Tag Archives: Dr. Halligan

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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Dr. Halligan, Harrison Medical Center, Lymphedema Update – Part 3 of 3

Sharon O'Hara

Thanks to four weeks at Harrison Medical Center Bremerton, Dr. Halligan, Doctor’s Clinic Silverdale and Martha & Mary Rehab Center in Poulsbo and my husband, Chuck, the latest annoying, painful Lymphedema outbreak is almost healed.

I hope with continued use of support stockings, I will never again see the open, painful weeping sores running down my lower legs.

Ignoring edema can lead to nasty painful Lymphedema outbreaks – not a place to go, folks – listen to your doctor.

The last two Lymphedema lesions might have healed months ago had not RLS or whatever the problem is, not raised havoc then and now forcing me to stand and move – the direct opposite of what I needed to do.

Following is Lymphedema By the Month Photos – from September 2011 to date.

And to think – it all started with Chronic Obstructive Pulmonary Disease after a forty year smoking history.

Thanks for reading…Sharon O’Hara

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Dr. Halligan and Harrison Medical Center Angels, Part 2 of 3

Sharon O'Hara

Our recent tragic killings and deaths make me doubly grateful for the incredible people and treatment I received from our hometown hospital and staff at Harrison Medical Center.

Those of us who have been patients there over a length of time know Harrison’s greatest assets are in their staff. Their nurses and aides, many named Elizabeth and one each named Joseph and Daniel. Joseph is notable for nursing skills and his uncanny ability to find anything….even a bridge….as in my missing two-tooth bridge. He found it in a little container with “?” on the lid.

Nurse Elizabeth on 3N is only one example of innovative, creative thinking.

Look at the contraption she put together to take the pressure off the bottom of my left calf to lessen the pain of the open weepy lesions and help it heal faster. The devise worked so well that when I was shifted down a floor they wheeled me downstairs right on the bed.

Nurse Sylvia on 3N brought me the Kitsap Sun newspaper every morning she worked. I always knew she was on shift when I awoke and spotted the Sun on my bedside tray. When I was moved to the private room on two – her spirit lifting thoughtful placing of the Kitsap Sun on the bedside table continued and never failed to make me grin in thanks.

A complication was the UW positive testing for MRSA. You do not want it – hospital visitors do not want you to have MRSA either. Gowning up and wearing rubber gloves to visit a friend in the hospital might well cut down on regular hospital visits. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004520/, http://www.mayoclinic.com/health/mrsa/DS00735

Dr. Halligan, Doctor’s Clinic in Silverdale, treated my leg daily in the hospital…he never failed to continue his daily treatment and re-wrapping of my lower left leg.

(I am hoping to go home tomorrow from rehab at Martha & Mary’s Rehab Center in Poulsbo. I have not been home in 8 weeks).

More later.

Thanks for reading…. Sharon O’Hara

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Dr. Halligan and Harrison Medical Center Angels, Part 1 of 3

Sharon O'Hara

I am writing this from a hospital bed on the cancer floor at Harrison Medical Center in hope someone will take note what edema can and may do to those who ignore it.

Also, I’m writing in heartfelt thanks to Dr. Halligan, Internist/Surgeon at Silverdale Doctor’s Clinic who saved my life and leg recently by taking over failed treatment for my Lymphedema/Cellulitis/Edema filled legs and painstakingly, day after day treated and changed leg wraps.

Dr. Halligan patiently explained my left leg needed debriding to remove the dead skin, much as burn victims and he couldn’t tell what was under the surface dead skin or how deep the dead tissue went. This four-month pain riddled sleep deprived patient gratefully lay in a bed at Harrison Bremerton 23 hours a day, 7 days a week. Four weeks total this Thursday.

Tomorrow, Wednesday, I am moving to a rehab place for rehabilitation and further healing.

I battled without success since early September the Cellulitis/Edema in my left leg until my right leg reddened with infection and edema and began the water blisters that experience taught would lead to lymph fluid running down my lower legs, scalding the skin it touched and spreading the poison…

Chris Goss, MD, my lung doc at the University of Washington Medical Center straightened out the Restless Leg Syndrome medication problem so I could sleep if the pain eased.

Edema patients – PLEASE – check out the following photos of the latest rise and fall of my edema filled legs and ask yourself if ignoring edema is worth it.

Dr. Halligan – thank you!

