Total Page Views

StepUp-SpeakOut.Org BlogSpot

Hello and welcome to the StepUp-SpeakOut.Org Blog Spot.

We will be using this blog for fast updates on news and information in the field of Secondary Lymphedema as a result of Breast Cancer.

We will be posting articles and information on new research and treatments, legislative and insurance information, and other pertinent information, and invite your comments.

Tuesday, August 14, 2012

Manual Lymphatic Drainage: Immune Booster?

About Lindsay  Link to original blog posting

In addition to her role as Clinic Director at Toronto Physiotherapy, Lindsay Davey is a Registered Physiotherapist with various post-graduate certifications including Combined Decongestive Therapy, Manual Therapy, and Acupuncture. Prior to completing her Physiotherapy degree Lindsay earned a Master's in Cancer Research at Princess Margaret Hospital in Toronto.

It is well appreciated that environmental and behavioral factors such as diet, stress, sleep, and fitness can significantly alter our susceptibility to infection.  Typically, when we think of these factors either enhancing or suppressing immune system function, we think of them altering the behavior of our infection-fighting white blood cells: our Leukocytes and Lymphocytes.  While these specialized cells are clearly the all-stars of our immune team, proper immune function requires more than just their game-day readiness. For starters, they need to show up to the game in the first place!  Individuals suffering from chronic swelling such as lymphedema 
have just this problem – a reduction in the circulation of infection and cancer fighting white blood cells.

Lymphedema is a form of chronic swelling that occurs in localized areas of the body (such as in a limb) due to impaired lymphatic system function.  The lymphatic system normally acts to transport excess fluid back to the heart for redistribution.  Congenital lymphatic deficiency or lymph node damage / removal during cancer therapy can disrupt this system, resulting in local fluid stagnation and the characteristic swelling.  Since white blood cells rely on proper fluid circulation for transportation, it is not surprising that lymphedema-affected limbs exhibit weak immune response, altered transportation of white blood cells, and increased risk of both local infection and cancer.  But can this depressed immune activity be recovered through decongestive therapy, a treatment that reduces lymphatic swelling but does not repair the underlying lymphatic system damage?  A small pilot study published this past month (Szolnoky, G. et al. J Eur Acad Dermatol Venereol. 2012 Jul 23) examined this very question:
The authors took eight patients with breast cancer-related lymphedema and exposed a small area of their normal and lymphedematous arms to a protein derived from the tuberculosis bacterium.  They measured the resulting immune response and found, as expected, that it was suppressed in lymphedematous arms relative to healthy arms.  Next, they treated patients with manual lymphatic drainage and compression therapy over a two week period and re-tested immune response.  Patients receiving therapy not only experienced a significant reduction in limb size, but also a substantial boost in immune response – and in only two weeks.
This study and the related body of research suggest something very poignant to individuals suffering from chronic swelling: not only is there a direct negative relationship between swelling and immune function, immune activity can be boosted almost immediately through effective management practices such as manual lymphatic drainage massage and compression.

Monday, August 13, 2012

Attai: A vital question for all women: Are you dense?

By the time I see my breast cancer patients, many of them already know their diagnosis. All are shaken by the discovery of cancer, especially those whose cancer was found belatedly and who thought they had done everything right — regular mammograms and self-exams — to catch any cancer early.
While tumor biology often dictates the course and aggressiveness of the disease, early detection can improve the chances of survival, which is why doctors recommend regular mammograms.
Yet, as a surgeon specializing in the treatment of breast disease, I know that mammography is far from ideal. This is particularly true for women with a normal and common condition called dense breast tissue — a relatively higher concentration of glandular tissue to fatty tissue.
But while normal and common, the added risk presented by dense breast tissue is not well known among women, which is why the California Legislature declared last Wednesday "Are You Dense? Day," as was called for in a resolution authored by state Sen. Joe Simitian, D-Palo Alto.
The goal of "Are You Dense? Day" was to inform women that dense breast tissue both increases the risk of cancer and makes it harder to detect. Dense breast tissue is present in approximately 40 percent of all women undergoing mammograms. Yet, fewer than 10 percent of women are aware of their breast density.
Women who are aware of their breast density, and who talk to their physicians about it, are more likely to discover any abnormalities early in their development. Every year in this country, approximately 200,000 women will be diagnosed with breast cancer, and approximately 40,000 will die from it. A woman with dense breast tissue is four to five times more likely to develop cancer than a woman without it.
The breast is a very difficult and complex organ to image. Because both dense breast tissue and cancer and calcifications create a mammogram image that is mostly "white," looking for cancer amid dense breast tissue has been described as "trying to find a polar bear in a snowstorm."
A woman with dense breast tissue has a 50 percent to 75 percent chance that her cancer will be missed on a screening mammogram, increasing the likelihood that it will not be detected until a later stage, possibly when it is no longer potentially curable.
In many areas of medicine, patients are given a copy of test results and can ask about results they do not understand. This often does not happen with a mammogram. The federal Mammography Quality Standards Act dictates that centers that perform mammography provide a woman with a "layperson letter," which in very basic terms notes whether an abnormality is present or not. It might commonly say "your mammogram shows no evidence of cancer," along with a recommendation to return in one year.
The patient's physician receives a very different report. It will describe detailed findings, including a notation of the density of the breast tissue such as "due to the breast density, the sensitivity of mammography is limited." Many physicians inform the patient only that the mammogram was "normal." Most women with dense breast tissue do not know that their mammogram might have missed something.
To assure that women receive this information, Senate Bill 1538, introduced by Simitian, would require that the patient's mammogram report include breast density information and suggest further discussion with her doctor of the possible benefits of additional screening.
The root of the word "doctor" is from the Latin docere — "to teach." Physicians should welcome the opportunity to provide patients with information and guidance.
"Are You Dense? Day" seeks to educate women about the importance of asking about their breast density.
If they learn they have dense breast tissue, this should prompt further discussion regarding risk factors and whether additional imaging such as ultrasound or MRI might be helpful, depending on the individual situation. Even though no imaging technique is perfect, supplemental screening increases the chances of discovering cancer, and newer, more sensitive tests are continually being developed.
Only when patients are provided with full test results, placed in proper context, can they partner with their physicians to make decisions that are in their best long-term health interest. Ask your physician, "Am I dense?"
Deanna Attai, M.D., is a breast surgeon at the Center for Breast Care Inc. in Burbank. She has been in practice for 17 years and has focused exclusively on the care of patients with diseases of the breast since 2004.
© 2012 Ventura County Star. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. 

