kerchner K, Fleischer A, Yosipovitch G. Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. Lower extremity lymphedema is an important medical issue which causes morbidity and is frequently seen by dermatologists. The subject has not been adequately addressed in dermatologic literature for many years. Primary lymphedema is caused by an inherent malfunction of the lymph-carrying channel, in which no direct outside cause can be found. Secondary lymphedema is caused by an outside force, such as tumors, scar tissue after radiation, or removal of lymph nodes, which results in dysfunction of the lymph-carrying channels. Treatment is based on rerouting the lymph fluid through remaining functional lymph vessels. This is accomplished through elevation, exercises, compression garments/devices, manual lymph drainage, and treatment is combined with good skin care practices. --------------------------------------------------------------------------------- 6/12/2008 Two-time breast cancer survivor among Senior Championships participantsBy Lucas Wiseman and Wendy Clem USBC Communications Linda McAndrews can't wait to get to the 2008 United States Bowling Congress Senior Championships next week in Reno, Nev., and try out her new 14-pound fingertip ball. The Farmington, N.M., bowler has no intention of backing down from the challenge of a heavier ball, even if it means changing her entire delivery. It's the same attitude she used to beat breast cancer not once but twice. "After my surgeries in 1992 and 1998, I told the doctors I was not going to quit bowling so don't even think about it," said McAndrews, a 60-year-old retired business teacher. "I also said that if I couldn't use my right arm anymore, I would switch to my left and start all over again, if that's what it took." McAndrews will put her new ball to the test as one of more than 400 senior bowlers from across the country who will compete at the National Bowling Stadium in the USBC Senior Championships starting Tuesday. Now carrying a 164 average, McAndrews hopes to regain her pre-cancer average of 173 and received some tips at a recent clinic. The coaches convinced her to move up from a 13-pound ball to 14 pounds. Her switch in 1999 to a fingertip already gave her renewed strength and control following a bout with Lymphedema, a painful after-effect of cancer and radiation therapy. "Not only has the drive to get well made me stronger and a better person overall, it has also made me an improved and more determined bowler," she said. "I've developed such stamina that I've rolled as many as 21 games in a row." McAndrews, who bowls with other cancer survivors as well as several former students in her league, said the geographic area around Farmington, N.M., is fraught with cancer stories, primarily due to the uranium mining industry there. The prevalence of the disease led to the establishment of San Juan Regional Medical Cancer Center, a teaching hospital. It's also home to an active chapter of the American Cancer Society, where McAndrews spends time as a volunteer. Before her 1995 retirement, McAndrews even incorporated her cancer progress and medical stories into classroom lessons. Students had curiosity and concern, both of which fueled her determination, she said. "The American Cancer Society's Reach to Recovery program provides important help for cancer patients," McAndrews said. "Bowl for the Cure is another way to raise awareness, and so is moving forward with my life with energy and hope." The USBC Senior Championships will feature a Women's and Open division, with bowlers competing in five age classifications (Super Seniors: 75 and older, Class A: 70-74, Class B: 65-69, Class C: 60-64 and Class D: 55-59). In order to qualify for this national event, competitors must have won their state association's senior handicap all-events title. The field is made up of bowlers from 49 states (only Rhode Island is not represented) and Canada who will compete for their share of more than $40,000 in prize money. The history of the Senior Championships, which is presented by the Eldorado Hotel Casino, dates back to the early 1960s, and from 1982 until 2002, the event was held on the championships lanes at either the Open Championships or the USBC Women's Championships. In 2003, the Senior Championships found a permanent home in Reno and has been held at the Stadium each year since. __________________________________________________________________ Jun 16 2008 Tactile Systems Technology Completes Accreditation with ACHC MINNEAPOLIS - (Business Wire) Tactile Systems Technology (www.tactilesystems.com) has been awarded accreditation status by the Accreditation Commission for Health Care, Inc. (ACHC). Tactile Systems Technology provides a patented, innovative, at-home therapy through its Flexitouch® System to improve the health and quality of life for individuals with lymphedema. Lymphedema is a chronic, progressive medical condition affecting more than two million people in the United States. It is caused by a disruption to, or malformation of, the lymphatic system resulting in the accumulation of excessive amounts of fluid, most commonly in the arms, legs and torso. It is often an unintended consequence of cancer treatment. Accreditation is a voluntary activity in which health care organizations submit to peer review of their internal policies, processes and patient care delivery against national standards. By attaining accreditation, Tactile Systems Technology has demonstrated its commitment to maintaining a higher level of competency and is striving for excellence in its products, services and customer satisfaction. “This accreditation is a fitting acknowledgement of the life-changing therapy delivered by the Flexitouch system,” said Gerald R. Mattys, Chief Executive Officer, Tactile Systems Technology, “and it validates the hard work that has gone into the development of our products and services.” ACHC, a private, not- for-profit corporation which is certified to ISO 9001:2000 standards, was developed by home care and community-based providers to help companies improve business operations and quality of patient care. Referring to the value of accreditation, ACHC President Tom Cesar said, “The survey process leads an organization to examine its policies and practices continually to clarify its strengths and improve its weaknesses.” Tactile Systems Technology, Inc. was founded in 1995 to develop and market a medical device for the effective treatment of lymphedema and venous insufficiencies. It received U.S. Food and Drug Administration (FDA) marketing clearance for the device in 2002. The Flexitouch system has been proven effective in relieving the symptoms of lymphedema and has recently received marketing clearance from the FDA for the treatment of wounds. In 2007, Tactile Systems Technology was named “Corporation of the Year” by the Lymphatic Research Foundation. Tactile Systems Technology Mary Rausch, 952-224-4885 Director of Marketing __________________________________________________________________ 06/29/08 Names & Faces CROPSEY — Kristin Helmers of Cropsey completed the doctor of physical therapy (DPT) degree May 23 from Midwestern University, Downers Grove. Helmers is the daughter of Dennis and Cindy Helmers of Cropsey. She graduated from Prairie Central High School in Fairbury in 2001. She has accepted a position with Evergreen Hospital in Seattle, Wash., where she will specialize in acute care and lymphedema. _____________________________________________________________________ June 30, 2008 Longaberger Horizon of Hope to Raise Money for American Cancer Society Breast Cancer Initiatives Horizon of Hope Products Available at 20 Percent Off for Limited Time NEWARK, Ohio--(BUSINESS WIRE)--The Longaberger Company is kicking off its 2008 Horizon of Hope campaign with a special offer that will enable customers to buy Horizon of Hope products at a 20 percent discount while also supporting American Cancer Society breast cancer research and education initiatives. The campaign features a Horizon of Hope Basket and other products that Longaberger designs exclusively for the fundraising effort. Proceeds ($2 from each Horizon of Hope Basket, accessory set or set of travel mugs) go to the American Cancer Society. The campaign is from July 1 through August 31, with the discount on Horizon of Hope products available from July 1 through July 16. “It is our hope that we not only spur more awareness of this program that is bringing results in the fight against breast cancer, but that this promotional offer also acts as a catalyst to raise more money for the American Cancer Society,” said Julie Moorehead, Longaberger’s national executive director of sales. Longaberger products can be purchased through independent Home Consultants nationwide or at www. longaberger.com. Since Horizon of Hope’s inception in 1995, Longaberger, its Home Consultants and the American Cancer Society have raised approximately $13 million and reached an estimated 19 million women with potentially life-saving information. “Our company and our Home Consultants are passionate about Horizon of Hope because we’ve seen first-hand how we are together making a difference,” Moorehead said. “We’re proud to support the American Cancer Society.” Horizon of Hope supports American Cancer Society programs aimed at improving the quality of and access to mammography services, breast imaging quality standards, the quality of clinical breast examinations, and the quality of life for young survivors and women with breast cancer recurrence. It also supports research into lymphedema, a debilitating swelling of the arms that can be a side effect of breast cancer treatment. To learn more, visit www.HorizonOfHope.com. Founded in 1973, The Longaberger Company is America’ s premier maker of handcrafted baskets and offers a variety of home and lifestyle products, including pottery, wrought iron and fabric accessories. There are approximately 45,000 independent Home Consultants in all U.S. states who sell Longaberger products directly to customers. ------------------------------------------------------------------------ July 1, 2008 Managing upper extremity lymphedema Denise Goodwin The Union-Recorder Few ordeals are as frightening as breast cancer treatment. The words chemotherapy and radiation alone produce anxiety and fear. When treatment is over, survivors are just so happy to be cancer-free that they often don’t consider the after-effects of their treatment — one of which is upper extremity lymphedema. Symptoms of this condition include limb swelling, tenderness, heaviness, tightness and pain in the arms, chest wall and soft breast tissue. Left untreated, lymphedema can lead to serious infections. Removing lymph nodes is an important part of breast cancer treatments so doctors can determine whether the cancer has spread from its primary site. Without these nodes, however, lymphatic fluid often builds up in tissues, causing lymphedema. Three stages — ranging from mild to severe — characterize lymphedema: n Stage One (mild lymphedema). During this phase, tissue is still in a pitting stage. This means that when you press an area with your finger, it will indent and hold the indentation briefly. Usually when you wake in the morning, the area is normal. As the day progresses, however, slight