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Lymphedema Tied to Obesity? Exercise helpful too it seems

Greetings… Part 3a of 3b.

Dr. Halligan, surgeon, Doctor’s Clinic Silverdale, saved my life/legs when he checked to see if the deep lesions on my left leg could be treated without surgery….and wanted a daily cleaning –debriding – and rewrapping of the leg. The doctor ultimately did it himself – everyday in the hospital.

Back home my husband, trained by Doctor’s Clinic Silverdale took over the leg lymphedema wrap.

Restless Leg Syndrome (RLS) – now called

Willis-Ekbom Disease (WED) Foundation www.willis-ekbom.org – was my biggest hindrance to healing.

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“Lymphedema Tied to Obesity

By Todd Neale, Senior Staff Writer, MedPage TodayPublished: May 30, 2012

“Obesity may contribute to the development of lymphedema, a small study showed.

Among 15 obese patients with enlargement of the legs, the average body mass index was significantly greater for those with confirmed lymphedema (70.1 versus 42.0 kg/m2, P<0.001), according to Arin Greene, MD, of Children’s Hospital Boston, and colleagues.

“Our findings suggest that obesity … may be a cause of lower-extremity lymphedema,” they wrote in a letter to the editor in the New England Journal of Medicine.

“As the amount of adipose tissue increases in the lower extremity, lymphatic vessels may become dysfunctional (possibly because of compression or inflammation), thereby reducing proximal lymphatic flow,” they explained.

“Alternatively, elevated production of lymph from an enlarging limb may overwhelm the capacity of a normal lymphatic system to remove the fluid from the extremity,” they continued. “Although lymphedema is typically progressive, we speculate that

http://www.medpagetoday.com/Endocrinology/Obesity/32986

Steven Gardner, political reporter at the Kitsap Sun, will have Bariatric surgery at Swedish Hospital in Seattle probably in the April time frame. Steven tells his story here: http://fieldofsteve.com/

“Obesity is known to be a major lymphedema risk factor” Part 3a of 3b

Fitness and Exercise:

It is very important for individuals with lymphedema to be physically fit and maintain a healthy weight. A safe form of exercise is an essential part of a fitness program for people with lymphedema. Fitness and exercise are not the same. Exercise includes many different types of physical movement. The three main types of exercise are: aerobic, strength, and flexibility.

These three types of exercise, along with Lymphedema Remedial Exercises, are addressed

in this paper. There are many other types of exercise that have health benefits such as Pilates, yoga, Tai Chi, Qigong, aquatic exercise,1trampoline rebounding, breathing exercises, and relaxation exercise that have not been adequately studied in people with lymphedema. However, the person with lymphedema can use the benefits of any system of exercise if he/she follows the general safety principles of exercise with lymphedema, seeks medical guidance, and uses caution in starting any new exercise program.

Exercise and types of lymphedema:

Lymphedema has many causes. The type of exercise that is best for an individual depends upon the severity and cause of lymphedema and other co-existing medical conditions (e.g. heart disease, diabetes, arthritis, etc).

Exercise for breast cancer-related lymphedema is the most studied lymphedema condition. Many conclusions about exercise and lymphedema are based on studies of breast cancer survivors that may or may not apply to other forms of lymphedema.

Lymphedema Remedial Exercise:

Lymphedema Remedial Exercise is a part of treatment for lymphedema when reduction of size of a limb is necessary. Lymphedema Remedial Exercise involves active, repetitive, non-resistive motion of the involved body part.

Exercise in Phase I and Phase II Complete Decongestive Therapy (CDT) (see Position Paper “Diagnosis and Treatment of Lymphedema” http://www.lymphnet.org/pdfDocs/nlntreatment.pdf) is performed with compression as an essential part of the total (complete) reductive phase of lymphedema therapy.

3-5

Lymphedema exercises, used with compression, help the body’s natural muscle pump to increase venous and lymphatic fluid return to the circulatory system and out of the swollen areas. Remedial Exercises for lymphedema are similar to some movements of low impact Tai Chi and Qigong, but are different in that lymphedema Remedial Exercise is used with Phase

I treatment of lymphedema to reduce size of the body part.

Lymphedema Remedial Exercise has been studied and shown to reduce limb swelling.3-5

It is unknown whether Lymphedema Remedial Exercise alone can prevent

lymphedema in at-risk individuals, or whether they can maintain reduction of swelling without compression.

Flexibility or Stretching Exercises:

Flexibility exercises include a wide range of activities that stretch muscle and connective tissues to increase and/or preserve range of motion. Flexibility exercises can minimize skin scarring and joint contractures that may lessen lymph flow. Flexibility exercises should be performed slowly and progressed gradually. Flexibility exercises are not a treatment for lymphedema, but are a part of optimal lifestyle management for reducing the complications of lymphedema. Lymphedema has a tendency to restrict motion of muscles and joints.

Optimal lymphatic function requires full mobility of muscles and joints. Lymphedema from cancer treatment can be associated with tight muscles and connective tissues due to fibrous adhesions from surgery or radiation. Tight muscles and scars from surgery or radiation may require Physical or Occupational Therapy to treat before attempting to do self-stretching.

Specific stretching exercises for cancer treatment-related scars and joint restrictions in an area at risk of lymphedema should be prescribed by a provider familiar with the management of lymphedema. A specialized form of stretching exercise may be required for Axillary Web Syndrome (AWS) or axillary cording, a condition that can occur in cancer survivors who have had axillary (armpit) lymph nodes removed.6

AWS may benefit from treatment by a certified lymphedema therapist and specific home stretches taught by a therapist.7

Resistance or Weight-Lifting Exercise:

Resistance exercises are usually thought of as weight-lifting. Resistance exercises may involve lifting body weight (such as push-ups) or lifting objects (such as dumbbells, weight machines, etc).

Resistance exercises can be performed without moving a joint (isometric) or by moving the joint through a range of motion (isotonic). All of these types of resistance exercise may be utilized by individuals with lymphedema, but should be done cautiously, starting with low weights, low repetitions, and gradual progression. Resistance exercises are performed against an opposing load to enhance muscle power, stamina, and tone. Resistance exercise may reduce limb volume when used as an adjunct to compression therapy8

One study showed that guided participation in resistance exercise, as a part of a total fitness program, did not increase the risk of developing lymphedema in breast cancer patients at risk over the group who did not exercise.9

Lymphedema did occur in both groups. No increase in lymphedema development was noted between the exercise and the non-exercise group. There have been many studies on resistance exercise in breast cancer-related lymphedema that show no harmful effect on lymphedema and beneficial effects for overall health.10-20

Aerobic Conditioning or Cardiopulmonary Exercise:

Aerobic conditioning exercise is often referred to as “cardio” exercise. Aerobic exercise involves activity that uses large muscle groups to increase the heart rate to 60-70% of an individual’s maximum heart rate. This type of exercise, when progressed gradually, increases the heart and lung capacity while also improving muscle conditioning.