More next time on Harrison Medical Center’s Angels in disguise.

….thanks for reading. Sharon O’Hara

Thanks for reading…Sharon O’Hara

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Cancer Loses – Kathi Trostad of Poulsbo Wins

Sharon O'Hara

Cancer Loses – Kathi Trostad Wins

13 Jun e 2011 marks six months cancer-free for survivor Kathi Tronstad of Poulsbo!

After four operations in five and a half months, after times being told, “You have Cancer”, Kathi celebrates six months CANCER FREE.

Where does the Kathi Trostad cancer story begin?

Did her childhood add to the someday-adult Cancer risk?

1. Kathi’s mother took DES to avoid miscarriages when she was pregnant with her.

2. Kathi was sexually abused as a young child that turned her as an adult into an outspoken child advocate

3. Kathi took HRT and lived with stress.

5. Female

6. Kathi’s mother’s aunt died of breast cancer about 1942.

7. Kathi’s mother had breast cancer, developed Lymphedema and lived another 27 years with COPD and the Pulmonary Fibrosis that killed her brother.

8. Kathi’s father had prostate cancer, and it spread later to his bones and lungs. His stomach ruptured and he bled to death.

9. Her uncles died of lung and prostate cancer. Each of Kathi’s parents had a sibling female with uterus cancer in their 30’s but both survived to their 70’s.

“Then cancer came to my cousins but still I was told I had only a small risk.”

Following is Kathi’s story…

In April of 2010 after feeling rotten and in treatment for a UTI and kidney stones, I went to the ER in Silverdale. An urgent care doctor said I might have Diverticulitis. Of course I said oh, no wouldn’t I know if I did?

2 1/2 weeks in the hospital to drain the abscess in my colon then home to rest and of course I had a hole although it didn’t show up on the test so then I had a fistula. I was making 3 dozen krumkake one night and was on #30 when I thought I was getting too warm from the iron, so I put on summer pajamas.

On the #34 krumkake, I went in the bathroom, saw a red round circle on my tummy, and took my temperature, 102ᵒ. After doing #35 and #36 krumkake, I told my husband to get me to the Silverdale ER fast. Emergency surgery drained the wound. They left it open for a colon resection the next week. I was feeling lucky, feeling great and could eat for the first time.

I was on 4 West and I love those people – they were so good to me! My surgeon is Dr. Halligan and what an angel of a man. I had 18 inches of colon removed – all old abscess scars – so how I am alive is a miracle.

Of course, I had to change my check up with my gyn doctor and to get my regular mammogram so when I was well enough in August, I had no idea what was ahead.

December 13th I was diagnosed with breast cancer and then again on the 21st so I had a double lumpectomy on the 22nd. I had one node involved.

Hearing it was cancer 3 times is a tad much. I felt sorrier for Dr. Halligan than for myself but he did a fabulous job. It looks more like the cosmetic mini-breast reduction that I was wanting.

Two years ago without all these new tests now available, they would not have found the spots. I had tumor tests so did not need chemo and the 60 dose4s or radiation left me only a little tired.

The day after my last radiation treatment, I started my work on the NK Relay For Life. Claudia Kilburn has joined the team too. I spoke for a couple minutes at Poulsbo’s Daughters of Norway, they donated $100 to the ACS, and another member gave me a check for $25. We have lost too many members to breast cancer.

Dr. Halligan has ordered two low key years for me -maybe a tad boring!!! 4 surgeries in 5 1/2 months is a bit much but it is all on the same deductible so it is all good! I have met so many wonderful people it has been a blessing and I have renewed passion for some things I do.

My tumors were found in a regular mammogram and could not be felt by me or any of my doctors.

I was shocked when my doctor told me that the Norwegian community in the PNW has a lot of MS and breast cancer. I have heard of pockets of both here. They do not know why. My brother just passed away May 29 of Muscular Dystrophy at 42 years – most of those years in a wheelchair.

I now have about 36″ of scars on my torso! The cancer center has a knitting class for us to help us think after all the meds, drugs and such. I was new that day and we were of course discussing things. We were thinking of all the positive things that had happened to us during treatment.

Breast Cancer survivors is a real sisterhood (men get it too). Cancer does not care who you are or what your plans are. Nobody cares how much or how little money you have, what kind of house you live in, or if you have many degrees or none.