swelling can occur. n Stage Two (moderate lymphedema). The tissue now has a spongy consistency and is nonpitting. This means that when pressed, it bounces back without any indentation. Fibrosis (formation of fibrous tissue) begins in this stage, marking the beginning of limb hardening and notable swelling. n Stage Three (severe lymphedema). In this stage, swelling is irreversible, and usually the affected area is very large. The tissue is hard (fibrotic) and unresponsive. Treatment Options No quick cures for the condition exist. But you can find relief from properly trained therapists who can move accumulated fluid out of affected areas. This process is called Complete Decongestive Therapy (CDT). CDT is based on a self-education concept that includes Manual Lymph Drainage. This is a form of massage consisting of rhythmic strokes that stimulate lymphatic vessels to contract and encourage lymph flow. CDT also includes compression bandaging; exercise, such as swimming, biking and walking; and skin care. If skin isn’t maintained, lesions can develop that allow bacteria to enter an already immune- compromised system. This can lead to additional lymph system destruction, hospitalization or further functional limitations. With CDT treatment, however, skin is maintained and swelling reduction usually occurs in four to 14 treatments over two to four weeks, depending on the severity of your symptoms. To help sustain swelling reduction in the arms, medical-grade compression garments are usually required. If you have chest wall or breast lymphedema, compression bras are also available, offering support that conventional and athletic bras don’t. With proper education and care, lymphedema can be avoided: 1. Don’t ignore any slight increase of swelling in your arm, hand, fingers or chest wall. 2. Never allow an injection or blood drawing in your affected arm(s). 3. Have your blood pressure checked regularly. 4. Keep the edemic or at-risk (arm)s spotlessly clean. Use lotion after bathing, and when drying, be gentle and thorough. 5. Avoid vigorous, repetitive movements, such as scrubbing, pushing and pulling. 6. Avoid heavy lifting. Never carry heavy handbags or bags with over-the-shoulder straps on your affected side. 7. Don’t wear tight jewelry or elastic bands around affected fingers or arm(s). 8. Avoid extreme temperature changes when bathing or washing dishes. Protect your arm from the sun at all times as well. 9. Avoid trauma, such as bruises, cuts or sunburns. 10. When air traveling, wear a well-fitted compression sleeve. 11. Maintain your ideal weight through a low sodium, high-fiber diet, and avoid smoking and alcohol. With proper education, you can recognize lymphdema’s signs and seek treatment early to avoid the condition’s irreversible effects. Adapted from Advance for Physical Therapists _________________________________________________________________ July 30, 2008 Since then, studies have shown that exercise combined with diet can help prevent cancer recurrence, in addition to providing other benefits such as improved spirits and better overall health. Dragon boating has the added advantage of allowing members to vary the intensity of their workouts. “I come home from this and I feel great,” said Nichole Melone, 41. “Even with all the working out I do, this uses a different muscle.” Huifeng Reports Progress on Diosmin Contract Huifeng Bio-Pharmaceutical Technology (OTCBB: HFGB) announced it is on track to gain COS (European Certificate of Suitability) approval in September to provide Diosmin to Safic-Alcan, a French chemical company. Diosmin is a semisynthetic phlebotropic drug, a member of the flavonoid family that can be isolated from various plant sources or derived from the flavonoid hesperidin. It is used as a supplement to treat chronic venous insufficiency, hemorrhoids, lymphedema, and varicose veins. In November 2007, Huifeng signed an agreement with Safic-Alcan under which it will supply at least 50 tons of Diosmin to Safic-Alcan, an amount that increases yearly to 500 tons in the last year of the five- year contract. The COS is required before Huifeng can begin delivering product. Huifeng expects to begin delivery Diosmin in the fall, and it has begun building up its inventory of the product in anticipation of those deliveries. http://www.istockanalyst.com/article/viewarticle+articleid_2455295~title_Huifeng-Reports-Progress.html _______________________________________________________________________________ _ July 26, 2008 Dragon boat crew's special Cancer survivors come together for workouts By Julie Brossy UNION-TRIBUNE MISSION BAY – In their battles with cancer, they've been through surgeries, radiation, chemotherapy and more. Some are still under treatment, and they live with the possibility that the disease could recur. But you would never guess that from the energy and enthusiasm that the women of Team Survivor bring to their weekly dragon boat workout on Mission Bay. At the command of “paddle, set, go,” crew members plunged paddles into the bay on a recent Sunday. As they pulled back, the heavy dragon boat leapt forward and sliced through the flat, gray water. “More than anything, it's about the camaraderie,” said Penny Navarro of La Mesa. “This puts you with people who have been in the same place you have been, and it's easy to work together when you have that commonality.” Navarro, 53, was one of 17 team members who gathered to paddle the traditional Chinese boat at the Youth Aquatic Center on Fiesta Island. Cancer-free after treatment for an early- stage breast cancer in 2001, she learned of the dragon boat team through a woman in her quilting class, and has been to four practices. “It's a 10-mile drive, but at this point in my life, I'm looking to make that connection,” said Navarro, an executive assistant in the University of San Diego's continuing education program. The dragon boat crew, which began forming in April, is one of scores of cancer survivor boat teams in the United States, Canada and several other countries. While most teams are composed of breast cancer survivors, some, such as San Diego's, also include people who have had other types of cancer. The San Diego team is hoping to recruit new members. The dragon boat movement for cancer survivors came about after a Canadian doctor, Donald McKenzie, formed a breast cancer team in 1996 on the theory that paddling would help women strengthen their upper bodies, improve their range of motion and stimulate the immune system, among other benefits. At the time, it was common for doctors to order restrictions on breast cancer patients' activity in the belief that exercise might bring on lymphedema, a type of swelling that can be a side effect of radiation and lymph node removal in breast cancer treatments. No new cases of lymphedema occurred among those first team members. Since then, studies have shown that exercise combined with diet can help prevent cancer recurrence, in addition to providing other benefits such as improved spirits and better overall health. Dragon boating has the added advantage of allowing members to vary the intensity of their workouts. “I come home from this and I feel great,” said Nichole Melone, 41. “Even with all the working out I do, this uses a different muscle.” DETAILS Dragon Boats What: Team Survivor dragon boat crew. Who is eligible: Women with a history of cancer. A medical release and consent form are required. All levels of fitness are welcome. Where: Youth Aquatic Center, Fiesta Island, Mission Bay. When: Practices are held most Sundays from 8:30 to 10 a.m. Contact: Cheance Adair, adair@sandiego.edu, or Angie Bagnas, (858) 578-5731. _____________________________________________________________ July 2, 2008 Rockstock lineup still growing Still more bands are being added to the Aug. 16 Rockstock lineup. Organizer Lachlan Kennedy announced Monday that Flatlined, Finding Core, Kid Gib, Square Root of Margaret, Bury the Bully and Mean Tangerine are now on the bill. Finger Eleven, Sloan, the Trews and Thornley are already booked for the show, to be held at the Chatham-Kent Municipal Airport. For more details and ticket information, visit www.rockstockconcert.com. New address for Cultural Coalition The Chatham-Kent Cultural Coalition has moved to the United Way Community Resource Centre on McNaughton Avenue. The cultural integration organization assists community partners in the attraction and retention of newcomer business owners, provides support to immigrant entrepreneurs and assists with the integration of all cultural and newcomer groups in Chatham- Kent. The United Way office is home to several community groups and the resource centre provides meeting rooms for not-for- profit organizations. For further information on the relocation of the Chatham-Kent Cultural Coalition, contact Teresa Fysh or Karen Kirkwood-Whyte of the United Way at 519-354-0430. The United Way office is located at 425 McNaughton Ave. in Chatham.Fundraiser goes beyond its goal A fundraiser for a local infant has exceeded all expectations. "A Night of Music & Dance for Peyton" raised $12,000 for Shawn and Deb Meriano and their daughter. It was held last Thursday at the Ursuline College Chatham theatre. Deb was diagnosed with cancer during pregnancy. Peyton was born 13-weeks premature and spent four months in the neonatal intensive care unit in London, while her mom underwent chemotherapy and radiation treatments. In a release, organizer Charlene Roy said she was hoping for $5,000. She praised the performers and volunteers for making the night a success. Lymphedema session coming An information session about lymphedema will be held at Myles' Miracle Mission CANcer Assist Wellness Centre on Saturday. Lymphedema is abnormal swelling that can occur as a result of mastectomies and lumpectomies. Registered massage therapist and certified manual lymph drainage therapist, Freda Yako-Malott, will be facilitating the session. The program, which is free for cancer patients and their families, will be held from 10 a. m. to noon at the centre on Victoria Avenue. To reserve a space, call 519-351- 4811. No fish licence for weekend events Residents can fish licence-free in provincial waters during the Ontario Family Fishing Weekend. From this Friday until Sunday, there will also be more than 50 fishing events, derbies and festivals across the province. During family fishing weekend, anglers fishing without a licence must follow the conservation licence limits set out in the Ontario Recreational Fishing Regulations Summary. Information on these limits will also be available onsite at most local events. For more information, visit www.familyfishingweekend.comor call the Natural Resources Information Centre at 1-800-667-1940. Voyeurism suspect to return to court A 48-year-old man accused of voyeurism is scheduled to return to court on Aug. 7. Defence lawyer Greg Elliott appeared on behalf of Charles David Huls, of Charing Cross Road. A pre-trial for Huls was held on Monday at Chatham court and Elliott requested an adjournment to the August date for a continuation of the pre-trial. Huls is facing three charges of voyeurism in connection with a June 1, 2007 incident. Police describe voyeurism as a person secretly filming someone in a place where there's an expectation of privacy. According to