Aerobic conditioning enhances cardiovascular fitness, effective weight management, and overall health and well-being, all of which are very beneficial to people with lymphedema from all causes.10-21

Walking, jogging, cycling, and swimming are examples of aerobic conditioning exercise. Aerobic conditioning has not been studied formally as a treatment for lymphedema. One study showed no adverse effect on lymphedema from aerobic exercise.17

Resistance Exercise plus Aerobic Exercise:

Studies of combined resistance and aerobic exercise have shown no adverse effects on lymphedema.21

No studies have specifically evaluated resistance plus aerobic exercise as a stand-alone treatment for lymphedema. One study in breast cancer-related lymphedema showed that the individuals who performed aerobic conditioning and weight lifting had better control of their lymphedema and had fewer flares of lymphedema than those who did not exercise. However, individuals with lymphedema still had to utilize standard lymphedema therapy techniques for flares.

Another study about women at risk for breast cancer-related lymphedema showed that aerobic conditioning and weight-lifting reduced the risk of developing lymphedema.

Considerations for Designing an Exercise Program:

A number of studies have shown that aerobic and resistance exercises are safe and beneficial for people with lymphedema or at risk of lymphedema if they follow the guidelines for progressing slowly, use recommended compression, and report any adverse effects to a professional who can help them adapt their exercise regimen.9,16-21

Most studies on lymphedema and exercise have been done on breast cancer survivors, but the principles may guide exercise in other forms of lymphedema. Individuals with or at risk of lymphedema must report other health conditions that need to be considered in developing a personal exercise regimen (diabetes, heart disease, neuropathy, arthritis, etc).

Modifications of aerobic and resistance exercise that are commonly recommended for individuals with lymphedema are:

1) Allowing adequate rest intervals between sets; 2) Avoiding weights that wrap tightly around an extremity or clothing that cause constriction; 3) Wearing compression sleeves or bandages during exercise; 4) Maintaining hydration; 5) Avoiding extreme heat or overheating; 6) Exercising in a circuit that alters the type of exercise and body part within the exercise session.

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.

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Thanks for reading… Sharon O’Hara

Continued…in Part 3b

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Does a tumor mean Cancer? Part 3 of 4

Sharon O'Hara

Does a tumor mean Cancer? Part 3 of 4

Glimpses of a patient’s life and the medical folks who helped save my life. The University of Washington Medical Center(my lung doctor is here) and the Cancer Alliance of Seattle worked together to give me a life again.

One of the cheeriest technicians I have been around is right there at the University of Washington Medical Hospital. Washington State first class teaching hospital. The U – students and staff – alike is loaded with inquisitive, open minded, brilliant medical doctors teaching students to seek answers to patient’s medical woes.

Of the tremendous group of my tumor surgical medical team, this superb doctor stood out by his mention and appreciation of my first iPad covered Otter when he spotted it at my bedside table. I appreciated his comments and conversation about a non-medical related product. Btw… I think younger people are generally surprised many of us older folks appreciate and use new technology.

The view from my window was of one of my favorite bridges, the Montlake Bridge by the U. Beautiful views helped lessen the pain.

Need you ask? This is without doubt the best-arranged toilet area of any I have had the privilege to know and love. The shower is just on the other side of the low wall. The toilet was at a comfortable height and I let go of the walker, hung on to the low wall, and grasped the support bar on the other side. I gently lowered myself and my new equipment onto the throne.

The day I was standing by the bathroom door when my incision opened and the blood flow began through the popped seal to the machine. The bloody fluid flowed through the fingers I had pressed against the gaping open belly wound trying to hold stuff in where it belonged. Instead, bloody fluid flooded the floor and formed running rivers downhill through my room.

The professionals who answered my call light moved swiftly to stem the bloody flow and no one raised a voice in alarm – not one. I was immobilized in place hanging on to the pole with one hand and feeling the warm blood rush through the fingers of the other. The warm blood flowed on down my legs while they quickly, quietly told me where to move. They did their job with aplomb and took care of a horrified patient…like another normal day. I had an incredible feeling of well-being in spite of the thought other belly parts and stuff might flow past my open fingers over the wound trying to hold back the blood flood.

Checkout day… the dried remains of one of the bloody flows remain under my soon to be vacated bed.

…Inhalers are important to lung patients. The order we take them is also important. I mention it here because my inhalers are rarely dispensed in proper order for the full benefit of my lungs. Luckily, I know the right order to take them and do pass on that information.

I take Foradil first – a fast acting inhaler few nurses have heard of. It is one of the best for me – opens my airway fast. Spiriva is long lasting and second, while Qvar (inhaled steroid) is third.

Harrison Medical Center, University of Washington Medical, and Martha and Mary in Poulsbo – none dispense Foradil…and I do not understand why.

I hope patients and med dispensing folks using other inhaler combinations see they are taken properly.

One nurse told me she did not know there is a proper order to taking inhalers. Why not? One possible answer… If I were in the cancer area recovery, the nurses would be cancer oriented, not lung patient oriented for inhalers.

One of the terrific and friendly docs from my informative medical team. Another super University of Washington/Seattle Cancer Care Alliance doctor that I cannot name due to misplacing my notes/business cards.

Kristin, physical therapist…

Meet Gretchen, one of the outstanding nurses I had and now, my discharge nurse. She is putting together the little vac machine that will collect the fluid from the tube sealed inside the unstapled lower belly surgery site. I will wear it day and night for the next few months…while Harrison Home Health nurses will change it out every three days, per doctor orders.

Gretchen showing how the vac – the entire devise works.

Gretchen read directions and showed me how to change the container when it got full of the bloody belly fluid. I was told an alarm would sound first giving me plenty of time to take care of it.

…Goodbye Nurse Gretchen …another patient going home – another patient tomorrow. Thanks for your care and kindness.

Thank God for nurses like you…and…your detailed instructions on the belly vac came in handy the very next evening at home.

