Tag Archives: Melissa Mercogliano

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.

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

Harrison’s Strength is in Her Volunteers and Staff

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