previously published reports, the Chatham-Kent Police Service investigated a man after receiving a complaint at the end of January. Police said the man's home was raided and evidence was seized. The charges stem from alleged incidents last summer at the man's home, police said. ___________________________________________________________________ July 26, 2008 Sick wait to join queue at Victoria's public hospitalsGrant McArthur Herald Sun MORE than 33,000 sick Victorians are waiting just to get on an official waiting list for treatment at public hospitals, the Opposition claims. They are in addition to almost 40,000 people already waiting for elective surgery on the State Government's official waiting lists. Documents obtained by the Opposition under Freedom of Information, and seen by the Herald Sun, show that in December last year 33,869 Victorians were waiting for an outpatient appointment. People must be assessed in hospital outpatient clinics before they can be put on a waiting list for surgery - meaning those who are yet to be assessed do not show up on the official elective-surgery waiting lists. Liberal health spokeswoman Helen Shardey said public hospitals were being forced to manipulate waiting lists to avoid being penalised by the Government. "There are literally tens of thousands of patients languishing on the Government's secret outpatient waiting lists and thousands more who don't have appointments who are waiting to get on to these lists to see a doctor," she said. "We are now in the unconscionable position of having people waiting to get on to these lists in order to join the queue for elective surgery. "In many cases these people are waiting years." The documents show that the "secret waiting list" grew by 8722 patients in just three months leading up to December 2007. The Royal Children's Hospital did not provide information, saying the data was not available. Forty-four per cent of those waiting for outpatient appointments are from regional Victoria, with 14,855 people waiting at Ballarat, Barwon, Bendigo and Goulburn Valley Health. One Barwon patient waited four years for an outpatient review appointment to see a specialist about their lymphedema, while two patients had already waited 194 days for oncology appointments at Ballarat Base Hospital. ____________________________________________________________________ July 25, 2008 Paddling team best therapy for breast cancer survivors Dustin Munroe, The StarPhoenix The Busting With Energy (BWE) team is used to moving in unison, both in spirit and in paddle strokes. As the pounding of a dragon boat drum provides the heartbeat for the crew, the BWE team provides a stable rhythm of hope for Saskatoon's breast cancer survivors. The team trains together, competes together and moves forward in the face of adversity. "Our aim as a team is to promote positive energy and let other breast cancer survivors know that there is life after being diagnosed with cancer," said BWE spokesperson Julie Gyoba. "We are living proof of it." The group is splitting up this weekend, for the first time in its 10 years of existence. Half of the team will travel to Dartmouth, N.S., to participate in the Bosom Buddies Atlantic Survivors Dragon Boat Festival. The other half will stay in Saskatoon for the FMG Dragon Boat Festival at Rotary Park. Dartmouth is the furthest BWE has travelled for a dragon boat race. Not everybody could make the long-distance trek. "We try to pick something different each year," said Gyoba. "We try to do one home one and an away one." Edmonton, Regina and Vancouver are a few of the cities the group has visited in past years. The "home team" has recruited friends and relatives to ensure they have a full boat for the FMG races taking place today and Saturday. The 18- person "away team" departed for Nova Scotia, via Regina, on Thursday for competition today through Sunday. The team starts a 12-week training program in February at Bourassa's Physiotherapy. They drop the boat into the water at the edge of Victoria Park for the first time in late May to begin their twice- weekly practice schedule. The complete 41-member BWE group encompasses the many faces of people dealing with breast cancer -- the terminally ill, those undergoing chemotherapy, others who are in physiotherapy to recover from mastectomies and 20-year survivors. They range from 30 to 71 years of age. Some members of the group have fallen, but none have been forgotten. "Since the inception of the team, we have unfortunately lost nine teammates," said Gyoba. "Each meet that we are in, we dedicate it to the memory of the lost teammates." Breast cancer survivors began dragon boating as organized groups in 1996 in Vancouver. Sports medicine physician Dr. Don McKenzie of the University of British Columbia formed the Abreast In A Boat team to test the theory that repetitive upper-body exercise in women treated for breast cancer encouraged lymphedema, a lymphatic system condition. "Initially, after a woman had a mastectomy for breast cancer, they were told not to do any upper-body exercise," said Gyoba. "His research proved the exact opposite, that exercise is the best thing that you can do." No new cases of lymphedema emerged among the participants and none of the existing cases worsened. BWE competed in a race two years ago that marked the 10th anniversary of McKenzie's study in Vancouver. "It was international, with 54 teams from all over the world," said Gyoba. "Dragon boating for breast cancer started in Vancouver and spread worldwide." BWE has expanded in numbers and added fundraising activities to its schedule since its inception, but remains committed to one ideal. "Just to be in the boat, we are all winners," said Gyoba.dsmunroe@sp. canwest.com __________________________________________________________________ July 13, 2008 Women with cancer find help at local store Owner, survivor quit job to follow dream BY DEBBIE KELLEY THE GAZETTE Bobbi Van Riper went on a scavenger hunt after a bout with breast cancer in 1996. She tried to locate a nice wig to cover her balding scalp, compression garments to reduce swelling in her left arm, a swimsuit that fit her post-lumpectomy figure and a remedy for her varicose veins. She eventually found what she wanted, but, as with a scavenger hunt, she had to go from place to place to get everything on her list. Nowhere could she find a convenient, one-stop-shop for her breast cancer needs. So she started one herself: In Care of You. Five years later, about 5,000 survivors of various types of cancer have turned to her Colorado Springs medical boutique to feel better about themselves in a time of hurt, confusion and fear. The shop offers products and services that cater to the particulars of cancer treatment, such as swelling from lymphedema, burns from radiation, hair loss from chemotherapy and disfigurement from breast removal or reconstruction. Need a breast prosthesis, mastectomy bra or swimsuit? The shop has it. How about a synthetic or natural wig, compression garments and pumps or skin-care products to help soothe radiation burns and dryness? You can find those, too. Van Riper even has a makeup specialist on site who does nipple and areola restoration on reconstructed breasts. Although the shop is geared toward women with cancer, any woman in need of a wig, scarves, hats, bras or permanent eyeliner, eyebrows or lip coloring is welcomed. Business has been steady enough for the 12-year breast cancer survivor to purchase an office condo. A few weeks ago, she relocated from a rented, hard-to-find office on North Cascade Avenue to a new, airy space in the Pueblo Bank & Trust building at Pikes Peak and Wahsatch avenues. But Van Riper's business extends beyond sales. She tries to provide an oasis not just for the body, but for the mind as well. The boutique stresses confidentiality and a personal touch, complemented by three staff members who befriend customers, listen to their stories of courage and pain, and freely distribute hugs. They also know what they're doing - all are certified stocking, mastectomy-prosthetics and bra fitters. "Everyone here understands and cares. That's what I wanted - to make a difference in people's lives," Van Riper said. The wig that cancer survivor Lori Woshner purchased from Van Riper greatly improved her life. "The people at In Care of You help you feel as normal as possible, which is very important because it's a long illness," said Woshner, a mother of three. "You're already self-conscious because you've lost your hair. You're going through chemotherapy, so you don't feel so great. I got so many compliments on my new hairstyle - people thought it was my natural hair." Nancy Forgy, a 14-year breast cancer survivor, said she'd been looking for the right bra for more than a decade, after a botched reconstructive surgery. In Care of You ended her search and embarrassment. "Bobbi fitted me for a bra, and I can't tell you how nice it is," Forgy said. "I feel so good." That's exactly the response Van Riper was hoping for when she decided to take a risk and leave her high-paying job as an IBM sales executive to follow her heart and open the medical boutique in 2003. She marketed the concept to local doctors' offices and hospitals and got involved in health fairs. She became certified and registered as a fitter through an industry board and became qualified to accept health insurance from customers, including Medicare and Tricare. Word-of-mouth helped the shop blossom, and with more diagnoses of cancer - one in six Colorado women will fall victim to breast cancer, according to Susan G. Komen for the Cure - the demand is increasing for the shop's products and services. "We now see more mastectomy patients in a day than we used to see in a week," said Van Riper, who also chairs the Colorado Springs Race for the Cure, a fundraiser for breast cancer research, treatment and prevention. "If you can walk out of here and look good, you'll feel good. There is life after breast cancer. People come in here and realize that." CONTACT THE WRITER: 636-0235 __________________________________________________________________ 24 July 2008 Policy guidelines for wound care to be developed Joy Online Accra,Ghana The World Health Organisation, with the support of a specialist group from the US is developing clinical policy guidelines on modern wound care that makes treatment of wound care universal. In an interview with the GNA in Accra on Wednesday after a day’s workshop in Accra on best practices in wound care, Ms. Mary Geyer of the University of Chatham in the USA and a member of the group, said the World Health Organisation (WHO) regarded both modern wound care and lymphedema management as a global imperative and the new knowledge and that technique and material should be made available to developing countries as well. The team is in Ghana to exchange ideas with their Ghanaian counterparts and make room for their input into the formulation of the policy. She said there was the need to include the African practical approach in the policy, adding that, Ghana had a centre of excellence in wound care. Participants made up of plastic surgeons and nurses were taken through topics including Physical Therapy, Current Roles in Wound lymphedema Management, Approach to the Treatment of Diabetes Foot Ulcers and