I am very lucky. They found no wingding blooming cancer – only some strange looking cells that bear watching every four months for a while.

Please understand – Kitsap County has first class cancer docs and treatment – I’ve talked to enough cancer survivors to know it.

That said…My first and primary medical condition involves my lungs – COPD first and Sarcoidosis second. I will not do any surgical procedure that involves anesthesia without my pulmonologist as part of the discussion as a consultant. While Karen Eady, MD, is my wonderful primary doctor, right here in Kitsap County, Christopher Goss, MD is my lung doc at the U . Thanks to you all!

Harrison Home Health. Part 4 of 4, next time.

Thanks for reading… Sharon O’Hara

Good-bye and thank you, Lisa Marie. You’ve moved on to a fabulous person and forever home, and we’re grateful for the eight years we had with you. Mom S

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Does a tumor mean Cancer – Part 2

Sharon O'Hara

Christopher Hooper Goss, MD, UWMC is my lung doctor at the University of Washington and was part of the team preparation for my operation. It was clear to me that this operation was mandatory. The huge and growing tumor was killing me and it might be cancerous.

I could and did live with the bone on bone left hip problem. A hip operation is not mandatory.

The growing tumor I hadn’t known about was choking the life out of me. Quality of life had turned into an existence – an existence squeezed with the tumor that filled my belly. As a lung patient, I believe the best chance for a good outcome requires my lung doctor involvement. Luckily, wonderful surgeon and Assistant Professor, University of Washington Medical Center Dr. Urban and her team agreed.

I know Kitsap County has wonderful cancer doctors and professionals. I have been told by survivors and written about them.

In my patient point of view, however – my lung diseases were primary and meant that my best chance for survival and a good result – was including Dr. Goss, my lung doctor with the operating team. I believed then and now that his involvement was vital to my waking up after the operation.

Christopher H. Goss, MD and Sherryl Davey, Medical Specialties Center, Scheduling/Appointments UW Medicine

The aftercare machine was large and the University of Washington Medical Hospital nurses regularly changed out the container holding the fluid. My camera was usually ready whenever I heard the ‘okay, shoot’ from the nurse or technician.

The machine’s tube stuck in my belly pumping the excess fluid away.

To come home the ACTI V. A. C. is the device that let me come home after six days at the University Hospital and into the capable hands of the Harrison Home Health Care folks. Otherwise, I was willing to learn the wet to dry method of wound care and do it myself.

The University of Washington Docs and nurses were universal in their patient interest and I enjoyed listening to the different ideas flow until there was a consensus for treatment.

I have misplaced most of the business cards I had asked for – including for this photo. The girl here was extraordinary in her care and helpfulness. Interesting too, she is a shop steward for the local union – a bright girl.

I write this blog for reasons I have stated many times before. As hard as it is sometimes I have to tell the whole story or I cannot write about them at all.

The fact is there were too many times I had to pull myself into the doorway of my room out to the hall to find someone to help me. It was hard not to notice all the folks at the end of the hall doing nothing but talking together ignoring the light I had on – time after time.

I progressed quickly into pulling myself and whatever I was attached to into the bathroom. I could not wait long enough for the light to get someone there to help me and remember feeling surprised that the aides at Harrison are incredible in their zeal to help patients while the U aide folks were different. Most of the aides I encountered at the U were just the opposite.

One person told me “If you don’t trust me, I can’t help you.” He wanted me to let go of the bed and hang on to him while he lifted me into the bed. (A rule of thumb…a patient needs to be able to get into and out of the bed before they can go home) At that point, another person had helped me discover I could get into bed using the other side of the bed and just needed help lifting my legs up at the same time to lessen the left hip pain.

Trouble is, if he dropped me, I was the one to get hurt not him. I could not do it. Patients need to do for themselves as quickly as possible to heal quickly. Often times, after a while, a nurse answered my call light…not their job – but I’m grateful they did. Incidentally, I rarely called for help.

Truth be told, had those folks worked for me, I would have fired every one that refused to do their job and hire folks with empathy and concern for the patient – such as the aides at Harrison.

On the other hand – the flip side of this coin – if wanting to do things for myself makes me a difficult patient…? I hope not.

This person was wonderful in her care. The plastic is part of the machine that steadily drew the excess fluid and blood out of my belly.

My left leg was still healing from Lymphedema and traces of the recent bloody waterfall show on my upper legs. The machine had apparently lost its suction when I strained in the bathroom.

When I stood up and moved, the backed up fluid burst like a waterfall through the opening in my belly. My hands tried to help the wound close and stem the tide but the bloody fluid burst like a waterfall through my fingers and formed little rivers over the floor.

The portable machine had arrived and the plan was for me to go home the next day. However, after the bloody waterfall I wouldn’t leave until I knew it would stay in and so I stayed one extra day. The doctors, nurses and many of the staff are extraordinary, fun caregiver professionals but I wasn’t comfortable about leaving. The next series of photos show the machine connected in the opening below my staples.

Seeing the gloves go on, I knew the suction tube was ready to be inserted into my belly and the machine turned on.

The tidy row of staples above the opening to be soon filled with the black sponge and suction tube.

Measuring the opening width

…and depth

The black sponge is cut to size and placed inside the open wound with an empty clear tube inside to gather the fluid and run it into a small reservoir on the side of the machine.

The black sponge is inside the wound.

The tube is inside and the plastic type sheet, cut to size will help seal the opening

All finished, the tube and little machine and I were new best friends and almost ready to go home.

More later – Part 3 of 4 next time.

Thanks for reading… Sharon O’Hara

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Does a tumor mean Cancer

Sharon O'Hara

Yesterday I graduated from Harrison Home Health services; an organization I didn’t know existed two months ago and where I learned firsthand that Kitsap County has the greatest group of RN’s and LPN’s on this planet for medical home care.

My June 11, 2012 belly tumor operation at the University of Washington was a rip roaring success, thanks to surgeon, .Renata R. Urban, MD and her superb medical team.

Six days after the operation I returned home to husband and dogs and into the caring, capable hands of the Harrison Home Health services team.

The Harrison Home Health services team followed doctor’s orders exactly – a team care RN or LPN came every three days to change the dressing, including weekends. The vacuum machine hooked to and inside my belly became my best friend 24/7.

