Know Your Nodes, Part I

By Riva Preil

Can you believe that Labor Day has come and gone?  Yes, dear readers, summer is officially over.  But boy, was it an amazing and memorable summer!

Believe it or not, when asked about the highlight of my summer, I unequivocally and enthusiastically respond that it was my lymphedema certification course.  (#PTnerd.  And darn proud of it too).  Fortunately, I had the wonderful opportunity to return to class this summer and learn some pretty incredible, stimulating, and practical material. Touro College, right here in New York City, hosted a course taught by The Academy of Lymphatics, one of the highly recognized training centers in the world of lymphedema.  The course was an intensive nine day class which was three classes condensed into one.  In addition, each participant was required to complete seven modules which included extensive textbook reading. Each module contained a written online examination which we were required to complete prior to attending the class. I found this approach extremely beneficial, because it allowed me to begin with a strong foundation.

The course itself was fascinating!  The instructor, Marina Maduro, and her assistant, Kirat Shah, are excellent educators who were clearly well versed in the material and who explained difficult concepts well. I would be one to know; let’s just say I am not shy when it comes to asking questions, and I challenged them on many a concept that they clarified and explained clearly.

You are probably wondering, okay Riva, so what did you ACTUALLY learn, in a nutshell, in this course?  Let’s start off by first discussing the lymphatic system itself.  I like to call the lymphatic system “the secondary circulatory system.”  It is an OPEN system without a central pump. The primary circulatory system, which consists of the heart, blood vessels (arteries, veins, and capillaries), are responsible for transporting fluids, nutrients, gases, and waste products throughout the body.  It is a CLOSED system with a pump (the heart)…

To learn more, stay tuned for my next post!

Node Knowledge

By Riva Preil

Breast cancer awareness is sweeping the nation this October!  In honor of the many inspirational survivors who have undergone mastectomies, I have decided to blog about rehabilitation post mastectomy.  In western societies, breast cancer is the most commonly diagnosed tumor amongst women.  In fact, 27% of tumors diagnosed amongst females are breast tumors.  Fortunately, recent research has helped develop minimally invasive surgeries (including sentinel or axillary lymph node dissection) that allow for faster healing.  However, as with any surgical procedure, internal scarring may occur after the surgery which may affect upper extremity joint and muscle function.  Furthermore, removal of lymph nodes may result in dysfunctional drainage of the lymphatic system into the venous system, a condition called upper extremity lymphedema (associated with swelling and heaviness in the affected limb).  This may lead to impairments in functional abilities, including carrying heavy objects and overhead reaching.

A recent study in “European Journal of Physical and Rehabilitation Medicine” (2012, vol 8, No. 4) explored the benefits of early rehabilitation following surgery.  Of the 83 participants in the study, 25 were in the control group (no physical therapy until after discharge from the hospital) and 58 were in the experimental group (physical therapy beginning the day after surgery until discharge from the hospital).  The physical therapy interventions including exercises to maintain shoulder muscle flexibility, decrease pain, improve lymphatic circulation through the affected upper extremity, and breathing exercises to maintain proper pulmonary function.  Each P.T. session was 30-40 minutes during hospitalization, and they were educated on appropriate home exercises for post discharge.

Follow up was performed with both groups 6 months after surgery.  There was a statistically significant difference between the groups regarding the presence of lymphedema- those who had participated in early post-op intervention were less affected than those who had not.  Furthermore, those who had participated in physical therapy earlier on were more flexible and capable of greater function.  Once again, research has proven that physical therapy, including lymphedema treatment, is very beneficial post-surgery, and women are encouraged to use their arms freely post-surgery rather than “taking it easy” in attempt to heal.  Fortunately, we here at Beyond Basics Physical Therapy offer lymphedema treatment!  Our skilled physical therapist, Roseanne Cruz Schoen, is a Certified Lymphedema Therapist.  If you or someone you know may benefit from lymphedema treatment, please contact us- we would love to help!

Lymphedema and Diet

By Roseanne C. Schoen, PT, DPT, LLCC

There is no specific lymphedema diet, but there are some general guidelines to follow:

Limit salt intake– try to avoid processed foods or foods with high sodium content which can cause fluid retention and increased swelling

Adequate water intake– proper hydration is essential, especially following lymphedema treatment sessions, to remove waste products from the body

Balanced diet– it is suggested to a balanced diet of fruits, vegetables, lean proteins, whole grains, and healthy fats in order to maintain a healthy weight and lifestyle

 

Resources:

The National Lymphedema Network-http://www.lymphnet.org/lymphedemaFAQs/questions/question_01_00.htm

Dawson R and Piller N. Diet and BCRL: facts and fallacies on the web. Journal of Lymphoedema, 2011, 6:1. 36-42

Chill Out. With Lasers!