Venous Treatment of Diabetes Leg Ulcers and Modern Wound Care. The mission of the initiative includes education, advocacy and price negotiations with producers of modern dressings as well as identify national experts in wound care and institutions that can be involved in the development of modern wound care practices. Ms Geyer explained that modern wound care and related lymphedema management included leprosy, Buruli Ulcer and common tropical ulcers which had become a vital medical force. She added that the treatment of chronic wound care and lymphedema affected all medical specialties and all ages. More than one billion people in approximately 80 countries live at risk of contracting lymphatic Filariasis, more commonly known as elephantiasis, which is a devastating parasitic infection spread by mosquitoes. Currently over 120 million people are already infected, with more than 40 million incapacitated or disfigured by the disease. __________________________________________________________________ July 20, 2008 Keeping abreast By Dr HARJIT KAUR PERDAMEN What you need to know about breast cancer surgery. WHEN a woman detects a lump or any abnormality in her breast, her whole world often comes to a standstill. A million things run through her mind, especially the possible loss of her breasts. As a result, we often hear women seeking all forms of alternative treatments before finally seeing a breast surgeon. Unfortunately as a result of their unfounded fears and lack of awareness of the therapeutic options available, they usually end up with advanced disease. Breast cancer is still the number one cause of cancer death in Malaysian women, with about 30-35% of women having advanced disease. In an era where technology and skills are constantly advancing, it is truly a sad picture. The reason for this is multi- factorial, the most common being strong religious beliefs and taboos, the immense belief in faith healers, the lack of breast awareness and screening services as well as the lack of trained personnel to provide the necessary services. There are many therapeutic options available to women when they are detected with breast disease. About 80-85% of breast lumps are often benign or non-cancerous. In this group of women, treatment may be surgical or non-surgical. Surgery itself is often minimally invasive without significant cosmetic defect and can be done as a day case. In cases of malignant or cancerous breast lumps, the options are varied depending on many factors. Surgery may be breast-conserving or not. It is when mastectomy (the loss of the whole breast) is discussed as the best option to ensure a safe oncologic outcome that the woman often withdraws into her protective shell. Having to deal with the diagnosis of breast cancer and losing her breasts is often too much for many women to cope with. As a result, many default treatment. Conventional surgeries in breast cancer The most common surgeries carried out in the management of breast cancer are the breast conserving surgery (BCS) and the mastectomy (removal of the entire affected breast). These surgeries may be associated with axillary clearance (removal of the axillary lymph nodes). Although widely accepted as the standard surgical treatment, mastectomy and axillary clearance leaves a woman disfigured and at risk of lymphedema (swelling of the arm). When combined with radiotherapy, the skin changes over the already flattened chest add insult to injury. This in turn affects the women’s self-esteem and confidence. In some cases, women suffer from troubling backaches due to imbalance suffered as a result of the loss of one breast. Oncoplastic surgery as an option Oncoplastic breast surgery is a concept of combining surgery for the cancer together with reconstructive surgery at the same sitting or as a delayed procedure. This option must be made available to any woman who is diagnosed with breast disease that requires a mastectomy or significant tissue loss. Immediate reconstruction after a mastectomy can be done using implants, tissue flaps or a combination of both depending on the suitability of the patient and the oncological criteria. With this technique, a woman will be able to have a reconstructed breast at the same sitting as the mastectomy. This has a tremendous positive impact on a patient’s self-esteem and self-image and is becoming more acceptable in general. A technique called skin sparing mastectomy allows the patient’s skin to be preserved as much as possible. The entire breast tissue and in some instances even the axillary lymph nodes are removed via an incision around the nipple areolar complex. In this way the patient’s natural skin is preserved and reconstruction has a much better cosmetic outcome. In some women, there may be a possibility of preserving the nipple areolar complex as well. This however is case sensitive and strict criteria must be followed. Skin sparing mastectomy can also be combined with tissue flaps like the lattisimus dorsi (LD) flap (back muscle and tissue) and the TRAM flap (where abdominal tissue is used). The choice of reconstruction will very much depend on the best option and patients’ choice. Implant reconstruction with or without the combination of a LD Flap is a safe and short procedure with good outcome. Other tissue flap procedures may be more complicated and lengthy in surgical time and hospital stay. Patients must be given explanations and all the possible options with the risks and complications addressed in detail. The patient finally makes the choice of the procedure with some guidance and advice from her doctor. With the availability of oncoplastic breast surgery, patients have more options and this helps in decision-making about their treatment, thus preventing undue delays that may be detrimental to their prognosis. It is important to highlight here that the oncology aspect of surgery takes precedence over the cosmetics. Hence, it is important for a patient to seek treatment from a doctor who is trained in the field because at no time should the oncological aspect of the surgery be compromised. A multidisciplinary approach in the patient’s management offers the best outcome. Sentinel Node Biopsy (SNB) In all aspects of surgery, we are moving towards minimally invasive procedures. In breast surgery, this is the direction we are heading as well. Sentinel node biopsy is a minimally invasive technique of addressing the axillary lymph nodes and is practised all over the world, mainly in developed countries. SNB is most commonly associated with staging for breast cancer; however it can be used for malignant melanomas (skin cancer). Sentinel is a term derived from the French word sentinelle, which means “to guard over” or “vigilance”. The sentinel node therefore acts as the first filter of malignant cells in the lymphatic system. The technique of SNB is the identification of these sentinel lymph nodes (usually one to three nodes) with the assistance of radioisotopes and dye injections around the tumour. These sentinel nodes are then assessed intra-operatively with the help of frozen sections and is determined of its involvement of cancer cells. If the sentinel lymph nodes are clear of cancer cells, it avoids the patient having a full axillary clearance and all the morbidity associated with it. This procedure requires expertise and experience as well as a competent team in a multidisciplinary setting. It involves a trained breast surgeon, radiologist, pathologist and nuclear medicine facilities. Surgeons who are experienced in SNB can identify the involved node in 85-98% of the patients. The false negative rate is usually less than 5%. The risk of lymphedema (swelling of arm) is very much minimised with this technique. It can be done as a day case, compared to the traditional axillary clearance that involves a post-operative stay of at least three to four days. There is more to breast surgery than meets the eye. The surgical techniques have improved, providing much better outcomes to women affected with breast diseases. Awareness of the availability and options will hopefully get more women to seek treatment early. References: 1. National Cancer Registry 2003 2. Breastcancer.org 3. American Cancer Society Living with Cancer is a monthly column by the Malaysian Oncological Society (MOS) in collaboration with sanofi-aventis Malaysia. For any questions related to this article, please email cancer@malaysiaoncology.org by 27 July 2008. All questions will be answered, but only selected questions will be published the following month. For other enquiries, please visit the MOS website at www.malaysiaoncology.org. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. __________________________________________________________________ 21 July 2008 Electrothermal vessel sealing effective during mastectomy Source: Reuters Author: David Douglas An electrothermal bipolar vessel sealing system (LigaSure Precise, Valleylab) reduces operative time and appears to be effective in women undergoing modified radical mastectomy with axillary dissection, according to Greek researchers. "Even though modern day surgical management of breast cancer continues to focus appropriately on breast-conserving techniques," Dr. Haridimos Markogiannakis told Reuters Health, "modified radical mastectomy with axillary lymph node dissection remains the most frequently performed surgical procedure for locally advanced breast cancer." In the June issue of the Archives of Surgery, Dr. Markogiannakis and colleagues at the University of Athens note that the approach may engender a variety of complications, including those involving lymph vessel sealing and hemostasis. To see what advantages the electrothermal sealing system might have in this regard, the researchers prospectively studied 60 patients who underwent the same procedure performed by the same surgical team. Intraoperative blood loss ranged from 25 to 70 mL compared to 55 to 332 mL in historical controls. Corresponding ranges for operative time were 80 to 125 minutes and 117 to 210 minutes. For mean mastectomy drainage volume, the figures were five to 40 mL versus 213 to 320 mL. In addition, hospital stay was from three to six days, compared to 2.4 to 10.1 days in controls. There were no postoperative complications in the study group. "Our results," continued Dr. Markogiannakis, "showed that the technique is feasible, safe and effective. The main advantage of the device is that it simplifies the procedure while achieving efficient lymph vessel sealing and hemostasis. This technique seems to result in reduced perioperative blood loss, operative time, drainage volume and duration, and postoperative complications incidence such as seroma or lymphedema." "Further studies," he concluded, "are necessary to evaluate the results of utilization of the device and its impact on perioperative complications." Arch Surg 2008;143:575-580 _________________________________________________________________ July 23, 2008 Doctor awarded diploma honor Dr. Brenda Hallenbeck received a 25-year silver diploma from New York Medical College. Compiled by Azra Haqqie and Lindsey Hollenbaugh TimesUnion.com Hallenbeck graduated from New York Medical College in 1983. She underwent her residency training at Albany Medical Center. She is currently employed at Private Practice