At 73, I am lucky to be alive. I’ve learned several health lessons along the way since 1997 – the key one being to continue to do whatever I can to promote early detection Spirometry testing for COPD.(Chronic Obstructive Pulmonary Disease) the third leading cause of death behind heart disease and cancer.

Getting COPD for many of us means taking a nosedive into the immune system and developing other unpleasant medical conditions. COPD is slow developing, taking about twenty years to develop symptoms enough to tell your doctor. By then usually 50 % of the lungs have flipped from the healthy state – they are destroyed.

The fact is I was a healthy physically fit person until I was hospitalized with COPD in 1997. Since then I have gathered one disease after another.

This latest – a fluid filled belly tumor squeezed my lungs making it harder to breathe. It squeezed everything in its path and seemed to shut down my system with a growing hard belly and pain especially in my bone on bone left hip until I reluctantly shuffled from place to place. I canceled and rescheduled doctor appointments thinking the pain would ease with time.

As time passed and my ability to get around decreased, Chuck called various agencies in Kitsap County thinking Kitsap County must have public transportation with a lift available for patients trying to get to medical appointments. The problem was I could not lift my left leg to step up and couldn’t use the right leg either – too painful on my left hip. I could not lift it…only pull it after me.

We discovered one source in Kitsap but it would cost us over $400. to drive around from Poulsbo through Tacoma to the University of Washington Medical Center for my lung appointment.

It felt like something was growing in my belly but the only possibility was impossible so I shrugged it off to imagination. I never imagined a tumor nor mentioned it to my doctors.

Funny thing, a complete physical might well have discovered the hard as a rock-growing belly and tumor, had I not sworn off getting physicals.

It was only when I tried to cancel and reschedule my third week canceled appointment in a row with my pulmonologist, Christopher Goss, MD at the University of Washington Medical Center that I was told ”…couldn’t reschedule for the foreseeable future…” ( the doctor was off to Europe the end of the week)

I told my husband we had to make that appointment no matter what happened because I didn’t think I could manage much longer. We HAD to make that appointment and I asked him to get what I thought would help get me into the Suburban.

It included tying a rope across the back of the front seats to pull me into the back seat once I shuffled my way up the dog plank and it should balance me into turning to sit down. The plank was supported by the borrowed Poulsbo Wal-Mart milk crates he placed underneath the plank.

I shuffled up the plank aided by my walking sticks but the rope failed after I pulled myself inside and let go of one end. The rope wasn’t tied off and I fell forward and twisted with my neck strained across the top of the back seat.

As soon as I could talk, I asked Chuck to get in and drive “We’re making my lung appointment…we’re going to Seattle and ferries don’t wait.”

At the UW’s parking garage, Chuck ran to get a wheelchair and I pulled myself out of the car and into the chair. He raced us to my appointment on the third floor.

I told Dr. Goss about my hard belly and the pain. Thank heavens he looked. When my hard belly wouldn’t budge, Dr. Goss scheduled an x-ray and blood testing. The x-ray showed up black and by the time Chuck wheeled me out of the blood lab, Dr. Goss was there and told us I had a room and that an ultrasound was scheduled in a few hours..

Most medical folks are cool about letting me take photos and allowing me to use them here once I explain about my purpose – COPD and Other Stuff.

Its important that people understand that COPD is only the beginning – an opening door to really nasty, painful medical conditions that follow for too many of us.

Ask your doctor for an early detection Spirometry test. Please.

COPD itself is a long slow smother – not painful. Some of the medical Other Stuff can be really nasty.

Renata R. Urban, MD – Assistant Professor

Department of Obstetrics & Gynecology – Division of Gynecologic Oncology

Seattle Cancer Care Alliance

Following are the photos Dr. Urban sent taken during the operation.

Tumor weight: 1,881 grams

Tumor weight: 1,881 grams

Somehow, I thought of operations as messy and bloody – see the tumor?

The pain from the tumor and the 1.5 gallons of black fluid they drained out twice had taken over my life.

The wonderful team of doctors – and their ability to verbalize with patients was superb…

Great doctors and teamwork

Dr. Urban and team – thanks!

I think this was the pain medicine machine that was available to me checked by a helpful nurse.

I had super docs with a great patient connection. The gowns were worn by everyone who came into my room – MRSA.

Molly Blackley Jackson, M.D. – Attending Physician

Medicine Consult Service, Division of General Internal Medicine. UW Medicine

Dr.Salahi will be a wonderful Radiologist if patient rapport matters. He did a super job of making me feel at ease during an intensive pre-patient interview. I am glad for the opportunity to meet him on his last day in Internal Medicine.

Dr. Jackson was a bright spirit this day and every time she visited after the operation. She and the other docs were incredibly verbal, friendly and informative…Just what this patient would order.

Thanks for reading…Sharon.

Part 2 of 4 Next time… the machine that acts like a sump pump was inserted into my belly and more ….

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University of Washington Medical Center Educating Patients/vs.Nature and Causes of Disrespectful Behavior by Physicians

Sharon O'Hara

Greetings!

I’ve recently returned from a couple days at the University of Washington Medical Center Hospital going through tests I’d only read about and where they ultimately stuck a very long needle in my belly and pumped one and a half gallons of blackish fluid from a tumor that took over the space.

Did you know that an x-ray of a belly full of fluid shows up as a blackish nothing? I didn’t.

Next time I have a few things to say about that including showing photos of incredible shots taken of the inside of my belly drained of the excess fluid and showing the tumor still taking up an inordinate amount of space.

The attending doctor, Brian Story Porter, MD, took the time to show me the photos on a computer in my room and then showed them a second time when my daughter was there. More proof that UWMC doctor’s not only teach medical students, they educate their patients too and have all along!

My lung doctor, Christopher Goss, MD – looks at the whole patient – not just their lungs. His patients are more than a lung, including his disease passion, Cystic Fibrosis.

That said, I was shocked yesterday to run across the following Perspective: A Culture of Respect, Part 1 and 2: The Nature and Causes of Disrespectful Behavior by Physicians and thought you’d be interested too.

I am running most of it here. I’m also asking what we, as patients, can do to help change it?

***

“22 May 2012

Perspective: A Culture of Respect, Part 1: The Nature and Causes of Disrespectful Behavior by Physicians

Leape, Lucian L. MD; Shore, Miles F. MD; Dienstag, Jules L. MD; Mayer, Robert J. MD; Edgman-Levitan, Susan PA; Meyer, Gregg S. MD, MSc; Healy, Gerald B. MD

A substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect. The authors identify a broad range of disrespectful conduct, suggesting six categories for classifying disrespectful behavior in the health care setting: disruptive behavior; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behavior; passive disrespect; dismissive treatment of patients; and systemic disrespect.