We’re proud to announce that we are now using Cold Laser Therapy here at BBPT! 

But what does that mean?

Cold Laser Therapy, also known as low-level laser therapy, is a non-invasive procedure in which low intensity lasers are used to relieve pain. ‘Cold’ refers not to the temperature but to the intensity of the laser itself. The laser works by stimulating repair of damaged tissues, ultimately moving toward pain relief. 

At BBPT, we are now using Cold Laser Therapy to decrease pelvic pain, to break up scar adhesions, and for lymphedema (swelling in the limbs and pelvis).  This is a great adjunct to manual therapy treatment. BBPT team members recently gathered to work with the new Cold Laser equipment. Take a look below!

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It’s National Lymphedema Awareness Day!

By Roseanne Cruz

Today is National Lymphedema Awareness “D” Day! Each year, on March 6, the National Lymphedema Network and the lymphedema community celebrate Lymphedema Awareness “D” Day, a special day to honor inspirational lymphedema patients: those who have contributed to the community or who have shown great courage in their struggle with disease. We show the world lymphedema is no longer a rare condition by honoring the many people living with it today, and the exceptional health care providers who, with dedication and support, have touched their lives and hearts. In past years, some have been honored at gala events, some in small, intimate gatherings, and others, one-on-one by their health care provider, family, or friend.  This day provides us with a special opportunity to alert our local media, medical community and neighborhoods about lymphedema; to create awareness about the condition, who is at risk, and available treatments, so not one more person will be told they just have to live with it, that nothing can be done.

Lymphedema Risk Reduction

Risk Reduction Practices For People With Lymphedema According to the National Lymphedema Network

By Roseanne Cruz

It is not known why some people with the same risk factors develop lymphedema and some do not. People at risk of lymphedema are individuals who have not yet displayed the signs and symptoms of lymphedema but have a known insufficiency of their lymphatic system. This includes people who have undergone removal of lymph nodes or radiation therapy, which increases the risk for developing lymphedema. At-risk individuals have altered lymphatic function that may impede the body’s ability to take up excess fluids in the tissues.

For those with a confirmed diagnosis of lymphedema or at risk for developing it, consider the following:

  1. Routine medical check-ups
  2. Report changes- such as increase in size, change in sensation, color, temperature, or skin condition
  3. Body Weight- maintain normal body weight and seek help to lose weight if needed
  4. Exercise- incorrect or unsafe exercise may exacerbate lymphedema
  5. Compression garments- wear for air travel, exercise, and exertion
  6. Infections (cellulitis)- be aware of any signs of redness, warmth, pain, fever, or flu-like symptoms
  7. Skin care- maintain proper hygiene and use a moisturizer regularly
  8. Trauma- avoid trauma; protect against falls, fractures, and burns; use non-involved limb for venipunctures; proper nail care
  9. Constriction- ensure properly fitting compression bandages and clothing; avoid tight stockings or bras
  10. Avoid exposure to extreme heat or cold
  11. If you are having surgery, inform your surgery of your lymphedema condition
  12. Stasis- move, change position, and exercise periodically throughout the day
  13. Varicose veins- treating varicose veins may help to reduce lymphatic load and improve lymphedema
  14. Air travel- it is imperative to wear compression garments for the duration of the flight. It is also important to move around and exercise the affected limb and hydrate well to lower the risk of venous thromboembolism

Conquering Lymphedema

by Roseanne Cruz

According to recent studies, the incidence of breast cancer-related edema can range from 6-70%. Lymphedema, which can affect both men and women, is a persistent swelling of a body part due to a blockage in lymphatic flow when nodes or vessels are damaged or abnormal, such as post-radiation or chemotherapy treatment. Individuals who have lymphedema may complain of discomfort or pain in the affected limb, feeling of fullness in the limb, fatigue, or decreased flexibility. They may also complain of breast or pelvic pain, tight-feeling skin, difficulty fitting into clothes, or tightness when wearing rings, bracelets, watches, socks, or shoes.

Lymph drainage therapy (LDT) consists of a gentle massage technique that is said to aid in the circulation of body fluids, drain toxins from the body, stimulate the immune system and the parasympathetic system, reduce pain and/or muscle spasms, increase ROM, and decrease swelling.  LDT 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 LDT.  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,” or do a search through the National Lymphedema Network.

Roseanne Cruz, PT, DPT, LLCC, is certified in lymphedema management through the Upledger Institute.  Roseanne received her B.S. and doctoral (DPT) degree from New York University.  Roseanne has been interested in working with patients with pelvic pain, pelvic floor dysfunction in adults and children, and lymphedema for many years and has spoken in the Greater New York area on these topics. Roseanne is a member of the APTA (Women’s Health and Oncology sections), National Vulvodynia Association, International Pelvic Pain Society, and the National Lymphedema Network.