October is Breast Cancer Awareness Month

breast cancer awareness

Fiona McMahon PT, DPT

It’s here again. You can see pink on everything, ribbons, coffee cups, even football players. October is National Breast Cancer Awareness Month. Breast cancer is the most common form of cancer in women in the developed world. Over the years a concerted effort has been made to raise awareness for early screening and treatment of breast cancer to help save lives. We go over the basics about breast cancer screening in last year’s Breast cancer awareness blog which you can check out here.

For this year’s blog we are going to take a more physical therapy centric approach and talk about what happens from a functional standpoint, once you are finished with treatment and how you can help yourself to reduce pain, improve strength, and mobility with physical therapy.

There are different treatments for breast cancer, and based on the specific type (there are many different types) and how advanced it is, as well as personal considerations. It is important to manage recovery from your treatment as you would any other procedure. Although survival rates are improving, which is excellent news, it was found in an Australian study that 62% experienced an upper extremity impairment and approximately 27% had 4-6 impairments 6 years later. An impairment in the upper extremity can be described as loss of range of motion, which can impair one’s ability to groom oneself, clean, etc. Other impairments can include pain, loss of strength, and lymphedema. Lymphedema is a condition in which the body’s ability to filter return fluid and waste products out of a limb is impaired and severe swelling as well as permanent tissue changes can occur.

Physical therapy can be a wonderful and helpful tool in treating symptoms following breast cancer treatment and the benefit can extend beyond just symptoms following surgery. In the study cited below, hormonal and radiotherapies were the top contributors to pain. The good news is, physical therapists, especially the one’s at Beyond Basics are specially trained to recognize and treat chronic pain syndromes. Physical therapists may use techniques such as nervous system down training, gentle exercises and expert massage techniques to help lessen pain.

It may seem obvious, but if you are experiencing any difficulty with the strength or mobility of your shoulder or upper extremity, you should see a physical therapist right away. Scar tissue and fibrosis from your original treatment can severely reduce your ability to move your shoulder and the quicker it is identified and treated, the faster and easier treatment will be.

Patient’s experiencing swelling in their arm following breast cancer treatment should see a Certified Lymphedema Therapist (CLT). CLT’s are physical therapists who enroll in rigorous training to be able to treat and manage lymphedema. Lymphedema should be managed aggressively to prevent permanent tissue changes. We at Beyond Basics are lucky to have Victoria Lamanna PT, DPT, CLT working with us. She is specially trained to treat complex lymphedema cases and will be able to perform manual lymphatic drainage, fit compression garments, and provide you with lifestyle changes to help manage lymphedema.

Once you are done with treatment for breast cancer, it is important to take stock and note how you body feels. If you feel like you aren’t moving the way you used to, there is something that can be done and physical therapy is a great option from routine orthopedic care to higher level pain management and lymphedema treatment. If PT sounds right to you, give Beyond Basics Physical Therapy a call today or search the Lymphedema Education and Resource Network for a LANA certified lymphedema therapist near you.

Also check out our other blogs on lymphedema physical therapy:

Sources:

Hidding J, Beurskens C, van der Wees P. Treatment Related Impairments in Arm and Shoulder Patients with Breast Cancer: A Systematic Review. PLOS ONE. May 2014;9(5): e96748

March 6th is Lymphedema Awareness Day!

lymphedema

Victoria LaManna PT, DPT, CLT

March 6th is Lymphedema Awareness Day! The lymph system carries the body’s waste products, dead pathogens, and water. Eventually these substances are cleared by the body. Problems can occur if the lymph system gets blocked and cannot clear these substances. Problems with the lymphatic system can cause swelling in affected limbs, and sometimes pain, as well as fibrotic changes in the skin.

You can be born with issues in your lymph system which can cause primary lymphedema or you can have damage to your lymph system because of surgery or radiation treatments, especially for breast cancer.

If you are living with lymphedema, try these tips from the Mayo Clinic to keep your limbs as healthy as possible:

  • Avoid injections, vaccinations, blood pressure monitoring, or IV’s on the affected limb
  • Don’t wear tight fitting clothing or jewelry
  • Avoid exposure to extreme temperatures, like hot baths, or saunas
  • Monitor your affected limb for signs of infection, and go to the doctor if you suspect infection

 

You can also check out our list of Self Care Tips 

Physical therapy can help manage lymphedema, which requires a very specialized lymphedema certified therapist.  At Beyond Basics Physical Therapy, we are lucky to offer lymphedema treatment with our own Certified Lymphedema Therapist, Victoria LaManna, PT, DPT, CLT . If you are interested in starting your lymphedema treatment journey, call and make an appointment with Victoria today!