At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change. Even more common are lesser degrees of disrespectful conduct toward patients that are taken for granted and not recognized by health workers as disrespectful.

Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients. Disrespect underlies the tensions and dissatisfactions that diminish joy and fulfillment in work for all health care workers and contributes to turnover of highly qualified staff. Disrespectful behavior is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture. A major contributor to disrespectful behavior is the stressful health care environment, particularly the presence of “production pressure,” such as the requirement to see a high volume of patients.

http://journals.lww.com/academicmedicine/Abstract/publishahead/Perspective___A_Culture_of_Respect,_Part_1___The.99620.aspx

Perspective: A Culture of Respect, Part 2: Creating a Culture of Respect

Leape, Lucian L. MD; Shore, Miles F. MD; Dienstag, Jules L. MD; Mayer, Robert J. MD; Edgman-Levitan, Susan PA; Meyer, Gregg S. MD, MSc; Healy, Gerald B. MD

Creating a culture of respect is the essential first step in a health care organization’s journey to becoming a safe, high-reliability organization that provides a supportive and nurturing environment and a workplace that enables staff to engage wholeheartedly in their work. A culture of respect requires that the institution develop effective methods for responding to episodes of disrespectful behavior while also initiating the cultural changes needed to prevent such episodes from occurring. Both responding to and preventing disrespect are major challenges for the organization’s leader, who must create the preconditions for change, lead in establishing and enforcing policies, enable frontline worker engagement, and facilitate the creation of a safe learning environment.

When disrespectful behavior occurs, it must be addressed consistently and transparently. Central to an effective response is a code of conduct that establishes unequivocally the expectation that everyone is entitled to be treated with courtesy, honesty, respect, and dignity. The code must be enforced fairly through a clear and explicit process and applied consistently regardless of rank or station.

Creating a culture of respect requires action on many fronts: modeling respectful conduct, educating students, physicians, and nonphysicians on appropriate behavior, conducting performance evaluations to identify those in need of help, providing counseling and training when needed, and supporting frontline changes that increase the sense of fairness, transparency, collaboration, and individual responsibility.

http://journals.lww.com/academicmedicine/Abstract/publishahead/Perspective___A_Culture_of_Respect,_Part_2__.99622.aspx

***

It all started with Chronic Obstructive Pulmonary Disease and a forty-year smoking habit.

Thanks for reading…. Sharon O’Hara

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Edema, Lymphedema and Cellulitis – you don’t want it

Sharon O'Hara

Do not ignore edema in your ankles and lower legs as I did for years. Get the edema checked out and find out what is causing it. Follow your doctors directions to get rid of it before it develops into something I can promise you do not want, Lymphedema and Cellulitis.

My recent visit to Harrison Silverdale er and Dr. Gilbert Ondusko is fixing my right leg. The great news is the growing painful lump and spreading painful area on my inside; lower right thigh is not a blood clot waiting to burst loose and run amuck willy nilly, hither and yon to create havoc.

Its called Thrombophlebitis a swelling and inflammation of a surface vein and I’m guessing mine was caused by abrasion from the large hard plastic noodle we use for water exercising. The one exercise that could have caused the problem is the slow and fast jumps out of the water, including shifting of feet. We have built up to 125 times and I will be sorry not to continue with that particular exercise because I am getting into a good muscular shape. No doubt, Marilyn will come up with another way to accomplish the same thing without the noodle.

The CEPHALEXIN has done a great job – the pain of the infection on my right leg has decreased to tender and the lump is almost gone.

Almost in direct opposition, the lymphedema in my left leg is alive and throbbing. The antibiotic for the right leg is not doing a thing for the left leg. I’m calling my doctor later this morning because it is not getting better – the skin feels on fire and I’m oozing lymph fluid.

The point of this blog post is to let you know there can be serious consequences to ignoring lower leg edema and the pain is a big part of it.

The gorgeous sunset seen outside the Harrison Silverdale ER. I had to stop and take the picture.

Thanks for reading… Sharon O’Hara

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Lymphedema, Bone on Bone Arthritis, COPD – Prayer, Predisone, Water Workouts Help Heal this Patient

Sharon O'Hara

Regular rehab is fabulous. But? It doesn’t go far enough – long enough – it hurts and it isn’t challenging enough.

Years ago, before beginning a concentrated physical exercise routine I asked my pulmo how high I should allow my heart rate to go and he sincerely and thoughtfully said I probably shouldn’t let it get over 100 at the beginning. I laughed and told him it shoots to 100 just getting up from a chair! I’ve not asked anyone since.

I’ve had a few really outstanding rehab technicians and I’ve learned from them. They have to follow rules though and I don’t. I’m a patient and I’m through coddling myself when I feel sick because I have a goal and it has to happen this year.

Except for one day when I was in Harrison and couldn’t make my swim session…we haven’t missed one swim session since we began 1 February 2011. No matter what, my legs can ooze, my lungs labor and wheeze or burn with a fever – nothing stands in the way of a swim session.

Marilyn Grindrod is my swim coach and a miracle worker. The only thing she said when we met and she asked if my doctor approved of what we planned to do and I told her I believed they did but I would not ever ask my doctors to give me a written note guaranteeing my fitness to exercise. They couldn’t. Nobody could. Marilyn nodded and said, “get in the water, let’s get started.”

She doesn’t say I can’t do something. She leads the way and I follow as best I can. Gradually I’m improving to a physical fitness I haven’t had in years and is proving out what Anna Marx, PT, DPT at Kitsap Physical Therapy in Silverdale proved to me: the right machine/exercise WILL help my left hip get better and manageable.

Marilyn also, by changing my work-outs and her focus on breathing, must be getting oxygen to areas that have suffered without the oxygen they’ve needed…such as the Lymphedema in my lower legs.

Melissa will be surprised when I have to go in to be measured for another set of support stockings. Lower leg muscle will meet her measuring tape, not the flab of yesterday.

My legs (left leg mostly) occasionally still need and get the Old Guy’s expert spiral and padded wrapping when the skin gets too painful and I know if we don’t catch it, the skin will crack and lymphatic fluid will again ooze out. This is the longest stretch I’ve not needed to see a doc or Melissa at NW Orthopedic and Lymphoma rehab in Port Orchard for another outbreak! Melissa’s patient education works.

