Tag Archives: Journal of the American Medical Association.

Lymphedema, Kissing Frogs and the Right Match

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.’

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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.

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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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Mummies and Fast Food and Clogged Arteries

Sharon O'Hara

The following study shoots down many of today’s theories with the discovery that clogged arteries existed 3,500 years ago.
Clogged arteries show up everywhere, even thousands of years ago.

What does the National Bank of Egypt in Cairo, Siemens Healthcare in Florsheim, Germany, and St. Luke’s Hospital Foundation in Kansas City, MO have in common? They supported the study showing the recent discovery of 3,500-year-old mummies with clogged arteries and not a Big Mac or Fries in sight.

So far as I know, no fast food restaurant existed 3,500 years ago, so who do we blame and tax now for making present day America a nation of obese, tubby folks?
Big Macs, French fries and fast food restaurants are not to blame, folks…they were not even a twinkle in someone’s eye 3,500 years ago.

Randall Thompson, MD … “”I tell my patients that I think these ancient Egyptians had a genetic hand-me-down as my patients do,” Thompson said, “that we have to look beyond traditional risk factors to explain atherosclerosis.”

Randall Thompson, MD from Mid America Heart Institute, Kansas City, MO made the surprising report at the American Heart Association meeting in Orlando and in the November 2009 issue of the Journal of the American Medical Association.
“
Of the 16 mummies housed in the Egyptian National Museum of Antiquities in Cairo that had vascular tissue available for CT examination, nine had probable or definite evidence of calcification in the arteries.

“The calcification in these arteries looks just like it does in modern humans,” Thompson said.

Co-author L. Samuel Wann, MD, of Wisconsin Heart Hospital in Milwaukee, said it was surprising the mummies had calcification at all.
“We would have thought that atherosclerosis and heart disease is a disease of modern man, a disease of McDonald’s, if you will.”

The oldest mummy to have the finding — Lady Rai, nursemaid to Queen Ahmose Nefertari — lived between 1570 and 1530 BC.

Although ancient Egyptians did not smoke tobacco or eat processed foods, and likely didn’t lead sedentary lives, the researchers said, they were not a society of hunter-gatherers.
“Agriculture was well established in ancient Egypt and meat consumption appears to have been common among those of high social status,” they said.
Additionally, Thompson said, the ancient Egyptians salted their food for preservation, and so they may have had a high salt diet.

Commenting on the study, Sidney Smith, MD, of the University of North Carolina at Chapel Hill, said, “Food other than that which comes in packages can also do us in.”
“The study emphasizes the importance of understanding dietary and environmental factors that may cause coronary disease,” said Smith, an AHA spokesperson.

On the other hand, the development of atherosclerosis could be at least partially hard-wired in humans.
“I tell my patients that I think these ancient Egyptians had a genetic hand-me-down as my patients do,” Thompson said, “that we have to look beyond traditional risk factors to explain atherosclerosis.”
He said this helps his patients get past some of the guilt and denial about their condition.

The idea for the study came from a visit to the museum by two of the study authors. They noticed that the descriptive plate next to one of the mummies — Pharaoh Merneptah — said he had had atherosclerosis.
The researchers didn’t believe that there would be any way of knowing that, Thompson said.

So a team of Egyptologists, preservationists, and imaging experts used six-slice computed X-ray tomography to examine 22 mummies, selected because they were in good condition.

They dated from 1981 BC to 334 AD. Of the 16 for which social status could be determined, all were from a high social class. They were either members of the pharaoh’s court or priests and priestesses.
Evidence of vascular tissue was found in only 16; four had an intact heart.

Definite atherosclerosis — defined as calcification in the wall of a clearly identifiable artery — was present in five of the mummies. Probable atherosclerosis — defined as calcification along the expected course of an artery — was found in another four.

Atherosclerosis was significantly more common in the mummies estimated to be at least 45 when they died (87% versus 25%, P=0.029), but it was equally likely in men and women.

“While the presence of calcification does not demonstrate that atherosclerosis was a common cause of clinically manifest disease or death,” the researchers said, “it does provide evidence that humans in ancient times had the genetic predisposition and environment to promote the development of promote the development of atherosclerosis.”
http://www.medpagetoday.com/MeetingCoverage/AHA/17061?utm_source=WC&utm_medium=email&utm_campaign=Meeting_Roundup_AHAtherosclerosis.””

More later… Sharon O’Hara

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