For more reading on lymphedema, check out our previous blogs:

Lymph Drainage  Therapy for Breast Health at Beyond Basics Physical Therapy

Beyond Basics’, Victoria LaManna Receives Lymphatic Drainage Therapy Certification

 

Sources
Ness S. Living with lymphedema: Take precautions, get support. 2011. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/cancer/expert-blog/lymphedema-management/bgp-20056387. Accessed February 10, 2017

Lymph Drainage Therapy for Breast Health at Beyond Basics Physical Therapy

Victoria LaManna, PT, DPT, CLT

lymphAs Breast Cancer Awareness Month comes to an end, we at Beyond Basics are working hard to help spread the word on the importance of regular self-examination and early detection. For further review, please see our blog post from earlier this month.

In addition to regular self-examination, regular breast massage is shown to help increase the circulation in your breasts. Therapeutic breast massage can also lessen discomfort associated with breast cancer treatments, help relieve post-surgical symptoms, and reduce discomfort during pregnancy, breastfeeding and weaning. Breast massage also contributes to improved skin tone while promoting relaxation and balancing your energy.
With regular massage, you will help diminish benign breast cysts while helping to flush lymph nodes and stimulating your glandular system. The breasts are soft tissue and do not have muscles to help them move, therefore they require assistance for improved circulation and lymph flow.
If you have been diagnosed with breast cancer and have undergone lymph node removal, mastectomy and/or radiation, you may experience lymphedema. About 15-20% of women who have axillary lymph nodes removed during breast cancer surgery will develop lymphedema. Working closely with your medical team to manage lymphedema is key! A Certified Lymphatic Therapist (CLT) can effectively apply gentle hands-on techniques to help enhance circulation and drainage.
Lymphedema is an accumulation of protein-rich lymphatic fluid in the tissues that contributes to swelling secondary to blockage in lymphatic flow when nodes or vessels are damaged. Individuals who have lymphedema may complain of discomfort in the affected limb, feeling of fullness in the limb, fatigue, or decreased flexibility. They may also complain of breast pain, tight-feeling skin, difficulty fitting into clothes, or tightness when wearing rings, bracelets, or watches. Venous insufficiency and obesity can contribute to lymphedema.

Complete Decongestive Therapy (CDT) consists of Manual Lymphatic Drainage (MLD) that aids in the circulation of body fluids, drains toxins from the body, stimulates the immune system and the parasympathetic system, reduces pain and/or muscle spasms, increases ROM, and decreases swelling. CDT can be used to treat conditions such as post-surgery and scars, fibromyalgia, chronic fatigue syndrome, infertility, painful periods, constipation, and irritable bowel syndrome. In conjunction, it is important to have an exercise program of stretching and strengthening to get the maximum benefits of CDT. After treatment, the patient may experience increased urinary frequency or increased amount of urine, increased sleep time or better quality of sleep, tension release and/or emotional release, or improved senses.

If you are seeking treatment, you need to see a licensed healthcare provider that is trained in Lymphedema Drainage Therapy. To find a specialist in your area, go to www.apta.org and click on “Find a PT”, specializing in LDT. Alternatively, you can search through the National Lymphedema Network or the Lymphatic Association of North America (LANA).

victoria2016Victoria LaManna, DPT, CLT, is our lymphedema expert. If you have had a mastectomy and are unsure about lymphedema care, she is an excellent resource. She will be able to instruct you in self- care and lymphedema prevention measures. Physical therapy can also help to release scar tissue in the breast and upper arm area, regain strength in the arm, and ultimately improve your function. Visit us, and read up on Victoria’s bio here, as well as on our website at: www.beyondbasicspt.com/lymphedema.

Beyond Basics’s Pro-Bono Clinic for PT Day of Service!