My ideal week is four, one hour or longer sessions in the warm pool water. The work-outs are nonstop, smooth and I can feel my locked body become more flexible, more agile and I’m beginning to feel muscle again.

A couple weeks ago working out close to the diving board I impulsively reached up and grabbed the end of the board and began doing ‘chin ups’- shooting myself up out of the water and above the board to my chest, lowered myself and repeated 15 times. That was a lot of weight I pulled up – the point is I did it easily – the first twelve anyway.

So, you can’t live a life in the water can you? No. What I can now do on land is lift my left leg about a foot and flex my left ankle. They’ve been – sort of – frozen. When something hurts we have a tendency to back off and it becomes a spiral into a body that doesn’t work and eventually gets dumped into a wheelchair.

My patient opinion is that physical rehab works best, is most effective in the water. The warm pool water resistance gets us further faster with less pain.

I believe in miracles.

In a Pulmonary Function Test two months ago, 16 February 2011 my FEV 1 (Gold Standard for COPD) sats had dropped across the board: 35% – 31% – 29%.

Last week 6 April 2011 across the board they were: 56% – 50% – 48%

Christopher Goss, MD at the University of Washington Medical Center was amazed and doesn’t need to see me again for five or six months.

What made the difference? The longer non-burst of Predisone he extended? A miracle? Prayers? Serious water work-out by a professional swim coach?

My sister lives in a small town in Kentucky and goes to a Revival church. She and her companion each stood up and asked the minister and congregation to “pray for Karen’s sister, Sharon in Washington” and Karen says they do!

Kristin Okinaka, a reporter at the weekly CK Reporter AND a runner recently came out and wrote an article and took a photo that shows some of my recumbent trikes… http://www.pnwlocalnews.com/kitsap/ckr/news/119501909.html

The following article is what prompted this post today: If Great Brittan can do it – we can too!

“Exercise pilot is successful for rheumatoid arthritis

People with rheumatoid arthritis (RA) in Portsmouth reaped the benefits from an exercise pilot, which was the first of its kind in the UK.

Volunteers took part in a 10-week programme to get exercising in the local area. They had tried various activities, including yoga, tai chi, walking and circuit-based exercises.

‘Appropriate, regular exercise is very important for people with rheumatoid arthritis, even when they are experiencing a flare of their symptoms,’ said Colin Beevor, matron and service manager of musculoskeletal outpatient department services at Queen Alexandra Hospital, where the pilot was launched. ‘Being more active helps to control joint swelling and ultimately can reduce the pain, stiffness and fatigue a patient may experience.’

Rather than hospital-based exercise, local facilities were used to encourage participants to become accustomed to working out in a familiar environment. By learning the basics of a variety of activities, participants were also able to discover which forms of exercise they enjoyed the most, with a view to continuing with the exercise after the pilot ended.

Around 700,000 people in the UK have RA, and while many recognise the importance and benefit of exercise for their condition, obstacles such as the prohibitive cost of classes or feeling stigmatised or embarrassed in group classes can stop people with RA regularly exercising.

Local firms such as private gyms and sports centres are now being encouraged to offer discounts to people with RA to enable the participants of the pilot to continue their exercise programme….”

The pilot, run by Portsmouth Hospitals NHS Trust, Solent Healthcare and UCB Pharma Ltd, received positive feedback from participants. http://www.arthritiscare.org.uk/NewsRoom/Latestnewsstories/Exercisepilotissuccessfulforrheumatoidarthritis

More later…thanks for listening… Sharon O’Hara

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Is Cycling Healthier for a Lung Patient with Right Heart Failure Than Walking?

Sharon O'Hara

I am a patient with questions and one of them is:

Is cycling better or healthier for a lung patient with Right Heart Failure than walking.

Based on medical terminology I clearly don’t understand – it APPEARS to say so to this patient…based on the paper I blogged on and the paper I found using the Google search for: oxyhemoglobin desaturation.

“Oxyhemoglobin desaturation can be quite severe and can even lead to damage to vital organs, particularly the heart, to the point of being life-threatening.3”

Identifying Sleep Disordered Breathing in Neuromuscular Disorder Patients

by Joshua Benditt, MD, and Louis Boitano, MS, RRT

***

Chronic Obstructive Pulmonary Disease is one thing, add bone on bone left hip and a person has to really fight to move it and I’m doing in the pool what I can’t do ‘on land’ easily – leg up and loosen and build muscle around that hip so I can ride again. One day the muscling should support it and make it comfortable enough to ride my recumbent trikes again.

I KNOW it will work because when I had physical therapy last year, the personable and talented Anna Marx at Kitsap Physical Therapy in Silverdale put me on a machine I could not only tolerate – a recumbent elliptical – over time I actually loosened up enough where I could and did – close my eyes and built speed and a rhythm on that machine – exactly like riding a recumbent trike, a horse…without the pain of the bone on bone left hip!

I’ve begun working out four days a week with an amazing professional swim instructor and I hope and expect to regain much of the function I lost. There is nothing to lose and everything to gain. It appears to be working – a ‘study’ in itself. More later.

That said, what about my question:

Is cycling better or healthier for a lung patient with right heart failure than walking?

************************

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) exhibit greater oxyhemoglobin desaturation during walking than with cycling. The purpose of this investigation was to investigate differences in ventilatory responses and gas exchange as proposed mechanisms for this observation.

http://pugetsoundblogs.com/copd-and-other-stuff/2011/02/08/a-new-study-for-copders-mechanism-of-greater-oxygen-desaturation-during-walking-compared-with-cycling-in-copd/

Read more: http://pugetsoundblogs.com/copd-and-other-stuff/#ixzz1DTzzcGaW

“Oxyhemoglobin desaturation can be quite severe and can even lead to damage to vital organs, particularly the heart, to the point of being life-threatening.3”

Identifying Sleep Disordered Breathing in Neuromuscular Disorder Patients

by Joshua Benditt, MD, and Louis Boitano, MS, RRT

Joshua Benditt, MD, is a professor of medicine at the University of Washington School of Medicine, Seattle. He is also director of respiratory care services, Northwest Assisted Breathing Center, University of Washington Medical Center. He can be reached at benditt@u.washington.edu. Louis Boitano, MS, RRT, is codirector of the Northwest Assisted Breathing Center, University of Washington Medical Center. Boitano can be reached at boitano@u.washington.edu.

