Tag Archives: Center for Orthopedic & Lymphatic Physical Therapy

Lymphedema = Pain = More Pain = Avoidance = Get Educated = Get Fit

 

Lymphedema = Pain = More Pain = Avoidance = Get Educated = Get Fit  

National Lymphedema Network – Educating Patients Online 

Part 3b of 3b 

Exercise and Compression Garments:

Lymphedema Remedial Exercise as a part of CDT requires compression garments or bandages.3-5 There are no studies on the use of compression garments when performing stretching or flexibility exercise alone.

Our visiting young cousin from Norway rode her first recumbent trike in Silverdale and wore "What is COPD" tee shirt while she was here.
Our visiting young cousin from Norway rode her first recumbent trike in Silverdale and wore “What is COPD” tee shirt while she was here.

My young cousin, Malin from Norway is included here because COPD (Chronic Obstructive Pulmonary Disease) began in 1997 for me and led into my long ride into medical conditions – one after the other and my gathering weight attracted lymphedema as surely as fresh bread and butter sticks to peanut butter and strawberry jam. 

“The NLN Medical Advisory Committee (MAC) recommends using the guidelines for aerobic and resistance exercise to guide use of compression during flexibility exercise since flexibility exercises may be combined with other forms of exercise. 

The amount and type of compression for exercise should be decided with input from a professional knowledgeable about lymphedema. There is no strong evidence basis for the use of compression garments during exercise; however, most experts in the field of lymphedema advise the use of compression during vigorous exercise for people with a confirmed diagnosis of lymphedema.

Melissa showing me the latest fast, protective lower leg support
Melissa showing me the latest fast, protective lower leg support

Melissa Mercogliano, Center for Orthopedic & Lymphatic Physical Therapy in Port Orchard, WA. recently showed me a new and easy way to add support stockings…easy except for we Tub’ettes.

“One study suggested that individuals with lymphedema who do resistance exercise without compression may increase swelling. 

20 Resistance exercise may reduce limb volume when used as an adjunct to compression therapy in people with confirmed lymphedema.

8 One study showed that aerobic and weight-lifting exercise was safely performed without compression in women at risk for breast cancer-related lymphedema.

9 That study showed patients who developed lymphedema could continue to exercise with compression garments. Compression garments should be measured by an individual trained and experienced in fitting compression garments for lymphedema and should be at least Class I compression for upper extremity. Higher classes may be required for more severe lymphedema and for lower extremity lymphedema.

 1-IMG_29033-IMG_29074-IMG_2909

Custom sized, each leg. This pair is old...notice the crinkles below the rubber dotted band. The replacement compression stockings are black.This pair is about one year old.
Custom sized, each leg. This pair is old…notice the crinkles below the rubber dotted band. The replacement compression stockings are black.
This pair is about one year old.

I throw the stockings in a little zippered mesh cloth bag and into the washer on a short cycle, regular soap, extra rinse – cold water and smooth out and let them hang to dry.

I prefer the toe less stocking so my toes don’t get scrunched up and have two different kinds. The little rubbery tips around the tops of both help them from sliding on down my leg and cutting off circulation.  Ask your doctor. 

“A hand piece (gauntlet or glove) is recommended when exercising with a sleeve to avoid causing or exacerbating hand swelling. 

Definition of Individuals At Risk for Lymphedema:

Individuals at risk for lymphedema have not displayed signs and symptoms of lymphedema but may have sustained damage to their lymphatic systems through surgical lymph node removal or radiation therapy.

Additionally, individuals at risk may have surgical incisions in the vicinity of lymph transport vessels.

Individuals who have family members with hereditary lymphedema may also be at risk.

An individual’s risk of lymphedema may change over time depending on factors such as weight gain, age, and changes in medical condition. 

It is the position of the NLN that:

Exercise is a part of a healthy lifestyle and is essential for effective lymphedema management

Before starting any exercise program, individuals should be cleared for the program of activity by their physician.

Lymphedema Exercises (also known as Remedial Exercises) are specific rhythmic muscle and breathing exercises used as a part of lymphedema treatment in Phase I and Phase II

Complete Decongestive Therapy (see the NLN Position Paper on Diagnosis and Treatment). http://www.lymphnet.org/pdfDocs/nlntreatment.pdf 

In Phase II lymphedema maintenance, these exercises can be combined with or integrated into a regular exercise program.