201510_blog_globalptdayofservice

Victoria LaManna, DPT

October is around the corner! And a busy month for many. Whether you are getting back into the swing of school or work after summer vacation, preparing your Halloween costume or getting ready for all the upcoming holidays right around the corner – there is a lot going on!
This time of year is also an opportunity to do good and give back. October is National Physical Therapy Month, where physical therapists celebrate their amazing field of healing and getting people back to optimal function. In addition, many of the PT’s throughout the U.S. give back to their communities during this month. This year we are taking it up a notch. Physical therapists WORLDWIDE are getting involved for the second annual Global PT Day of Service Saturday, October 15th. Whether it is by hosting a pro-bono clinic, serving in a soup kitchen, participating in a 5k for a cause, or cleaning up a community garden – physical therapists globally as a profession are coming together to make a positive impact on the world around them.
At Beyond Basics, we have decided to host a pro-bono clinic Saturday, October 1st to give back to those in the New York City area who may not have insurance or access to physical therapy. We are providing 30 minute one-on-one evaluations and recommendations for home programs to up to 30 participants. For more information and to sign up please visit: http://signup.com/go/Nu1T4Q
You can also check out PT Day of Service here and follow on twitter (#PTDOS) to see how the day unfolds! http://ptdayofservice.com/
The American Physical Therapy Association (APTA) is also involved in hosting National Physical Therapy Month. This year the APTA’s focus is on it’s national public awareness campaign, #ChoosePT. This campaign lets consumers know about the risks of opioid use and that physical therapy is a safe, non-opioid alternative for managing pain.
I encourage you to check out educational resources provided by the APTA (www.apta.org) and Move Forward PT (http://www.moveforwardpt.com/Default.aspx). Learn all about how physical therapy can help you overcome pain without the use of opiods, improve mobility and maintain independence throughout your lifetime.

day-of-service

Beyond Basics’, Victoria LaManna Receives Lymphatic Drainage Therapy Certification

victoria2016Victoria La Manna, PT, DPT, CLT of New York, NY successfully completed Norton’s School of Lymphatic Therapy’s Lymphedema Certification Program. The certification signifies advanced skill in the application of complete decongestive therapy (CDT) in the treatment of lymphedema.

Lymphedema is the abnormal accumulation of protein rich fluid due to a disorder of the lymphatic vessel or nodes. It is a chronic condition that will usually worsen over time if left untreated. Complex Decongestive Therapy is the conservative treatment of choice for lymphedema and is reimbursable in New York by medical insurance. CDT involves a regimen of manual therapy, medical compression (bandaging, wrapping of the area), skin care, aerobic conditioning, and isotonic exercises done during the therapy session and at home.

Manual Lymphatic Drainage (MLD) Therapy is a gentle hands-on modality used to stimulate lymph flow and its specific rhythm, direction, depth, and quality over the entire body. This technique is used to aid excess lymphatic fluid to healthy neighboring territories and return it to the intact lymphatic system. The effects of MLD consist of:
• Relaxation, analgesic, diuretic
• Increases performance of the lymphatic system
• Re-routes fluid from congested area
• Softens connective tissue

MLD may also benefit these conditions:
• Lipedema
• Phlebo-lymphostatic
• Post-trauma or post-surgical swelling and healing
• Chronic Regional Pain Syndrome (CRPS)
• Cyclic-Idiopathic Swelling
• Inflammatory Rheumatism
• Migraine Headache
• Sinus Headache
• Scleroderma
• Chronic Fatigue
• Fibromyalgia
• General Relaxation

Victoria La Manna, PT, DPT, CLT earned, and successfully received, the 140-hour Lymphedema/CDT Certification which fulfills the requirements to sit for the national certification testing with the Lymphology Association of North America (LANA). Dr. La Manna is an expert physical therapist at Beyond Basics Physical Therapy, which is located in midtown Manhattan. She began, and is currently the head physical therapist for, the Lymphedema Program, which addresses the upper and lower extremities and the trunk region in men, women, and children. She is a member of the Women’s Health and Orthopedic sections of the American Physical Therapy Association and the National Lymphedema Network. Victoria is also a member of the National Vulvodynia Association and the International Pelvic Pain Society.

Know Your Nodes, Part IV

By Riva Preil

So, how does physical therapy help treat lymphedema?  Great question, I am glad you asked.  The gold standard of care to treat lymphedema is COMPLETE DECONGESTIVE THERAPY (CDT).  CDT consists of four components:

  1. Manual Lymphatic Drainage (MLD)
  2. Compression
  3. Exercises
  4. Skin Care

MLD was pioneered by Dr. Emil Vodder in the early 1900s, and it is series of various manual techniques (including “pump,” “rotaries,” “scoop,” “and pump-push,” to name several) which promote moving the excess lymph fluid from the distal extremities towards proximal, healthy open lymph channels.  Another way to think about lymphedema due to lymph node removal is that there is congestion on one “road”.  Therefore, the certified lymphedema therapist (CLT) seeks to open up and create new channels on uncongested “roads,” thereby creating detours for the lymph to return to the venous system through alternate routes.  MLD allows the CLT to direct the lymph along healthy, open lymphatic pathways.