The symptoms of sleep disordered breathing in patients with neuromuscular disease can be subtle, but once recognized and treated, symptoms can improve.

http://www.sleepreviewmag.com/issues/articles/2007-01_03.asp

I don’t know how this all fits together for us – I also have sleep apnea and sleep with a bi-pap and concentrator bleed in to the bi-pap.

More later… Sharon O’Hara

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Lymphedema, Kissing Frogs and the Right Match

Sharon O'Hara

Greetings!

And another reminder that I am a patient – not a medical person. My comments are based on my own experiences and others and I take full responsibility for my opinion and perceptions. My hope is that patients will speak up and question the medical people trying to help us when need be. They can’t help us without an open and honest dialog.

That said, Lymphedema treatment is available. Finding the right help at the right time is not easily available and getting the right treatment for the right diagnosis is sometimes difficult. So is finding the right medical help match for a patient yet both are key to a patient’s survival and the best quality life possible.

Did you ever wonder how many frogs the fabled Princess kissed before she found the right frog? Well, if frogs were medical providers, patients occasionally need to kiss lots of frogs to get the right match.

Lymphedema is nasty stuff and I was sorry to learn lymphedema can be a real problem for cancer patients, especially breast cancer.

Lower leg lymphedema disease is apparently different though since cancer caused lymphedema support groups don’t allow ‘regular’ lymphedema patients to join. I know because I looked for close by lymphedema support groups and learned Harrison Medical Center had one. I called to ask if I could attend a lymphedema support group session and the Harrison spokesperson didn’t think so. She did promise to ask at the next meeting and let me know. That was several months ago.

During the pleasant phone conversation, Harrison’s spokesperson asked how I knew I had lymphedema and I had to say I assumed it was caused from years of ignoring edema and pitted edema.

Her question stayed with me though and I recently asked my pulmonologist at the University of Washington Medical Center what caused it and his answer surprised me “Sleep Apnea” …something to do with ‘insufficiency’…wow, Dr. Christopher Goss, I need to learn more about that!

Lymphedema is lymphedema or isn’t it? When is lymphedema not lymphedema if

Harrison Medical Center’s Lymphedema Support Group is limited only to cancer patients?

I’m happy to say there is good news for ‘Breast Cancer-Related Lymphedema.’

***

http://www.lymphnet.org/pdfDocs/nlnexercise.pdf

JAMA. 2010 Dec 8. Weight Lifting for Women at Risk for Breast Cancer-Related Lymphedema: A Randomized Trial.

Schmitz KH, Ahmed RL, Troxel AB, Cheville A, Lewis-Grant L, Smith R, Bryan CJ, Williams-Smith CT, Chittams J.

University of Pennsylvania School of Medicine and Abramson Cancer Center, Philadelphia (Drs Schmitz and Troxel and Mss Lewis-Grant, Bryan, and Williams-Smith and Mr Chittams); Department of Dermatology, University of Minnesota Medical School, Minneapolis (Dr Ahmed); Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (Dr Cheville); and Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine, Philadelphia (Drs Cheville and Smith).

Abstract

Context Clinical guidelines for breast cancer survivors without lymphedema advise against upper body exercise, preventing them from obtaining established health benefits of weight lifting. Objective To evaluate lymphedema onset after a 1-year weight lifting intervention vs no exercise (control) among survivors at risk for breast cancer-related lymphedema (BCRL)

. …

Weightlifting May Not Increase Risk for Lymphedema in Breast Cancer Survivors http://www.medscape.com/viewarticle/734429

Laurie Barclay, MD

…

December 17, 2010 — A slowly progressive weightlifting program for breast cancer survivors does not increase the risk for lymphedema, according to the results of a randomized controlled equivalence trial reported online December 8 in the Journal of the American Medical Association.

“Breast cancer survivors at risk for lymphedema alter activity, limit, activity, or both from fear and uncertainty about their personal risk level, and upon guidance advising them to avoid lifting children, heavy bags, or other objects with the at-risk arm,” write Kathryn H. Schmitz, PhD, MPH, from the University of Pennsylvania School of Medicine and Abramson Cancer Center in Philadelphia, and colleagues. “Such guidance is often interpreted in a manner that deconditions the arm, increasing the potential for injury, overuse, and, ironically, lymphedema onset. Adherence to these precautions may limit physical recovery after breast cancer and, for some women, result in lost employment.”

The goal of the study was to compare onset of lymphedema after a 1-year weightlifting intervention vs a no-exercise control group among survivors at risk for breast cancer–related lymphedema (BCRL) who were enrolled in the Physical Activity and Lymphedema trial.

“We specialize in the treatment of acute and chronic orthopedic injuries and the evaluation and treatment of swelling disorders including lymphedema and vascular insufficiency.”

http://colpt.com/about.html

FREQUENTLY ASKED QUESTIONS ABOUT LYMPHEDEMA:

1. What is Lymphedema?

Lymphedema is an abnormal accumulation of protein-rich fluid (lymph Fluid) and specialized cells (fibroblasts, keratinocytes) in the spaces between tissues throughout the body. When the lymphatic Fluid cannot be readily moved from the extremity to the trunk swelling is seen in the limb.

2. What causes Lymphedema?

Lymphedema may be primary or secondary. Primary is when swelling is the result of lymph vessels that are too small, too few in number or too wide so the valves cannot work properly. Secondary occurs from some kind of damage to the system. This could include surgery for lymph node removal, radiation to treat cancer, trauma or parasites that block the lymphatic vessels.

3. What are the symptoms of Lymphedema?

Symptoms include tightness, swelling or thickening anywhere in the trunk or extremity, feelings of heaviness in the extremity, difficulty fitting into clothing in one specific area. Swelling may increase with activity and decrease with rest.

4. Why did I get Lymphedema?

Medical science is not able to determine why one person gets lymphedema and the next person does not. It probably has to do with the number of lymphatics you had originally and what percentage are not working.

5. Is Lymphedema curable?

Lymphedema is not curable; however, it is manageable with treatment.

6. What kind of treatment is available for Lymphedema?

There is a treatment approach called Complex Decongestive Physiotherapy(CDP). This method consists of several parts including manual lymphatic drainage, bandaging, proper skin care, compression garments, remedial exercises, and self-manual lymphatic drainage and bandaging. This treatment can be done by a physical therapist that has extensive training in the subject.