Read more:

Individualized Care Best for Lymphedema Patients, MU Researcher Says

MU researcher directs foundation that reviews published research; makes recommendations based on findings
By Kate McIntyre
COLUMBIA, Mo. – Millions of American cancer survivors experience chronic discomfort as a result of lymphedema, a common side effect of surgery and radiation therapy in which affected areas swell due to protein-rich fluid buildup. After reviewing published literature on lymphedema treatments, aUniversity of Missouri researcher says emphasizing patients’ quality of life rather than focusing solely on reducing swelling is critical to effectively managing the condition.
Jane Armer, professor in the MU Sinclair School of Nursing and director of nursing research at Ellis Fischel Cancer Center, said many insurance providers and health care professionals assess whether lymphedema patients need treatment based solely on how swollen their limbs are. However, several studies have shown that the volume of fluid doesn’t necessarily correspond with patients’ discomfort.
“Practitioners need to treat the swelling while considering patients’ distress. We don’t want to burden them with unnecessary or ineffective treatments,” Armer said. “Health care providers should focus on managing symptoms and choose carefully among various treatments to provide individualized care plans that comfort patients, which may require modifying existing protocols.”
In their literature review, Armer and her colleagues found that Complete Decongestive Therapy (CDT), a comprehensive approach for treating lymphedema involving skin care, exercise, manual lymphatic drainage and compression of the swollen limbs, may be the best form of specialized lymphedema management.
“Patients have different medical needs and come from culturally diverse backgrounds. They have different goals, support systems, pain levels and treatment tolerances. All these factors influence patients’ responses to care, which affects their well-being,” said Marcia Beck, a review co-author and an MU graduate who now works at Truman Medical Centers in Kansas City, Mo.
“Caring for lymphedema patients should be flexible and adjusted to maintain patients’ quality of life,” said Ausanee Wanchai, another co-author who received her doctorate at MU and now teaches at Boromarajonani College of Nursing in Buddhachinnaraj, Thailand.
In a separate literature review, the researchers found that Intermittent Pneumatic Compression (IPC) therapy, in which sequential inflatable devices surrounding swollen limbs are used to increase lymphatic circulation, is beneficial as an adjunct therapy for chronic lymphedema patients who have limited or no access to medical care; patients can use the compression devices in their homes.
Armer said further research is needed to demonstrate the usefulness of various lymphedematreatments, such as CDT and IPC. The literature reviews were the third and fourth in a series of 12 to be published in conjunction with the American Lymphedema Framework Project (ALFP). As director of the ALFP, Armer works alongside clinical experts and investigators to increase awareness of lymphedema and related disorders. The ALFP was founded in 2008 and is headquartered at the MU Center for Lymphedema Research, Practice and Health Policy. Its steering committee and staff currently are partnering with the International Lymphedema Framework (ILF) in producing an updated edition of the ILF Best Practice Document from 2006.
The article, “Palliative Care for Cancer-Related Lymphedema: A Systematic Review,” recently was published in the Journal of Palliative Medicine. Armer’s co-authors also included researchers from MU and the University of Texas. The other review, “Intermittent Pneumatic Compression Therapy: A Systematic Review,” was published in the journal Lymphology earlier this year. Researchers from the NorthShore University HealthSystem, Walter Reed Military Medicine Center and University of Texascontributed to the review.
Story Contact: Jesslyn Chew, (573)