After intensive treatment with CDT, the person with lymphedema should work with the certified lymphedema therapist or qualified lymphedema specialist provider (MD, NP) to adapt their remedial exercises into their fitness and weight management program at the time they are moving from Phase I (treatment phase) to Phase II (self-management).

Individuals with or at risk for lymphedema can and should perform aerobic and resistance exercise in a safe manner.

The individual with or at risk for lymphedema may benefit from working with an Exercise Physiologist and/or Personal Trainer. The person with lymphedema should inquire if the trainer or exercise physiologist has experience working with lymphedema and other medical conditions. Certification for personal trainers varies. Patients who are unsure of about the qualifications of a community exercise practitioner should work with a certified lymphedema therapist or health care provider to assist them in finding a community exercise program or professional.

In general, individuals with a confirmed diagnosis of lymphedema should utilize compression garments or compression bandages during exercise.

Individuals at risk for lymphedema may or may not utilize compression garments during exercise; this is an individual decision to be made with guidance from a care provider and/or therapist based on risk, activity, and conditioning level.

Individuals at risk for lymphedema will benefit from most forms of exercise tailored to their individual needs.

Individuals at risk for or with a confirmed diagnosis of lymphedema should avoid repetitive overuse of the affected part. Sudden increase in an individual’s usual exercise duration or intensity may trigger or worsen lymphedema. It is likely that a program of slowly progressive exercise for the affected body part will decrease the potential for common daily activities to result in overuse.

Exercise should be started gradually, increased cautiously, and stopped for pain, increased swelling, or discomfort.

The risks of exercise for the individual with or at risk for lymphedema must be balanced against the risks of deconditioning that undoubtedly results from not exercising. A deconditioned body part with or at risk for lymphedema can do progressively less without risk of overuse. As a result, exercise is recommended for those with and at risk for lymphedema.

The NLN cannot specifically determine the safety of exercise for any individual. The guidelines in this Position Paper provide general principles, but do not substitute for medical evaluation and recommendations from a health care professional. It is the responsibility of all individuals with or at risk for lymphedema to consult with their health care provider regarding their own specific needs. 

References:

1. Tidhar D, Katz-Leurer M. Aqua lymphatic therapy in women who suffer from breast cancer treatment related lymphedema: a randomized controlled study. Support Care Cancer. 2010;18(3):383-392.

 2.Moseley AL, Piller NB, Carati CJ. The effect of gentle arm exercise and deep breathing on secondary arm lymphedema.Lymphol. 2005;38(3):136-145.

3.Boris M, Weindorf S, Lasinski B, Boris G. Lymphedema reduction by noninvasive complex lymphedema therapy. Oncol (Williston Park). 1994;8(9):95-106; discussion 109-110.

4.Földi E, Földi M, Weissleder H. Conservative treatment of lymphoedema of the limbs. Angiol. 1985;36(3):171-180.

5.Földi M, Földi E, eds-in-chief. Foldi’s Textbook of Lymphology for Physicians and Lymphedema Therapists, 2nd ed. Munchen, Germany:Urban & Fischer; 2006.

6.Bergmann A, Mendes VV, de Almeida Dias R, do Amaral E Silva B, da Costa Leite Ferreira MG, Fabro EA. 

Incidence and risk factors for axillary web syndrome after breast cancer surgery [published online ahead of print October 17, 2011].

Breast Cancer Res Treat. doi:10.1007/s10549-011-1805-7.

7.Fourie W, Rob KA. Physiotherapy management of axillary web syndrome following breast cancer treatment: discussing the use of soft tissue techniques. 

Physiotherapy. 2009;95(4):314-320. 

 

NLN • 116 New Montgomery Street, Suite 235 • San Francisco, CA 94105

Tel: 415-908-3681 • Fax: 415-908-3813

Infoline: 1-800-541-3259 • Email: nln@lymphnet.org •

Online: www.lymphnet.org 

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Several years ago, I called Harrison Medical Center and asked if non-cancer patients with lymphedema could attend their support group meetings.  At that time, it was limited to cancer patients.

