COPD and Other Stuff

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Posts Tagged ‘obesity’

Lymphedema Tied to Obesity? Exercise helpful too it seems

Monday, March 11th, 2013

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

/p


Lymphedema Risk Reduction Practices Part 2 of 3

Friday, March 8th, 2013

  Greetings!  Part 2 of 3 is the, “Summary of Lymphedema Risk Reduction Practices”

Note that “Obesity” is mentioned as a risk and I’ll have more to say about it in part 3. 

A reminder to ask your doctor – I’m a patient who believes in patient education.  Talk to your doctor.

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“Summary of Lymphedema Risk Reduction Practices

Please refer to the complete Risk Reduction document for details.

 

I. Skin Care – Avoid trauma / injury to reduce infection risk

Keep extremity clean and dry.

Apply moisturizer daily to prevent chapping/chafing of skin.

Attention to nail care; do not cut cuticles.

Protect exposed skin with sunscreen and insect repellent.

Use care with razors to avoid nicks and skin irritation.

If possible, avoid punctures such as injections and blood draws.

Wear gloves while doing activities that may cause skin injury (e.g. washing dishes, gardening, working with tools, using chemicals such as detergent).

If scratches/punctures to skin occur, wash with soap and water, apply antibiotics, and observe for signs of infection (i.e. redness).

If a rash, itching, redness, pain, increased skin temperature, increased swelling, fever or flu-like symptoms occur, contact your physician immediately for early treatment of possible infection.

II.

Activity / Lifestyle

Gradually build up the duration and intensity of any activity or exercise. Review the Exercise Position Paper.

Take frequent rest periods during activity to allow for limb recovery.

Monitor the extremity during and after activity for any change in size, shape, tissue, texture, soreness, heaviness or firmness.

Maintain optimal weight. Obesity is known to be a major lymphedema risk factor.

 

III. Avoid Limb Constriction

If possible, avoid having blood pressure taken on the at-risk extremity, especially repetitive pumping.

Wear non-constrictive jewelry and clothing.

Avoid carrying a heavy bag or purse over the at risk or lymphedematous extremity.

IV. Compression Garments should be well-fitting.

Support the at-risk limb with a compression garment for strenuous activity (i.e. weight lifting, prolonged standing, and running) except in patients with open wounds or with poor circulation in the at-risk limb.

Patients with lymphedema should consider wearing a well-fitting compression garment for air travel. The NLN cannot specifically recommend compression garments for prophylaxis in at-risk patients.”

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In part 3,  I’ll show you the two kinds of leg support stockings I use and why I like them.  There are many other support stockings out there – ask your doctor what she/he recommends.   Also, I’ll show you several tools that aid in putting them on.

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


Reduce risk of developing some forms of cancer – drop to a healthy weight

Wednesday, December 5th, 2012

Tubby’etes … Somehow I’ve seriously packed on an excess of thirty pounds or so since my tumor operation and I’m back to seriously climbing stairs.  I began again this morning. The possibility that obesity increases the risk of ‘developing some form of cancer’ is a call to cut obesity loose and off this short frame.

Poulsbo women, if any of you are 100 or more pounds overweight, you are welcome to join me in a health quest of diet and exercise.

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  • From: National Heart Lung and Blood Institute.

“ Your weight may be affecting you more than you may think.

Even a few extra pounds each year can affect your quality of life.

There are many benefits to achieving and maintaining a healthy weight that will improve your health and life in the short-term. These include:

If you are overweight or obese, losing weight and being physically active can help you control your blood sugar levels.

Weight loss of at least 5 percent of your body weight may decrease stress on your knees, hips, and lower back.

Weight loss often improves sleep apnea.

Not only can extra weight cause joint pain, it can lead to serious chronic diseases. If you are overweight or obese, losing just 5 to 10 percent of your weight can lower your chances of developing heart disease, type 2 diabetes, or having a stroke. Other long-term health benefits of having a healthy weight include:

 

    Reducing your risk of developing some forms of cancer.

    Lowering your risk for developing gallstones and fatty liver disease.”

http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/onepound.htm

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

 


Quest for Better Health: Whatever It Takes!

Friday, August 27th, 2010

Quest for Better Health: Whatever It Takes!

The Cystic Fibrosis Research, Inc.’s recent 23rd Annual Education Conference’s rallying cry for 2010 is the best I’ve seen anywhere, for any disease, for any life standard. It gives me the nerve to publically ask for help.

Quest for Better Health: Whatever It Takes!

Following are a few quotes from the warm welcome given the Cystic Fibrosis Research, Inc. participants by S. Joseph Simitian, State Senator, 11th District that can be applied to all medical conditions.

“…event is a valuable opportunity to bring people together to share the latest information … treatment, research, and services…. applaud the conference participants, volunteers and staff …for their efforts to provide education and support for individuals living with … raising awareness … and the need for continued research, you …make a difference.”

http://www.cfri.org/pdf/ConferenceBrochureFINAL,pdf.pdf

Quest for Better Health: Whatever It Takes!