Obstetrics and Gynecology in Worcester, Mass. Grant for Slater The USS Slater has received a $350 grant from Stewart's Holiday Match. The money will be used for educational programming aboard the destroyer escort moored on the Hudson River in downtown Albany. Gilda's Club honored Gilda's Club Capital Region has received two national Gracie Awards from the Foundation of American Women in Radio and Television. The awards were presented to Gilda's Club Capital Region and Ann Marie Lizzi, board member, AWRT member and production manager at Time Warner Cable Media Sales, along with other national winners at a luncheon on May 29 at New York City's Tavern on the Green. Funds for cancer program A $6,900 grant from Susan G. Komen for the Cure, a nonprofit network of breast cancer activists, will benefit a St. Peter's Hospital program that helps manage a lymph condition common to breast cancer survivors. The funds have allowed three physical therapists from St. Peter's to attend continuing education programs in lymphedema management. The rest of the money will buy special tape and bandage for about 45 patients who are newly diagnosed with the condition. The sets, which typically cost about $65, allow patients to treat themselves at home. Lymphedema is a chronic condition characterized by swelling of the limbs. Breast cancer survivors whose lymph systems have been compromised by surgery, radiation treatment or lymph node dissection are especially prone to developing lymphedema. The Susan G. Komen Northeastern New York Affiliate serves 11 counties including Albany, Rensselaer, Schenectady and Saratoga. Child dental care funded A $5,000 grant to St. Peter's Hospital and its Ronald McDonald Care Mobile from the Rite Aid Foundation will provide dental care to inner-city children. The traveling dental clinic provides dental care to students at five public schools in Albany. The clinic has been providing care for students at North Albany Academy, Philip J. Schuyler Achievement Academy, Giffen Memorial School, Sheridan Preparatory Academy and Thomas S. O'Brien Academy of Science and Technology. The St. Peter's program also teaches children about brushing and overall oral hygiene. It also provides sports mouth guards; nutritional counseling and demonstrations on proper dental care through videos, interactive games, and reading materials. For more information, call 525-1757 or go to http://www.sphcs.org/dental. CQ Community gardens Capital District Community Gardens will receive $7,456 raised at the third annual Community Resource Father's Day 5K Run and Fun Run for Kids at the Crossings of Colonie. It was organized by Community Resource, in association with the Hudson Mohawk Road Runners Club. Participants were 274 adults and 80 children. The money will help families in need grow their own food in community gardens and access healthy produce on The Veggie Mobile. ___________________________________________ 21 Jul 2008 Bioimpedance Spectroscopy is More Accurate and Reliable Than Other Methods of Subclinical Assessment of Lymphedema in Breast Cancer Patients, According to Paper Published in Journal of Clinical Oncology Author : ImpediMed Bioimpedance spectroscopy (BIS) is more accurate and reliable than other methods of subclinical assessment of lymphedema in breast cancer patients, according to a paper published in the July 20 issue of Journal of Clinical Oncology (2008; Vol. 26, Issue 21: 3536- 3542). Titled "Lymphedema After Breast Cancer: Incidence, Risk Factors, and Effect on Upper Body Function," the paper, authored by Sandra Hayes, PhD., and colleagues from Queensland University of Technology in Australia, is based on a study that involved 265 breast cancer patients. Approximately 87 percent of the patients had undergone lymph node dissection, 70 percent had received radiation therapy and 40 percent had received chemotherapy and/or hormone treatment. The study's investigators conducted assessments of the patients for the evidence of lymphedema at three monthly intervals between six- and 18-months post-surgery using a BIS device, sum of arm circumference (SOAC) and patients' self- reporting. Using BIS, the investigators were able to detect 60 percent of the lymphedema cases that were missed when assessments were conducted with the SOAC method and 40 percent that were missed through self-reporting. For women treated on their non-dominant side, the SOAC method exhibited even lower sensitivity, with approximately eight out of every 10 patients with subclinical lymphedema going undetected. The self-reporting method showed low specificity, with a 40 percent false positive rate (40 percent of patients who did not have lymphedema were reported as having the condition). "Early intervention is critical to the management and treatment of lymphedema, and these latest findings further support the use of bioimpedance spectroscopy as a direct, accurate and reliable measure to aid doctors with the clinical assessment of the condition," said Greg Brown, CEO of ImpediMed, which has the only FDA cleared device for the clinical assessment by health care providers of secondary lymphedema of the arm in women. About Lymphedema Lymphedema is a condition that can cause significant swelling of the upper and lower extremities due to the build-up of excess lymph fluid. This can occur when the lymphatic system, which is responsible for draining excess fluid from the body and is a key component of the immune system, is damaged or altered. In breast cancer patients, this can occur after surgery, such as removal or biopsy of the lymph nodes, and/or radiation therapy. It is estimated that 6 percent to 40 percent of patients with breast cancer develop lymphedema, and that it often occurs within the first two years after surgery. For some cancer survivors and others at risk, a low level lymphedema can occur 10 years to 15 years following the initial primary treatment and develop into a condition that has a serious impact on overall health and quality of life. . About ImpediMed ImpediMed is the world leader in the development and distribution of medical devices employing Bioimpedance Spectroscopy (BIS) technologies for use in the non-invasive clinical assessment and monitoring of human disorders and diseases. ImpediMed's primary product range consists of a number of medical devices that enable surgeons, oncologists, therapists and radiation oncologists to clinically assess patients early for the potential onset of secondary lymphedema. Pre-operative clinical assessment in breast cancer survivors, before the onset of symptoms, may prevent the condition from becoming a lifelong management issue and thus improve the quality of life of the cancer survivor. ImpediMed has the only medical device with FDA clearance in the United States for the clinical assessment, by health care providers, of secondary lymphedema of the arm in women. For more information, visit http://www.impedimed.com. Note: ImpediMed's device is not intended to diagnose or predict lymphedema of an extremity. Contacts: Wendy Lau or David Schull Russo Partners LLC (212) 845-4272 __________________________________________________________________ July 2, 2008 Pre-Operative Assessment of Breast Cancer Patients by Physical Therapists Improves Lymphedema Diagnosis and Treatment ARTEmIS--The Online Magazine of The Breast Center At Johns Hopkins A recent study shows that pre-operative assessments of patients with breast cancer by physical therapists allow for early diagnosis and successful treatment of lymphedema. The study, conducted by the National Naval Medical Center (NNMC) and the National Institutes of Health (NIH) and in collaboration with the University of Michigan-Flint and George Mason University, was published in the journal Cancer. The authors demonstrated the effectiveness of a surveillance program that included pre- operative limb volume measurement and interval post-operative follow-up to successfully detect and treat lymphedema, a chronic and often irreversible condition that can cause significant swelling of the upper and lower extremities due to the build-up of excess lymph fluid. "This study is significant for several reasons, but none more so than it showing that detection and management of lymphedema at early stages may prevent the condition from progressing to a chronic, disabling stage and may enable a more cost-effective, conservative intervention," said American Physical Therapy Association (APTA) spokesperson and the study's lead author, Nicole L Stout Gergich, PT, MPT, CLT-LANA, of the National Naval Medical Center (NNMC) Breast Care Center, in Bethesda, Maryland. Breast cancer related lymphedema is associated with decreased arm function, disability and diminished quality of life. If the condition is not diagnosed early and managed, it can progress to a situation where the patient is at risk for infection and further shoulder complications. The swelling is disfiguring and many times prohibits patients from finding clothes that fit properly. Stout noted that the baseline pre-operative assessment of 196 patients with breast cancer participating in the study - which was conducted from 2001 to 2005 - included basic strength, range of motion, limb volume, and physical activity level. "To measure limb volume, we employed infra-red technology that scans the limbs using beams and sensors, providing us with very accurate information," she said. All study participants were monitored one month post-surgery and at three-month intervals thereafter for one year even if they exhibited no swelling. "Using both the pre- and post-operative assessments enabled us to diagnose lymphedema before it became visible, which is an unprecedented accomplishment," Stout noted. Once lymphedema was diagnosed in 43 of the patients participating in the study, the condition was managed using a conservative compression garment, atypical of lymphedema treatment, observed Stout. A light-grade compression sleeve and gauntlet, fitted by the physical therapist, were prescribed for daily wear. "Lymphedema is normally treated with more aggressive and often costly and time-consuming techniques, such as complete decongestive therapy, which requires the patient to attend daily therapy sessions for weeks and wear bulky compression bandages. This study clearly demonstrates that the condition can be managed with a more conservative treatment option when it is diagnosed at its earliest presentation, which will be good news to breast cancer patients," she added. "What we hope to garner from publicizing this study is that it will encourage patients with breast cancer to ask the questions that need to be asked regarding their treatment, as well as galvanize physicians, surgeons, oncologists and other physical therapists to make early intervention and conservative treatment of lymphedema the standard of care in breast cancer care," Stout concluded. ___________________________________________________________________ _____________________ July 16, 2008 Extension of Therapy Cap Exceptions The Medicare Improvements for Patients and Providers Act of 2008 was enacted on July 15, 2008. One provision of this legislation extends the effective date of the exceptions process to the therapy caps to December 31, 2009. Outpatient therapy service providers may now resume submitting claims with the