I’m telling my recent Northwoods story backwards, my outpatient, twice-weekly rehab ends at the Northwoods picturesque, characteristic salt-water rehab pool and into a new beginning.

Other than my first solo horse-packing trip into the Cascades and living through a host of learning experiences, I have seldom learned so much in one week as during my stay at Northwoods, a five star rehab center just north of Silverdale. 

I hope to progress as I should, working out at home and/or in a commercial pool.  The primary goal here is to rebuild the muscling around my arthritic bone on bone left hip in order to pedal a recumbent trike.

One of Northwoods rehab specialist, Jeff, actually got me RUNNING in the chest high water, coming down on my left foot without the old debilitating pain…muscle building safely in the water. 

Incidentally, the second time I ran in the water I felt so Tarzana that when Jeff asked me to sit on the water stool for a series of other exercises; I made a surprising running leap for it… and slammed into it or would have if I’d got that far. 

I began the jump too far out and the side effect was a gut wrenching, breathtaking laugh – so hard I ran out of air and had to focus hard to stop laughing.  COPD is not for sissies – nor are fancied, imagined, graceful gazelle leaps of joy that I could put weight on that left hip. 

Good Physical Therapists cause little moments of joy for the patients they guide into better fitness as we work into better health.

Northwoods has many good or great physical therapists – I am talking a little about some of the people and my latest experience as a patient in one of two Kitsap County five-star rehab centers.

For information, I didn’t qualify for insurance coverage since I had only been at Harrison overnight for observation, yet encouraged by Harrison’s sharp good-by, good luck doctor,   Dr. Mathew Coates the next day,  I decided to give it a couple days…and stayed over a week.

This is the entrance to the Red Barn dining room leading to access to the salty rehab pool.

Antiques – some early Kitsap County settler and his family plowed ground with this nifty tool and a couple good horses – or, maybe it is a thresher – a hay cutter. 

Note the wonderful old artifacts displayed everywhere in the “red barn “ – take a gander at  the two-woman saw on the wall above the staircase. 

Open for dining 

These wonderful items are displayed on the way to the ladies changing room and the pool.  

On my way out, dinner guests coming in…hubby waiting for me to go home    Gorgeous quilts on the upper, left wall

Door to the pool

Roomy shower – kept spotless

The first dressing room/ladies room leading to a pool that I have seen decorated with real hand-worked framed quilt squares on the wall.

Kristi, left, following Jeff’s exercise plan had me run as fast as I could to the end of the pool – stop and walk backwards to the other end and repeat the run…got me laughing when I spotted her ‘running’ alongside.  She moved through the water like a prancing parade horse – head bobbing, smooth and graceful while I plowed through the water using my arms pulling forward – feeling plow horsey running through the deliciously warm water.  Kristi asked why I was laughing.  Her first time running through water, she said, when I told her.  She has a wonderful spirit and I howled…and did not tell her Jeff saved his energy and did not run alongside when he instructed me to run. 

Patients need the lightness of spirit and humor with the serious work they do helping put us together again,…we’re sort of like HumptyDumpty and they help us get back together again and teach us how to apply our own glue.Kristi and Shayla

Thanks Shayla, (PT) and Kristi (PTA) – What a great job you do for us!

Thanks for listening … Sharon O’Hara

Part 1 of 4

Tsaristic stuff happens, “we don’t live in a perfect world” a young nurse recently told me when I questioned the hospital discharge papers.  Used to transparency and kind consideration – I had expected better – much better.

28 March 2013 – The Global Rosemaling Club:

“Yesterday we went to  my surgeon for the third visit since my surgery last December 20th. I also had my first “commercial” haircut in over a year. But Joan has been nice trimming it several times. She used to do a great job! I also drove the car for the first time. Joan drove home. But I was happy to feel that I could handle the car after more than a year as a passenger.

The doctor didn’t give us the kind of news that I had hoped for. Each time I go there, they take a few x-rays to see how I’m healing. He said that due to the first hospital I went to let me out without knowing that I had 2 breaks in my back, the 6 extra months it took to find this out before the final surgery in a much better hospital, was too long to straighten out my old spine. So I’ll be living with an ugly hump and pain for the rest of my life. As well as not being able to lift more than 25 pounds while being very carefully without bending too much. If I was too ruff with my back, it just could brake again. He was very liberal on giving me prescriptions for pain medicine and indicated that I should not be afraid of taking them. From next Monday, I’ll start going to their “in house” physical treatment department. It will be from 2 to 3 times a week depending on what they think will be best for me. The doctor assured me that I could get anything I asked him for. I guess he felt sorry for the way this turned out for me.

He clearly admitted it was due to the poor treatment from my first hospital and added that this was not the first time they had failed with their surgery or diagnoses at that hospital. So he will hopefully be a good witness, because being ruined for the few years I have left, somebody should pay for not giving me the proper treatment. This will include the arthritis dr. that gave me the wrong medicine, which gave me internal bleeding and fainting. 

Even with all the above negative “news”, I feel a lot better despite it’s going to be hard to get used to having an ugly hump on my back!

However, I feel so badly for Joan who will be stuck with my part of many of my home duties which are way too heavy for her as well, because of all the arthritis problems she has of her own. At times she can hardly move. She often doesn’t sleep many hours in her bed and have to move between the sofa and her bed. Her hands are also swollen when she gets up in the morning.

Well, it’s “nice” to get old!”

(Thor Dahl)

http://www.rosemal.com/

the-global-rosemaling-club@yahoogroups.com

Joan & Thor

Dahl House Art & Rosemaling Center

16623 West River Rd., Caribee Shores

Based in Seattle, Consumer’s Union, “Washington Advocates for Patient Safety” (WAPS) is a Washington group advocating for patient safety. http://www.washingtonadvocatesforpatientsafety.org/patient-safety/

The fact is almost sixty years ago the epidermal needle intended to help me give birth was jammed into a spine disk.  No physician treated me – they could not find anything wrong. 