6. What happens if Lymphedema is not treated?

Lymphedema is chronic and progressive. If it remains untreated the protein-rich fluid continues to accumulate which could lead to increased swelling and hardening (fibrosis) of the tissues. The protein-rich fluid is a perfect environment for bacteria to flourish which could lead to recurrent infections. Untreated lymphedema can also lead to skin breakdown and loss of motion in the joints of the affected limb.

****

We have one life and, my opinion, a patient’s best bet is to get educated about whatever we have and learn how to best handle it.

Kitsap County Library System has a book on Caregiving for Lymphedema at the main library.

There are other helpful books the Silverdale Library (360-692-2779) had donated to them:

100 Questions & Answers about Lymphedema

Lymphedema: An Information Booklet

Lymphedema Management: The Comprehensive Guide for Practitioners

Melissa at the Center for Orthopedic & Lymphatic Physical Therapy in Port Orchard mentioned using a soft baby brush to clean the affected skin and it worked fine once my husband duck taped the baby brush to a section of pvc pipe. The extra length makes leaning over easy for a lung patient and he made two – the second one I use to apply the skin lotion. Dry skin cracks too easily for lymphedemia’ites.

I thought you’d enjoy seeing this old car photo. December 2009 I was rushing to Harrison Silverdale ER but had to stop to take this photo! I don’t know why the old car was there, what kind of car it is, who owned it or why it was parked with the stuffed critters outside the ER.

Part 4 of 4

More later… Sharon O’Hara

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Harrison’s Strength is in Her Volunteers and Staff

Sharon O'Hara

If the employees are representative of the leadership at Harrison Medical Center – Harrison will be around long after most of us living today move on to frolic and ride the best horses, in that great rainbow in the sky.

Friday, 9 April 2010 I had an appointment with Melissa Mercogliano at Center for Orthopedic & Lymphatic Physical Therapy in Port Orchard for a leg wrap.

She wouldn’t touch the right leg. I was infected again. (I cannot wrap your leg when it is infected – get to a Prompt Care now!) I opted for the closest one, Harrison Port Orchard Urgent Care: – across the street from Melissa’s Port Orchard office.

There I met Pamela Starling, ARNP and Tiffany Campbell, MA and was treated to an amazing medical visit… a culture taken of the infected area – a first of all the times I’ve seen medical folks in Kitsap County for the same problem…Harrison Port Orchard Urgent Care’s Pamela Starling, ARNP took a culture.

Tiffany Campbell expertly and loosely wrapped my right leg, I had a prescription for an anti biotic I had not had before and went home with instructions on leg care until the culture developed in a few days and Pamela promised she would be back in touch.

Pamela called on Tuesday, the 13th – she had the culture results. It was a serious infection requiring a different antibiotic.

A problem was that the antibiotic in tablet form was incompatible with another drug taken therefore the antibiotic had to be administered intravenously …in a hospital.

Pamela called my primary physician and she called me about the concern and recommended I go to Harrison Bremerton’s ER. After some confusion there, I was admitted into the “M” ward. Hooked up with IV’s, I was fed two different antibiotics.

The first thing I noticed was the toilet height – child size and I laughed. What I didn’t realize until I sat down and got up for the first time is how smart Harrison was to listen to their physical therapists.

The height is PERFECT for helping patients ‘leg up’ (build muscle) in the legs simply by sitting down and getting up from the toilet.

Harrison helps patients help themselves maintain or gain muscle while a patient in the hospital. They know muscle utilizes oxygen better than flab and the biggest muscles in the body are the upper leg muscles.

For years, my mother was in and out as a heart patient at Harrison. I was used to the sparkling, spacious modern cardiac ward and had not remembered the older section. The Cardiac ward is quite different from the ward I was in.

Once I learned it was not a ward reserved for pulmonary patients, I relaxed and opened my laptop.
Thanks to my first roommate’s visiting computer whiz son and granddaughter I set up my laptop in the hospital and learned how best to prop it up for typing.
The back of a pillow worked fine.

During the time Tuesday, 13th – Sunday, 18th I was a patient I had three different roommates – 3 different conditions.
I heard firsthand in the middle of the night or daytime, nurse and staff voices change from ordinary fun and interesting tones turned instantly into the perfect professional relating to the medical issues of their patients – patients with serious medical conditions I never knew existed.

The nurses, aids and staff reacted instantly, professionally and show kind concern doing jobs that must be difficult at times, I observed from the way they interacted with my different roommates.

The M ward is not an ordinary ward. The patients and their medical conditions were life and death – including operations – no two alike.
The ward held a collection of everything and the staff was ready in an instant for anything. They could and did handle whatever needed doing with immediate efficiency and professionalism. Their warmth and caring shone through everything they did.

The M ward and people I met there won’t be forgotten. I had a good time and enjoyed the people working there.

Something else Harrison has right is their volunteer group of dedicated people – one woman showed her 25-year pin for volunteering and I had two incredible hand massages – so relaxing. They were expertly done and complimentary from friendly volunteers.

The only thing I would do differently is supply my own low sodium V-8 juice -a funny story for another time.
Thank you …Pamela Starling, ARNP – you thought outside the circle and cultured my leg infection. You found – specifically – what infection I had in order to treat it with the RIGHT ANTIBIOTIC.

For anyone thinking edema is funny – a joke – take a look at something that can develop from simple puffy feet and lower legs and developed into one of the most relentless pain I have ever felt.

You can avoid it – talk to your doctor. Take edema seriously. I did not.

Following is the recent five-day quick turnaround Cellulitis/Lympthedema story in pictures.
(I have the pictures I want separated and marked in one folder – I HOPE – I can get them in order into this post)

Thanks to Joe Jack Davis, MD, Harrison’s Wound Care Center, for the idea of taking photos and his observations during his hospital visit. My photos have proven to be invaluable visuals of the healing process and I have been gathering them for a couple years. My husband is the photographer AND leg wrapper.

The photos here visually show how quickly the infection began to heal especially when I compare them with the past infections in my lower legs.
The right leg only completely healed a couple weeks ago – it went deep.

End of Part 1

Part 2 deals with the $11,376.32 loss to Harrison after two insurance companies paid $1,100.00 and $5,109.58.
How long can any business survive if they are compelled to absorb such losses? I discovered some answers from Harrison’s new Patient Financial Supervisor, Christine Warner.

Part 2 – More later… Sharon O’Hara

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