Who will join me to work together for one common goal, lose obese weight for medical and health reasons through education and practice of proper nutrition and exercise?

Each of us would become active participants by taking turns to research different nutrition and exercise topics and become a speaker to our group. We will learn and teach each other…a fun and educational commitment.

I hope that we will have professionals assist from time to time…otherwise, we’re patients helping patients.

If we are a small group, we can meet in my ex living room turned exercise room. It contains a treadmill, elliptical, recumbent trike, bow flex, dumb bells and a few other items.

The price is your time to get healthy through research, nutrition and exercise. In addition, for me, it is the support a group of like minded people can supply to help me do what I must…drop this weight. I’d like to meet at least three times a week…but I’m flexible.

Quest for Better Health: Whatever It Takes!

For more information or to offer suggestions, call 360-337-1454 and ask for Sharon.

A friend has even offered $1,000. to the person who loses the most weight in seven months.

More later… Sharon O’Hara


Will Employee Health Incentives Work? Should They?

Tuesday, May 18th, 2010

Chris Henry is writing a story of health, businesses and employees.
I could not stop myself from responding and decided my thoughts from my present patient standpoint and past small business owner belonged here too.

The fact is patients are not given enough information in my opinion.

Chris Henry, reporter says: “We all know what we should do to take better care of ourselves — eat healthier, exercise more, reduce stress (good luck on that last one). Employee wellness programs aim to get workers practicing better self care, but are they actually effective?”

Sharon, patient says:
If the velvet gloves are removed and employees are SHOWN (get patient volunteers) examples of life with different medical conditions caused by -smoking is one example- I’d guess a good percent of the present or wannabe employees might well change personal habits to reflect self preservation and to keep a good job.

If I had a small business today and included paid medical insurance for my employees, I would have a checklist for prospective employees to answer and incentives for present employees to get in the fitness lineup.

Blunt words and visual frankness works.

Years ago a good friend and 30 year smoker read a Reader’s Digest article showing photos of healthy lungs next to a chronic smoker lungs.
My friend told me he felt sickened and stopped smoking immediately.
He also showed me the article, yet I went on to smoke another 20 years or so.

Obesity is a despised condition by seemingly everyone, yet the productivity of an obese person can be double the effectiveness to the business of a ‘normal’ sized person.

I once had someone tell me I needed to get rid of one of my employees because her appearance did not reflect well on my business.

Why not?

She was fat…way fat…obese…truly a genuine tubbyette.

I told him I could not. For one thing, I liked her and she had worked for and with me too many years, since she finished school. She had also become the most productive employee I had.

The day came when she asked for another raise. She was at capacity. She was well worth a raise, no issue there.
The trouble is the way my pay scale worked I couldn’t give her one without losing money.

Therefore, to give her a well-deserved raise, I figured out new prices to her clients and I became a business with two price tiers and cost percentages within the tiers.

The reason for this little story is twofold.

1. Look beyond appearances.

2. Knowing what I know today about health issues, I would never have hired her based on her unhealthy size and lost out on getting to know a remarkable, artistically talented, kind, thoughtful individual. She became family.

http://pugetsoundblogs.com/kitsap-caucus/2010/05/18/employee-wellness-programs-do-they-work/

More later…Sharon O’Hara


Lungs Win the Fight Against Fat

Saturday, January 30th, 2010

If we are in a boxing match, Fat in one corner, and Lungs in another, Fat wins every time.
Why?
Fat takes up the chest room Lungs need to expand and for lung patients, fat compromises our ability to breathe.

The fat v lungs slammed home to me a couple weeks ago when a granddaughter, taking a new class on her way to becoming an RN, told me she just learned that each pound of excess fat is fed by SEVEN MILES of blood vessels.

I went online that night and found an airport-scanned photo (Digg) of a 250-pound woman next to a 120-pound woman. Fat filled her stomach and chest crowding her lungs and heart. Heaven knows what all that fat is doing as it surrounds and crowds the kidneys, bladder and other organs….it cannot be good!

Look, fellow Tubby’ettes and join me. To date, I have lost 133 miles of excess blood vessels supporting nineteen pounds of excess fat.
Regular Tubby’ettes is lucky if their health is not yet compromised.

Lung patients, easing the fat surrounding our lungs will not change the PFT numbers, but we are bound to feel a sigh of relief from our lungs as the fat around them retreats and they can finally expand to capacity and add to our quality of life.