KX modifier for therapy services that exceed the cap furnished on or after July 1, 2008. For physical therapy and speech language pathology services combined, the limit on incurred expenses is $1810 for calendar year 2008. For occupational therapy services, the limit is $1810. Deductible and coinsurance amounts applied to therapy services count toward the amount accrued before a cap is reached. Services that meet the exceptions criteria and report the KX modifier will be paid beyond this limit. Before this legislation was enacted, outpatient therapy service providers were previously instructed to not submit the KX modifier on claims for services furnished on or after July 1, 2008. The extension of the therapy cap exceptions is retroactive to July 1, 2008. As a result, providers may have already submitted some claims without the KX modifier that would qualify for an exception. Providers submitting these claims using the 837 institutional electronic claim format or the UB-04 paper claim format would have had these claims rejected for exceeding the cap. These providers should resubmit these claims appending the KX modifier so they may now be processed and paid. Providers submitting these claims using the 837 professional electronic claim format or the CMS-1500 paper claim format would have had these claims denied for exceeding the cap. These providers should request to have their claims adjusted in order to have the contractor pay the claim. In all cases, if the beneficiary was notified of their liability and the beneficiary made payment for services that now qualify for exceptions, any such payments should be refunded to the beneficiary. _________________________________________________________________ Posted date: 7/14/2008 ImpediMed Sets Up West Coast Operations Medical Device Maker Seeks Piece of $1B Market By HEATHER CHAMBERS San Diego Business Journal Staff Greg Brown ImpediMed, the maker of a hand-held device used to detect an often debilitating condition in breast cancer survivors who have undergone surgery or radiation treatment, is expanding its U.S. presence with an operations site based in San Diego. The Australian company, which trades under the symbol IPD on the Australian Securities Exchange, is hoping to capture part of the billion-dollar market for detecting a cancer patient’s risk for developing secondary lymphedema, a sometimes painful swelling of the arms and legs caused by trauma to the lymphatic system. Although there is no cure for lymphedema, early detection could help patients better manage their condition and possibly reverse or stop the swelling before it becomes irreversible. Shortly following its listing on the Australian Stock Exchange in October, the company acquired privately held Xitron Technologies Inc. of San Diego for $2.4 million plus $2.85 million in potential milestone payments in order to grow its business in the states. Chief Executive Officer Greg Brown said the acquisition gave ImpediMed access to a ready revenue stream, intellectual property related to its current technologies and a work force of eight people. It also helped the company establish a U.S. operations headquarters in San Diego. The Brisbane-based company also operates a satellite office in New York. “The U.S. market is, by far, the largest market in the world,” Brown said. “If you look at the rest of world, the markets there are very much a different type of health care system and are slower to adopt new technologies than, perhaps, the U.S. market.” ImpediMed reported a net loss of $5.6 million on revenues of $1.2 million for the half-year ended Dec. 31 as compared to a net profit of $3.4 million on revenues of $875,000 for the same period a year earlier. As of March 31, company reports showed it had $10.2 million cash. ImpediMed’s FDA-approved ImpXCA device employs electrical signals to assess fluid changes in the body. The device measures fluid outside the cells to determine whether a patient is at risk for developing lymphedema. According to the National Lymphedema Network, approximately 15 percent to 20 percent of all breast cancer patients are affected by lymphedema in the arms. Pinpointing Risks Today, there is no standard tool used to assess the condition although physicians commonly rely on tape measures and water displacement to track changes in limb size and circumference as well as to report changes in arm mobility. Bioimpedance spectroscopy devices, such as those used by ImpediMed, have been referred to as the next level of detection because of their ease of use and accuracy in determining risk. A study funded by the National Institutes of Health and published online in April in the American Cancer Society’s publication, Cancer, found that breast cancer patients put under lymphedema “surveillance” before and after surgery helped doctors diagnose the condition earlier, resulting in more successful treatment. Dr. Steven Schonholz, a breast surgeon and medical director of the Breast Cancer Center at Mercy Medical Center in Springfield, Mass., uses ImpediMed’s low-frequency device to detect changes in his patients’ fluid levels. ---------------------------------------------------------------------------------------- Aug 26, 2008 City sets tax rates, plans to annex CMU property Constitution-Tribune Chillicothe City Council members set the city’s 2008 tax rates for real and personal property following a public hearing during their regular meeting Monday night at City Hall. The new rate reflects an increase in both the general fund and park fund to produce a modest $4,728 increase in tax revenues. In the general fund, the city approved an increase from 0.6374 to 0.6451 per $100 assessed valuation and in the park fund from 0.1791 to 0.1813 per $100 assessed valuation for an overall increase of just less than a penny per $100 valuation (0.8165 to 0.8264 per $100 assessed valuation). Assessed valuations are down slightly from 2007 to 2008, according to assessment figures. The report shows a slight increase in assessed valuation for real estate at $63,498,018 in 2007 and $63,810,130 in 2008. Assessed valuation for personal property was $26,661,166 in 2007 and $25,841,126 in 2008. Total assessed valuation figures are $90,159,184 in 2007 and $89,651,256 in 2008. Council members on Monday also passed a resolution declaring the intent to annex the Chillicothe Municipal Utilities water treatment property south of Chillicothe. This amounts to 95 acres. The resolution states that the land is an area that is appropriate for incorporating into the city and has been identified as being reasonable and necessary for the physical growth and development of the city. The perimeter of the area is at least 15 percent contiguous to the current city boundary, the resolution stated. The matter must be considered by the city’s planning and zoning board prior to annexation. Also Monday night, council members were introduced to Carole Hobbs, the new director of Hope Haven Industries. Hobbs talked briefly about the services offered by Hope Haven and about the new “e- recycling” program. This program allows the public a free, easy and effective way to dispose of all obsolete or outdated computers, cell phones, printers and much more, either working or not working, that are used in offices, schools, homes and by people on the go. She said Hope Haven accepts almost any small appliance that has a cord. For more information, contact Carole at 646-5172 or 247-1967. In other appearances Monday night, Hedrick Medical Center’s CEO, Brian Johnston, discussed several new services being offered through the hospital. These included lymphedema services which started on Monday, a wound care program which was to begin today (Tuesday) and psychiatric services which are scheduled to start in September. He also said that an ear, nose and throat specialist is coming on board early this fall to provide that service via telemedicine and through on-site clinics and surgeries. Johnston said that the hospital continues its efforts to recruit a second obstetrician/gynochologist, a family practice physician and an internal medicine physician. The hospital is turning 120 years old this year and special events are planned for September, Johnston said........ _________________________________________________________________ August 26, 2008 Massage treatment helps restore mobility Therapy reduces leg swelling from lymphedema Kareem Copeland clarionledger.com Rhoden Hallman goes by the name "Tiny" despite a 6-foot-5, 350-pound frame. What really seemed tiny was a small lump on his left leg in 1971 that turned out to be cancerous. The 75- year-old retired Brandon military man had the lump removed, and then his problems grew. The rare form of soft tissue cancer was synovial sarcoma which affects fat, muscles and commonly develops in the leg. Hallman's options were to either amputate his leg or remove lymph nodes in the area. He obviously wanted to keep his leg but wasn't prepared for the side effects. The lack of lymph nodes led to a condition called lymphedema, a condition where protein-rich fluid builds up in a certain part of the body. It is most commonly found in the extremities but can also affect other parts of the body. The body fights infection by releasing extra fluid to the infected area. The lymphatic system helps drain that fluid. So, with damaged or removed lymph nodes, fluid builds up in the area. Hallman's leg eventually swelled to 30 inches around 10 inches up from the floor. "This has gone on all these years, and I've tried everything you can think of," Hallman said. "Really, no success." Hallman was receiving treatment for a fluid leakage on the leg three months ago at G.V. "Sonny" Montgomery Veterans Affairs Medical Center in Jackson when someone suggested trying complete decongestive therapy. "I said, 'I'm ready for anything,' " Hallman said. "Whatever we need to do." During CDT, a certified lymphedema therapist will stretch the skin using strokes with the hands to route the built up fluid to healthy lymph nodes in other parts of the body that then dispose of the fluid. The method is used in conjunction with compression wraps and garments, delicate skin care to prevent infection, and a series of exercises. Hallman started going to Therapy Solutions at River Oaks Hospital five days a week for two months then dropped down to three days. After three months of treatment, the leg is almost completely normal. "This is just unbelievable," Hallman said. "My balance is better. I can walk better. This thing has just helped me tremendously. "There was a point where I couldn't pick up my leg. Now, I can lay on my back and lift my leg straight up." There is no cure for lymphedema, but the main goal of CDT is to "return the lymphedema to a stage of latency, utilizing remaining lymph vessels and other lymphatic pathways," according to Joachim Zuther's book Lymphedema Management: The Comprehensive Guide for Practitioners. Primary lymphedema develops when a person is afflicted with an abnormal lymphatic system from birth. Secondary lymphedema can develop when a patient's normal lymphatic system is damaged as the result of an external influence such as injury, surgery or radiation that may have occurred recently or happened decades ago. CDT training in the United States began in the 1990s, but was developed