One of the funny comments was that now I have no need for dental records!

The NK Relay For Life is July 8-9. God is good. Our team name is the Peninsula Cancer Center. Dr. Madsen asked me to join on one of my first visits to her, which to me was a good sign! The good Dr. thinks I will be here to do it!

The morning of Dec. 13 when I went for the first report after having a biopsy at the hospital I was planning lunch with my husband and then some more Christmas shopping for the grandkids. The sun was out and the sky was blue! When my doctor told me I just got light headed and thought, he is saying something I do NOT want to hear, but I simply said how much of this can you do before the end of December so I can get it on the same deductible as my resection! The blessing here was I had already had 3 surgeries with Dr. Halligan and so I knew I was in good hands and could trust his judgment. My breasts look great, the incisions are pristine, and fine lines almost the same color as my skin.

I saw three doctors at the Peninsula Cancer Center in a calm atmosphere instead of me driving around the County to different appointments. They had met before I arrived to discuss my case and the plan. The bottom line is I am not maimed. When I count my blessings, I count Dr. Halligan twice!

I am in the best health of my life after 60 doses of radiation and I have met so many wonderful and helpful people in this past year.

We have a wonderful health community here. Dr. Halligan, Dr. Truong, Dr. Chiricella, Dr. Madsen, Dr. Meeks and Dr. Esser all got me the best care right here at home. I know me and if I had to go to Seattle every weekday for six weeks for radiation I would not be this far along to recovery! In addition, my tumors were tested so I did not need chemo because of the type they were. I do need to say that Harrison Hospital, AMI, the 4 WEST staff, Kristen Bakke at KPT and KPS did so much to make my recovery seem easy. My husband of almost 44 years, Rob, did everything he could to make recovery easier. There are so many people to thank.

Over the last year, I have learned so much about myself. So many people have helped along the way.

The day after my last radiation treatment, I met with Brie Storset at Starbucks to discuss the NK Relay For Life. Brie oversees the Relays in Kitsap and Mason County.

I know I am blessed and I do count my blessings every morning. I thank God for life.

While 4 surgeries in 5 1/2 months is a bit over the top, I do know lots of prayer and God given skill by my caregivers set me on a better path. I feel great, which is new to me but I am adjusting after feeling so awful for so long. I believe there is purpose in all of life’s experiences and I intend to spend the rest of my life doing things to help find a cure. Cancer still makes me grit my teeth.

I have had too many friends and family die from it and some at a young age. My daughter said that cancer will be sorry it paid me a visit.

One of the staff at the Center told me that I know how to make lemonade out of a basket of lemons. I do indeed!

Today I am a six-month survivor of Sequential Breast Cancer. I intend to have many more birthdays!!

One of the North Kitsap Cancer activities is the NK Luminaria Ceremony honoring those still fighting and those who have passed away.

Melanie Cena is the Luminaria Chair for this year’s North Kitsap Relay For Life.

moalie43@hotmail.com

American Cancer Society | www.RelayForLife.org |1.800.227.2345

Following are faces of cancer. The photographer for the first 5 is Kathi’s husband, Rob Trostad – 6th photo was taken by son-in-law, Marshall Menne.

Photos:

1. Me in the radiation room with Anthony, a radiation therapist. It was not scary or embarassing. He was showing my husband and they let Rob see the computer and watch while they did the treatment.

2. Me in front of the Peninsula Cancer Center

3. Me ringing the bell to celebrate my lst treatment, it is a tradition in cancer centers and let people in the clinic know that one more person has graduated.

4. Sometimes I wore costumes. One the second day Anthony said he could see me in a Vking helmet and my hair braided! The cake is a Boob Cake to celebrate the best breast care anywhere. Dr. Madsen loved it! You need comnedy relief during treatment. I went as the first day of spring,a leprechaun and a Viking Warrior princess and I wore hats.

5. Me with my radiation therapists, Cheri and Anthony

(these might me out of order as my memory is still a little off)

6. Life goes on. Be with my grandchildrens who are teenagers first cousin on their daqd’s side. I look healthy and holding newborn mattox was a healing experience. This is the best photo I have had of me in years!!!

Thanks, Kathi! Your inspiring story is a Shout Out – why so many people are so passionate about cancer. My own daughter led a Federal Way Cancer team last night.

Thanks for reading…. Sharon O’Hara

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