Yesterday I called the following number to be certain it was still up to date.  It is and the closest Lymphedema Support Group I know about.

If anyone knows of more, let me know – I can post it here.

 

Kitsap County Closest Support Group 

Northwest Lymphedema Center

Kent, WA (24.11 miles * Meeting times: Date varies  Phone: (206) 575-7775 

 

Tub’etts! 

I’d like to be part of a support group of fatties who NEED to lose weight for their health’s sake – with or without current medical issues. No dues – a scale and occasionally health professionals willing to talk to us – to educate us – to motivate us – guest speakers. 

I have been told that I’m not a good candidate for bariatric surgery…so, before I push that particular button – is there anyone beside me, who wants to be part of an obese/tubby support group to work together for weight loss and good health? 

To lose weight through good nutrition and exercise is my goal. 

We are dying of too much fat, fellow Tubby Ones.

Will you join me in our battle to shed the fat and live healthy?  Let me know…

 

Thanks for reading… Sharon O’Hara familien1@comcast.net

Kitsap County Library System has educational Lymphedema books for the layperson – just ask.

Lymphedema Stockings, Cream and Garden Gloves

Greetings!  Following are a few photos showing how to get compression stocking on step by step.  Each patient is different and what works for me/us, may not work for anyone else…ask your doctor.

That said, Mellissa Mercogliano of Center for Orthopedic & Lymphatic Physical Therapy in Port Orchard has not seen these photos and may note that we may be off from what she taught us  and  is not responsible for it.  She IS responsible for educating us and  leading to comforting and pain free leg wraps.


Part 3 of 4

More later…. Sharon O’Hara

Meet Lymphedema’s Healing Hands – Mellissa Right and Mellissa Left

Mellissa Mercogliano of Port Orchard’s Center for Orthopedic & Lymphatic Physical Therapy, is a Lymphedema patient’s healing and educational angel, in my opinion…and I am in no pain.  Following are a few photos of  Chuck”s wraps, thanks to Melissa’s tutoring – we’re getting better!  We use a mirror when I need to see what is going on and to take photos if need be.  The flashlight is an aid on an overcast day.

Mellissa’s healing hands


Melissa’s final touch…sensible, inexpensive masking tape to hold the wrap.  Note the herringbone elastic wrap to prevent the leg swelling edema to pop between the wrap like a striped swollen and puffy rising dough boy.

Melissa progressed this patient from someone who couldn’t stand the touch of the most delicate fabric against the skin of my lower legs to one who can.

Part 2 of 4

More later… Sharon O’Hara

Lymphedema and “Coaching With Compassion…”

A new acquaintance recently mentioned she had never seen a blog all about COPD and I didn’t correct her that “Other Stuff” is probably the main reason I am extra passionate about COPD and the lack of early detection Spirometry testing by the medical community for the unwary public.  And, for me, a whole new life began with a COPD (Chronic Obstructive Pulmonary Disease) Harrison Medical Center hospital stay in 1997.

The really nasty and painful medical conditions I’ve gathered began after COPD arrived on my doorstep.  My focus is to bring awareness to slow or prevent COPD from developing in people using the simple, fast Spirometry early detection.

Without the COPD door opener, would I have gotten these other diseases?  Probably not.  They should not be allowed to develop –  no one wants them.

Among them….

Venous Stasis Dermatitis

Cellulitis

Lymphedema

The following study results explain a lot to me, including – maybe – why I was able to walk up to the gas guzzler on World COPD Day 2010, lift my right leg up to the running board WITHOUT the stepstool, drag my foot close enough to pull myself up and ease into the driver’s seat for the first time in about a year.  Without the footstool.  Driving isn’t an issue – getting into the seat is.  Was.

I came to believe that treating my legs was hopeless – that I was doomed to an increasing level of open sores running ooze down my lower legs and to the most amazing unrelenting pain.  I’d been treated by good people in two different places with the same results.  I wouldn’t go back.

My doctor told me about another person in another place. I was reluctant to go and would not until the pain made me weary and desperate enough to see anyone – even Red Riding Hood’s wolf.

Melissa at Center for Orthopedic & Lymphatic Physical Therapy in Port Orchard could well be a poster child that “Coaching With Compassion…”works.  She reaches and teaches patients.  I know.