in Europe in the 1970s. There are 16 certified lymphedema therapists in Mississippi, and nine practice in the Jackson area. A major problem affecting those with lymphedema is a "pervasive lack of medical expertise in the diagnosis and treatment of this condition and the tendency of clinicians to trivialize lymphedema in patients who have been treated for cancer," Zuther wrote. According to Jill Brady, a certified lymphedema therapist at River Oaks Hospital in Flowood, patients have been treated with diuretics, water pills, compression garments and pneumatic pumps that simply attempt to remove the water backing up in the area. But the fluid is laden with protein, and those methods do not move the mass quantities of protein left behind. "When the protein's sitting there ... they actually attract collagen, what scars are made of," said Brady, who uses Zuther's book in treating the condition. "It's almost like a scar up under the skin ... that starts to be hard. If they don't get the right treatment, besides from the fact that they'll probably be in and out of the hospital with infections, it'll continue to get larger and larger and larger. "It can still be treated, but it takes a lot longer to break down those proteins." To comment on this story, call Kareem Copeland at (601) 961-7190. _________________________________________________________________ August 25, 2008 NUHS: A historic center for Kinesio TapingSource: National University of Health Sciences Ever since members of the U.S. Women's Olympic Volleyball team caught the world's attention with colored tape adorning their skin, people have been buzzing about Kinesio Taping. Kinesio Taping, which was developed by National University of Health Sciences (NUHS) alumni Dr. Kenzo Kase, is a cutting-edge sports medicine technique. Additionally, two NUHS faculty, Vincent De Bono, DC, vice president for Academic Services, and David Parish, DC, dean of clinics, are internationally known educators in this method and are certified Kinesio Taping instructors by Kinesio USA, LLC. Since its development nearly 25 years ago, Kinesio Taping has become the standard for therapeutic taping not only in the U.S., but also in the international practitioner world. This method of taping uses a uniquely designed and patented tape for treatment of muscular disorders and lymphedema reduction. The method and tape allow the individual to wear and receive therapeutic benefits on a 24-hour basis and can be worn for several days per application. The KT method involves taping over and around muscles in order to assist and give muscle support, or to prevent over-contraction of the muscles. The university's current curriculum includes hands-on application of Kinesio Taping during several courses and during students' clinical internship. _________________________________________________________________ August 25, 2008 Hillcrest Womens Center is Best Kept Secret in Tulsa By Kendra Blevins GTR NewsOnline Hillcrest health care system is considered the best place for obstetrics and Women’s care, which is housed in the brand new and state of the art, Peggy V. Helmerich Women’s Health Center. The care at the Women’s Center is like one stop shopping. It offers complete care for women including breast health, gynecology, obstetrics, urology, gynecologic oncology, fertility, and osteoporosis. The Leta M. Chapman Breast Center has the latest technology. The computer aided detection system, (CAD), enhanced visualization film and mammopad, which is a foam mammogram, is “way more comfortable than it used to be,” says Sandra Jackson, executive vice president. “The techs are great at distracting you,” she says. The digital imaging reduces radiation and repeat mammograms. It’s easier to enhance the picture on the new films and they are easily stored so that patients can take their records with them if needed. The center has the only female fellowship trained physician, Lynette Smith in Oklahoma who has her own private office at the Women’s Center. “The message should go out to everyone that Dr. Smith is seeing way too many patients,” says Jackson. “It’s staggering to see how busy she is,” says Delaine Bartsch, administrative director of women’s services. “There are new patients in their twenties, but if there’s an issue get it checked out.” “It’s important to talk freely about breast health. There’s a lot of advance technology here,” says Jackson. She personally answers questions that come in on the Hillcrest website, www.helmerichwomenscenter.com from the “Ask a Nurse” section. Jackson is a registered nurse. “I’ll get a physicians help if I need to. We help people get a doctor if they need one. We don’t want to lose anyone in cyberspace,” says Jackson. She cautions patients to look for only the official websites to find information because there is a lot of misleading information on web. The digital mammography screening and diagnostic offers a double check since a physician and a computer are both analyzing the results. The center offers breast MRI, stereo tactic breast biopsy, breast ultrasound, galactogram, cyst aspiration, PET scans, a lymphedema treatment clinic, a prosthetics salon and certified fitter, mobile mammography van, bone density scans and needle biopsy. The dedicated valet parking in on B1 of the basement level parking and it’s pink so it’s hard to miss the entrance. Adjacent to Hillcrest hospital on 11th and Utica is the Peggy V. Helmerich Women’s Health Center. The center is Eastern Oklahoma’s only hospital dedicated exclusively to women and infants. The center was built in 2003 and designed to have a hotel-style look, feel and amenities. It has dedicated valet parking that shares the same drive as Hillcrest hospital, but the center has it’s own entrance so that expectant mothers can get right in and up to delivery. The birth care center has a state of the art design that is unique to Hillcrest. The rooms are spacious and entirely private with hardwood floors, warm lighting, oversized showers and guest sleeping accommodations. There is a designated play area for children. The Women’s Center is the only hospital in Tulsa to offer couplet-centered care, where the mother and child have the same nurse. The couplet care is unique because it takes a larger staff to provide that kind of care. “ The patients absolutely love it. We do complete care, not traditional. The same nurse cares for mom and baby,” says Bartsch. “Our number one goal is to get mom better and provide education. I appreciate that Hillcrest allows the staff to make that model successful,” she says. The birth care center also provides a labor triage area and early labor lounge. The delivery suites and postpartum suites are close together and the antepartum rooms and neonatal intensive care unit (NICU) are close together. There17 private labor and delivery rooms, 32 private postpartum suites with guest accommodations, seven labor and delivery triage rooms and two cesarean-section rooms. Four board certified maternal fetal medicine physicians work in Women’s center and one is available at all times. The nursery has around the clock security for newborns. Each floor is secured with doors that can only be opened by nurses. Hillcrest has never had an issue with baby theft. The most critical aspect of the center is the NICU. The level three NICU provides the highest level of care and is recognized for the shortest average stay. The 40 bassinets are housed in a quiet environment, with pods that separate each patient for privacy. It is dark with soft sconce lighting. The noise and bright lights of traditional hospitals are not has conducive to development as the state of the art NICU at the Women’s Center. “We remain as developmentally appropriate as we can,” says Bartsch. “It’s awesome when you walk in there, it’s so quiet. The unit is incredible.” There are transition rooms for new parents where they can care for their new baby with a nurse on hand ready to answer any questions. Parents can stay one-two nights in the transition room. “Our nurses are role models for the patients,” says Bartsch. The center has a trained lactation staff that is internationally certified. Breastfeeding is important for the health of the baby and the Women’s Center has 80 percent of mother’s breastfeeding. All the nurses are trained to teach and consult women on breastfeeding. The lactation support team has internationally board-certified lactation consultants. The lactation support team has internationally board-certified lactation consultants. “ The main advantage is our education staff. There is dedicated education for both women and child services. We keep our staff updated and cutting edge,” says Bartsch. The education programs include classes for all parts of preparing for the birth experience: The Healthy Baby Program, Marvelous Multiples, Baby Touch Infant Massage, Breastfeeding Instructions, Infant/Child CPR, Baby- Care Basics and Life In The Womb. “I think our patients feel the difference and go out very happy,” says Bartsch. The Women’s Care Unit provides treatment for urinary incontinence, cancers of the reproductive system, breast cancer, dysfunctional uterine bleeding, endometriosis, and fibroids. It offers the latest multidisciplinary approaches and proven procedures. Hillcrest has all the physicians needed to handle an emergency at anytime of day, night, weekday or weekend. Hillcrest is a teaching hospital with residencies from University of Oklahoma Obstetrics, In His Image Family Practice and OU Family Practice. There are nearly 50 medical residents through the OU College of Medicine. The main benefit of having residencies at Hillcrest is the in house, board certified obstetricians, gynecologists, neonatalogists and neonatal specialists who are available at all times. A physician is always on hand. _________________________________________________________________ August 25, 2008 Medical moversNews-Leader.com Dr. Larry Halverson, a CoxHealth physician, has started a cross-country bike ride of nearly 3,500 miles to raise money and awareness for the Family Medicine Residency Diabetes Fund. The fund is an endowment managed through the CoxHealth Foundation. Halverson, who works with the Cox Family Medicine Residency and Family Medical Care Center, is raising money through donations and pledges. For more about his journey, visit www.coxhealth.com/ridefordiabetes. Thomas A. Martin, a psychologist with the Missouri Rehabilitation Center in Mount Vernon, is the 2008 recipient of the National Academy of Neuropsychology's Early Career Service Award. This award is given annually to one neuropsychologist who has made substantial contributions to the field of neuropsychology within the first 10 years of receiving his or her doctorate. Martin will be honored for the achievement on Oct. 24 in New York City. Martin began his career with University of Missouri Health Care in 2000 and joined Missouri Rehabilitation Center full time in 2002. Marianne Stanley, a massage therapist with Zen 3 Bodywork Studio in Springfield, has received certification in Manual Lymph Drainage (Vodder) through Klose Training via the Scherer Institute of Natural Healing, Santa Fe, New Mexico. Manual Lymph Drainage is a massage technique that helps people with lymphedema and a variety of other