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Obesity and the lung: 5 • Obesity and COPD
Thorax 20 08;63:1110-1117 doi:10.1136/thx.2007.086827
Abstract
Chronic obstructive pulmonary disease (COPD) and obesity are common and disabling chronic health conditions with increasing prevalence worldwide. A relationship between COPD and obesity is increasingly recognized, although the nature of this association remains unknown. This review focuses on the epidemiology of obesity in COPD and the impact of excessive fat mass on lung function, exercise capacity and prognosis. The evidence for altered adipose tissue functions in obesity—including reduced lipid storage capacity, altered expression and secretion of inflammatory factors, adipose tissue hypoxia and macrophage infiltration in adipose tissue—is also reviewed. The interrelationship between these factors and their contribution to the development of insulin resistance in obesity is considered. It is proposed that, in patients with COPD, reduced oxidative capacity and systemic hypoxia may amplify these disturbances, not only in obese patients but also in subjects with hidden loss of fat-free mass. The potential interaction between abnormal adipose tissue function, systemic inflammation and COPD may provide more insight into the pathogenesis and reversibility of systemic pathology in this disease.”
• Review series
1. F M E Franssen1,
2. D E O’Donnell2,
3. G H Goossens3,
4. E E Blaak3,
5. A M W J Schols1
1. 1
Department of Respiratory Medicine, University Hospital Maastricht, Maastricht, The Netherlands
2. 2
Division of Respiratory and Critical Care Medicine, Department of Medicine, Queens University, Kingston, Ontario, Canada
3. 3
Department of Human Biology, Nutrition and Toxicology Research Institute (NUTRIM), Maastricht University, Maastricht, The Netherlands
1. Dr A M W J Schols, NUTRIM School for Nutrition, Toxicology and Metabolism, Department of Respiratory Medicine, University Hospital Maastricht, P O Box 5800, 6202 AZ Maastricht, The Netherlands; a.schols{at}pul.unimaas.nl
• Received 15 February 2008
• Accepted 30 April 2008
• **************************
• http://digg.com/health/Body_Scans_of_a_250_lbs_Woman_vs_120_lbs_Woman
More later… Sharon O’Hara

Fat Airport Scan


The Ugly Psoriasis Picture

Thursday, May 21st, 2009

Psoriasis is many things – what it is not is just a skin disease. Some is painful – some is disfiguring – worst of all – it primarily hits our kids.

It is not enough for the kids to work their way thru puberty – many live with, most try to hide, the attention getting scales and crust of psoriasis.

Psoriasis is one of the early diseases I acquired after the initial COPD diagnosis when I was about 56. I was beyond the usual psoriasis age but COPD seems to be a trigger leading to Other Stuff. Psoriasis is one of mine.

I had it on my hands, elbows and the top of both feet. I cut off the top off my slippers so nothing touched the crusty, splitting, sometimes bleeding, scales. I had it a couple of years before the worst of it disappeared.

Dr. Barnes, University of Washington, Dermatology Department, diagnosed my psoriasis and he has the distinction of being the first and only medical doctor to recommend an on-line support group.

He called my psoriasis “a textbook case” and prescribed Clobetasol Propionate Ointment…probably outdated now.
He was the most outspoken, frank and informative doctor I had known up to that point. I felt like a student, exactly how we should be treated -he was an educator.

The online support group taught me about the kids out there with this ugly disease and how it affected them – many tragically, but right there, right then, they connected, shared experiences and their lives with each other.

• Psoriasis often appears between the ages of 15 and 25, but can develop at any age.
• Psoriatic arthritis usually develops between the ages of 30 and 50, but can develop at any age.

We have a girl right here in Kitsap County who is one of the exceptions. She does not cover up and hide. Psoriasis covers her…but it doesn’t run her life. She lives life to the fullest, plays sports in school and wears a ‘Here I Am’ folk’s hat. She is active in school and out of school.

Psoriasis does not have a physical support group anywhere in Washington – too bad. The shy kids with psoriasis should meet this student. A girl, a peer, with an attitude.
We need a combined support group filled with inspirational people to learn from – this girl for one.

Another, a woman I met from Mason County who has had five different arthritis operations – more importantly, has a terrific, upbeat attitude about them and many practical experiences to share including ideas she tried that didn’t work… If anyone is interested in being part of such a support group, let’s talk.

“Psoriasis appears to be associated with higher levels of a hormone that may contribute to obesity and metabolic abnormalities, according to findings by researchers in Taiwan (Chen YJ et al. Arch Dermatol. 2008;144[12]:1571-1575). “
Found in January 2009 Jama

“The Psoriasis and Psoriatic Arthritis Research, Cure, and Care Act (H.R. 930/S. 571) … need additional co-sponsors – Contact the Psoriasis Foundation … action@psoriasis.org or 800.723.9166,
ext. 407.

I wonder how many of us in Kitsap County have psoriasis?


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This is a patient to patient blog to exchange information and resources...from COPD (Chronic Obstructive Pulmonary Disease) to Arthritis to Cellulites to Sarcoidosis to Sleep Apnea to RLS to Psoriasis to Support Groups to Caregivers and all points in between. Written by Sharon O'Hara.

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