In addition, appropriate compression must be applied to promote the return of lymphatic fluid and to prevent it from improperly pooling in affected areas.  Therefore, compression is an appropriate component of CDT.  During the acute first phase of treatment, bandaging should ideally be worn 23 hours during the day and removed only for showering or bathing.  CLT therapists bandage patients with short stretch bandages and they teach patients how to perform self-wrapping.  During the chronic second phase of treatment, compression garments can be substituted for bandages during the day, either custom made or over the counter.  Bandaging is continued for nighttime usage in most cases.

No physical therapy experience would be complete without some exercise, right?  Exercises are important in treatment of lymphedema because the musculoskeletal system helps with venous return and promoting fluid movement by acting as a pump mechanism.  That’s why ankle pumps (ankle dorsiflexion and plantarflexion) are recommended after ankle surgeries, in treatment of postsurgical edema (swelling).  So too, similar upper extremity and lower extremity “pump-like” exercises help return lymphatic fluid to the venous system.  Depending on the type of lymphedema (upper vs. lower extremity) several examples of lymphedema appropriate exercises include ankle pumps, knee and hip flexion and extension, shoulder flexion and abduction, elbow flexion and extension, and wrist flexion and extension.

Finally, skin care is a huge component of CDT.  The reason for this is that increased swelling of any extremity increases the DIAMETER of the extremity.  This increases the distance that gases (ex. oxygen) and nutrients must travel to reach the surface of the skin.  This is referred to as increased diffusion distance.  Oxygen is a necessary component in skin healing after any injury, even simply a paper cut!  It is harder for oxygen to travel long distances compared to short distances, therefore increased diffusion distance (as in the case of lymphedema) SLOWS the healing process.  Slower healing rate increases the likelihood of developing an infection through the open wound.  Therefore, it is crucial for all patients with lymphedema to be vigilant about skin care and inspection.  Their wounds heal slower than those of other individuals, and it is important to minimize the chance of developing infection by keeping wounds clean and covered.

So there you have it!  That was a brief overview of “How I Spent My Summer Vacation.” I could not think of a better way to spend my time this summer.  Don’t get me wrong, a week in Italy or an Alaskan cruise are trips that I look forward to hopefully taking one day, but I am grateful that I had the opportunity to take this incredible course his past summer.  This course is rarely offered in New York, so I had to jump on my chance when I saw it advertised. Thank you to Amy for supporting my continuing education and to my co-workers for helping to treat my patients while I was at the course. Italy and Alaska can wait for me, because my patients are more important!

Know Your Nodes, Part III

By Riva Preil

Background complete- you have made it through the anatomy, good job!  Time to discuss the PATHOPHYSIOLOGY.  Unfortunately, things don’t always run as smoothly and perfectly as we just described, and dysfunction of the lymphatic system can result in LYMPHEDEMA.  Lymphedema (LE) is swelling of the upper or lower extremities due to impairment in the lymphatic system.  It can also develop in the trunk, head, neck, or genitals.  It is a chronic disease and treatment involves lifetime management of the condition.

There are two types of lymphedema, primary and secondary.  Certain individuals are born with a congenital malformation of the lymphatic system, (ex. the vessels are too large or too small).  This is known as PRIMARY LYMPHEDEMA.

Furthermore, an initially healthy lymphatic system can develop problems through infection, obstruction, or damage.  This is known as SECONDARY LYMPHEDEMA.  Globally, the most common cause of lymphedema is filariasis, a parasitic disease that is caused by thread-like roundworms which occupy the lymphatic system, including the lymph nodes.  The worms enter the lymphatic system through blood feeding mosquitos and black flies in certain tropical countries.

In the United States, the most common cause of lymphedema is breast cancer-related surgeries that involve removal of affected axillary lymph nodes.  Removal of lymph nodes results in impairment in the lymphatic system, and it disrupts the normal return of fluid to the venous angles.  This can result in swelling of the involved upper extremity.  Similarly, lower extremity lymphedema can develop after removal of pelvic and or inguinal lymph nodes (ex. due to prostate or gynecological cancer surgeries).

Lymphedema can develop days, weeks, months, or even years after surgical node removal.  Therefore, individuals who have undergone these types of surgeries should be aware of their predisposition towards developing the disease. Any abnormal swelling or changes should be reported to one’s physician immediately, because the prognosis is better if the disease is detected and treated earlier.