conditions. _________________________________________________________________ 19 August 2008 Hypoglycemia Not As Frequently Diagnosed As It WasSource: Sun-Journal Lewiston, Me. Red Orbit DEAR DR. DONOHUE: I was diagnosed with hypoglycemia 25 years ago. I have strictly followed the diet I was instructed to follow, a high- protein, low-carbohydrate diet with six small meals a day. The doctor who made the diagnosis has died, and I have a new one who doesn't believe I have hypoglycemia. He told me I can eat whatever I want. What's your opinion? - R.O. ANSWER: Not so long ago, hypoglycemia - low blood sugar - was an in-vogue condition popularized in many magazines and adopted by many celebrities. It isn't a common disorder, and far too many people were told they had it when they really did not. To make the diagnosis, the following three conditions have to be met: Blood sugar has to be 50 mg/dL (2.8 mmol/L) or less; A person must exhibit the signs and symptoms of low blood sugar at the time blood sugar is low; Giving the person sugar quickly eliminates signs and symptoms. Signs and symptoms of low blood sugar include sweating, tremor, nausea, a fast heartbeat, dizziness, confusion and headache. These things are common to many illnesses, so they aren't distinctive for hypoglycemia. At times, making the diagnosis of hypoglycemia entails hospitalization for a 72-hour fast, during which a battery of blood tests can be done, including measuring blood levels of insulin. When blood sugar is low, insulin production slows. If it remains high, then a pancreatic tumor that's making too much insulin comes under suspicion. Such a tumor is extremely rare. If you feel comfortable on your low- carbohydrate, high-protein diet, there's no reason why you should abandon it. It's a healthy diet. If you would like to try a more liberal diet, do so. The only way to find out what will happen is to experiment. READERS: The often-asked questions about leg and ankle swelling are answered in the booklet on edema and lymphedema. To order a copy, write: Dr. Donohue, No. 106, Box 536475, Orlando, FL 32853- 6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient's printed name and address. Please allow four weeks for delivery. DEAR DR. DONOHUE: If I don't use an antiperspirant, I sweat fiercely. I have wet marks on my blouse under my arms. The talk at work is that antiperspirants cause breast cancer and Alzheimer's disease. That scares me. I am waiting for an answer from you before I throw mine out. - K.M. ANSWER: If there were a strong link between antiperspirants and breast cancer and Alzheimer's disease, warnings would be all over the place. There isn't a proven link, and most believe there never will be a proven link. It's the aluminum in antiperspirants that people who promote this idea fixate on. I am not stopping my use of antiperspirants. DEAR DR. DONOHUE: Every evening, my wife and I take a long walk. It's our daily exercise. I attract mosquitoes, but she doesn't. Why? Is there a medical explanation for this? - L.P. ANSWER: People who emit more carbon dioxide than others draw mosquitoes to them. The mosquitoes are attracted by it. Mosquito magnets also have other compounds on their skin that entice mosquitoes. Cholesterol on the skin seems to draw them to a person. Skin cholesterol has nothing to do with blood cholesterol. Uric acid and lactic acid on the skin are other attractants. Mosquito repellent will keep you free of mosquito molestation. DEAR DR. DONOHUE: My sister, 59, has had a problem in her groin area since 1999 and has seen many doctors about it. No one diagnosed her problem until November 2007. It is called celiac disease. All she knows about it is to stay on a gluten-free diet. Can you give more information about the disease and some of the foods she can eat? - G.M. ANSWER: Once thought to be a rare illness, celiac disease is anything but rare. It's an intolerance to gluten, a protein found in wheat, barley and rye. Digestive tract symptoms are its hallmarks: diarrhea, stomach discomfort, bloating and weight loss. However, many symptoms not directly associated with the digestive tract also can occur - things such as anemia, early osteoporosis, iron deficiency, nerve disturbances and a skin condition called dermatitis herpetiformis. Your sister shouldn't be cut adrift with so little information and so few instructions. She needs a dietitian to guide her in how to avoid gluten foods. The Celiac Disease Foundation is a terrific source of information and help. Its phone number is 818-990-2354, and its Web site is www.celiac.org. Have her get in touch with the foundation quickly. The "groin" problem leaves me puzzled. I don't know what that might be or how it might be related to celiac disease. Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853- 6475. _______________________________________________________________________________ _ August 25, 2008 Flying with LymphedemaMy Breast Cancer Network by Phyllis Johnson "Flying isn't fun anymore," my brother-in-law frequently proclaims along with other travelers tired of security checks and crowded seats. I certainly agreed with him while I sat on full plane in New Hampshire for an hour waiting for clearance on my way home from visiting our children and new grandbaby. Flying definitely isn't fun anymore for me because I have lymphedema. No one explained it to me at the time, but I was at double risk for this condition that causes swelling because I had 24 lymph nodes removed when I had my mastectomy, and I had extensive radiation to my chest and lymph nodes. Sure enough about a year after my cancer treatment ended, one day I noticed that all the creases in my right wrist were gone. Wow! Did I gain weight that fast? Nope, the creases were still there on the left wrist. The surgeon prescribed a compression sleeve to control the swelling. The sleeve was uncomfortable and didn't help much, but I did get a little better. The next time I saw him, my surgeon told me about a new therapist on the other side of the city who specialized in lymphedema. He would be happy to write a referral if I didn't mind driving so far. An hour's drive through Kansas City traffic versus living with lymphedema? No contest! Having someone who knew the latest research about lymphedema made a real difference. She explained that compression sleeves can maintain progress, but they aren't very good for reducing swelling. Most women need one that has been ordered to their measurements. An off-the-rack sleeve that doesn't fit properly can make the condition worse. Fortunately my lymphedema was still in the mild stage, so she taught me self-massage and bandaging techniques. The bandages wrap the entire arm and make me look like the Michelin man, but they have worked for me. For nine years, my lymphedema has mainly stayed under control. If my arm starts to feel a little tight or if I see swelling, I bandage at night and wear a custom-fitted compression sleeve during the day until it's better. I've had two summers where that wasn't enough when I had to go for massages several times a week and wear the cumbersome bandages all the time except for showering. Getting regular massages is relaxing, if expensive. My insurance expects me to pay the $40 specialist copay for each one. But I consider myself lucky because my therapists have told me that not everyone is able to get lymphedema back under control, and my swelling has never measured higher than moderate on their scale. So what does flying have to do with all of this? The cabin pressure changes that can make your ears pop on an airplane, can also affect lymphedema. Another problem of flying is that all that sitting also encourages fluid build-up. If I don't remember to do some arm exercises, I can see swelling after a long car trip too. My therapist recommends that I bandage before a flight and leave the bandages on for a couple of hours after I get off the plane. I used to bandage before I got to the airport, but since 9/11, I've found that I am more frequently subject to "random" searches when I go through security with a wrapped arm. Now I carry my supplies with me and wrap at the gate. Part of me enjoys watching my fellow passengers' covert glances as they try to figure out what's going on. A woman who looks perfectly healthy takes out a plastic bag and lines up rolls of bandages in various sizes on the seat beside her. I watch them watch me as I tear eight little strips of masking tape and stick them on the handle of my luggage. I pull on a stockinette sleeve and adjust it. Then a foam rubber bandage goes over my thumb and wraps all the way up my arm. After the foam I have four more bandages to wrap, and then I'm ready to fly. Whether breast cancer survivors who have not had lymphedema should wear a compression sleeve when flying seems to be a matter of opinion. If you had an axillary node dissection or if you had radiation to your armpit, it's worth discussing with your doctor or a lymphedema therapist. My therapist says she sees a lot of women who had a lumpectomy and radiation who didn't realize they were at risk for lymphedema because of their radiation. If you had nodes removed AND radiation, then you are at double risk for lymphedema. You'll want to be especially cautious, especially if you are on a long trip with multiple landings and take-offs, or are on a small plane that isn't well pressurized. On this trip, I debated skipping the bandages. Then I remembered that I'd be holding my new grandson when I got to New England. He's definitely worth a few bandages. I'm going to be doing a lot of flying over the next few years to visit him, and I want that arm in good shape for hugs. __________________________________________________________________ AUG 14, 2008 Delayed axillary node dissection not detrimental in breast CA patients with positive sentinel nodes. By Will Boggs, MD Cancerpage.com Delaying axillary node dissection for a few weeks does not appear to be detrimental in breast cancer patients with positive sentinel nodes, according to a report in the July 20th Journal of Clinical Oncology. "Increasingly, women with breast cancer are able to make choices about their treatment," Dr. John A. Olson, Jr. from Duke University Medical Center, Durham, North Carolina told Reuters Health. "While we certainly do not want to turn one operation into two for most women with breast cancer and sentinel node metastasis, these data suggest that taking a stepwise approach to axillary management is a safe and reasonable option for women who do want to consider other options than axillary node dissection." Dr. Olson and colleagues compared pathological results and short-term complications between patients undergoing immediate versus delayed completion axillary lymph node dissection (cALND) after a positive sentinel lymph node biopsy. Timing of cALND was at the discretion of the patient and surgeon. The median interval between sentinel node biopsy and cALND in the delayed group was 19 days (range, 1 to 93 days), the report indicates. In the immediate cALND group, mean tumor size was larger and the rate of estrogen-receptor-negative tumors was greater, compared to the delayed group. Women who underwent immediate cALND had additional nodal metastasis identified 42% of the time, compared with 27% of the time in women who had delayed cALND. Women who underwent i |