********

Coaching With Compassion Can ‘Light Up’ Human Thoughts

Coaching happens just about everywhere, and every day, with learning as the goal.

Effective coaching can lead to smoothly functioning organizations, better productivity and potentially more profit. In classrooms, better student performance can occur. Doctors or nurses can connect more with patients. So, doing coaching right would seem to be a natural goal, and it has been a major topic of research at Case Western Reserve University’s Weatherhead School of Management since 1990.

For all the energy and money spent on coaching, there is little understanding about what kind of interactions can contribute to or detract from effectiveness. Ways of coaching can and do vary widely, due to a lack of understanding of the psycho-physiological mechanisms which react to positive or negative stimulus.

Internally funded research at Case Western Reserve has documented reactions in the human brain to compassionate and critical coaching methods. The results start to reveal the mechanisms by which learning can be enhanced through coaching with compassion (a method that emphasizes the coached individual’s own goals).

“We’re trying to activate the parts of the brain that would lead a person to consider possibilities,” said Richard Boyatzis, distinguished university professor, and professor of organizational behavior, cognitive science and psychology. “We believe that would lead to more learning. By considering these possibilities we facilitate learning.”

Boyatzis and Anthony Jack, assistant professor of cognitive science, philosophy and psychology, have used functional magnetic resonance imaging (fMRI) to show neural reactions based on different coaching styles. Their research builds on previous knowledge of Intentional Change Theory, which holds that positive and negative emotional attractors create psycho-physiological states that drive a person to think about change.

Boyatzis, a faculty member at Weatherhead School of Management, and Jack, director of the university’s Brain, Mind and Consciousness Lab, say coaches should seek to arouse a Positive Emotional Attractor (PEA), which causes positive emotion and arouses neuroendocrine systems that stimulate better cognitive functioning and increased perceptual accuracy and openness in the person being coached, taught or advised. Emphasizing weaknesses, flaws, or other shortcomings, or even trying to “fix” the problem for the coached person, has an opposite effect.

“You would activate the Negative Emotional Attractor (NEA), which causes people to defend themselves, and as a result they close down,” Boyatzis says. “One of the major reasons people work is for the chance to learn and grow. So at every managerial relationship, and every boss-subordinate relationship, people are more willing to use their talents if they feel they have an opportunity to learn and grow.”

What Boyatzis and Jack set out to do was to observe brain images which reflect coaching tone. Undergraduate volunteers met with two academic coaches, who intentionally used different interviewing methods. One encouraged envisaging a positive future, and the other set a more standard tone by focusing on a person’s failings and what he or she ought to do.

“We know that people respond much better to a coach they find inspiring and who shows compassion for them, rather than one who they perceive to be judging them. Sure enough, we found a trend in the same direction even for the neutral questions. Students tended to activate the areas associated with visioning more with the compassionate coach, even when the topics they were thinking about weren’t so positive,” Jack said.

“We were really struck by one particular finding in the visual cortex, where we saw a lot more activity in the more positive condition than in the more negative condition,” Jack explained. The brain areas observed are associated with imagination and operate at the intersection of basic visual processing and emotion. Jack says the fMRI images show the neural signatures of visioning, a critical process for motivating learning and behavioral change.

“By spending 30 minutes talking about a person’s desired, personal vision, we could light up (activate) the parts of the brain 5-7 days later that are associated with cognitive, perceptual and emotional openness and better functioning,” Boyatzis said. “The major implication is that people typically coach others in higher education, medicine and management with a bias toward the NEA and correcting what the person is doing that is wrong. Our study suggests that this closes down future, sustainable change, as we expected.”

Coaching with Compassion: An fMRI Study of Coaching to the Positive or Negative Emotional Attractor was presented at a recent Academy of Management Annual Meeting in Montreal and awarded as a Best Paper.

“Everyone’s got to look at weaknesses and take them on,” Jack says. “But often the focus is so much on the bottom line that we worry ourselves into the ground. It is more important to focus on what gets you going in the morning and gets you wanting to work hard and stay late.””

http://www.medicalnewstoday.com/articles/208498.php

A Lymphedema Story  Part 1 of 4

Never give up – Trek Tri Island American Lung Association of Washington

More later… Sharon O’Hara