Eventually, desperately, my parents took me to a recommended chiropractor and  I was given a pamphlet showing exercises.  He circled the ones he wanted me to do. 

He gave me hope and followed his instructions exactly.  He did not examine me, nor accept payment from my parents.

He gave me a life back – I worked through the pain. 

Through the years – every decade or so – I have followed the disintegration of the disk accidentally through x-rays given for other reasons.  A recent – on purpose x-ray showed the disk is gone. 

I lived through it without treatment and lived the physically active lifestyle I knew and loved.  COPD threw a different kind of curve in 1997.

Mistakes happen. 

Mistakes are sometimes turned around with the proper care and attention.  

Exercise gave me a life, and taught me to work through the pain.   

See your doctor.  Take a friend to be sure you both heard the same thing and be proactive in your own care. 

God Bless.  Happy Easter!

Thanks for listening… Sharon O’Hara

Dr. Melissa Mercogliano of The Center for Orthopedic and Lymphatic Physical Therapy, in Port Orchard,  http://colpt.com/mam.html is the person who helped us a few years ago and taught my husband and me how to properly wrap my legs.  She is a fountain of patient information and goes out of her way to inform and educate.

Now…a Lymphedema Scholarship is available!  .  The need is great.  So – those interested – please apply!

“Lymph Notes Scholarship – March 27, 2013

The National Lymphedema Network is proud to announce the establishment of the Lymph Notes Scholarship.

In the United States, access to treatment is still a critical factor for many lymphedema patients. Outside of major metropolitan areas, finding adequate treatment continues to be a major obstacle to care.

To help address the need for increases access to care, this annual scholarship, generously provided in honor of Lymph Notes, will cover up to $1,000 tuition for a healthcare professional to obtain specialty lymphedema training and certification.

Applicants are invited to submit an application online at:  http://tinyurl.com/lymphnotesscholarship  

The deadline for applications is July 15, 2013.   Questions regarding this scholarship program should be directed to the NLN office at 415-908-3681 or nln@lymphnet.org.”

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

In answer to numerous comments and inquiries about breast reduction, Cindy responds,

“Do the boob job. You will not regret it. I had some problems but I do not regret it at all. I love my new body. The stress is gone from my neck and back. I am sure there are Drs in Gig Harbor or Tacoma. I had a friend recommend Mary Lee. I like recommendations. I would highly recommend Mary Lee and her wonderful staff.”   cindydillion@yahoo.com

http://pugetsoundblogs.com/copd-and-other-stuff/2013/03/24/boob-voyage-party/#axzz2Orz2SZxT

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

Thanks for listening …

Sharon O’Hara <familien1@comcast.net>

Cindy – before breast reduction

Boob Voyage Party

According to the American Society of Plastic Surgeons…

“Breast Reduction, Also known as, breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts.”

http://www.plasticsurgery.org/cosmetic-procedures/breast-augmentation.html

Some women are born with the genes to grow the unwieldy, heavy huge breasts that can work to make their lives challenging and think about surgery, but hesitate.  Sometimes hesitate for years, a lifetime.

Cindy Dillion, 62, finally had enough earlier this year and determined to find a plastic surgeon to remove the excess burden of her oversize breasts.

Cindy’s sister had breast reduction done 35 years ago.  When the doctor asked what bra size, she wanted to be she answered – her only criteria – make breasts smaller and point my nipples, “nipples pointed at the sky.”   Thirty-five years later, Cindy’s sister declares her nipples still “point at the sky.”

Cindy’s body was marked before surgery – sculpted according to her plastic surgeon artistic eye and examination of the patients shape.  No to the fancy ‘starburst’ nipple – just smaller, balanced and each boob should be  looking ahead.  No pointy nipples. 

Cindy lost five pounds off her breasts and another four pounds off her body when they liposuctioned the fat around her belly, shoulders and back.

In the six and a half weeks since the operation, she has lost twenty-one pounds and got more than she bargained for when her body rejected the stitches – she was allergic to them.  Ten days post operation she developed an opening, by the twelfth day the slight opening was open around the nipple and caused the drain hole to shift.  An infection followed, leading to extraordinary effort from her long time husband – the husband she now calls, “Rock Star.” 

The couple turned one of their empty nest bedrooms into a spotlessly clean medical wound changing room where twice a day Rock Star follows doctor’s orders, changing the wrapping, and helping his wife heal through his devoted attention to the wounds. 

Cindy cannot bring herself to look at her wounds, as her husband does, but noted she can now see her nipples for the first time in fifteen years AND noted her active support group had their “Boob Voyage” party and look forward to the next one – the   BraBeque Party!   (burning of the old painful reminder bras)

Her bra size at the time of the operation was 42 K and Cindy guesses she may drop back to the 36 D-bra size she has not seen in twenty-five years. 

Cindy’s Seattle doctor is surgeon Mary Lee Peters, M.D.  I was impressed upon learning the doctor did not ask what bra size Cindy wanted since, it seems to me,  a good plastic surgeon should be medically artistic enough to take the patient’s body size and frame, in consideration to make the judgment call for each individual.  Hip, hip – hooray!

Insurance did not cover the cost of Cindy’s Breast Reduction – their deductible was too high and the out of pocket cost was $13,000 .00 $9,000.00 for breasts and $4,000.00 for the liposuction[S1] . 

---

Cindy healing into a new size

 [S1]Cindy Dillion is a professional Realtor working out of the Coldwell Banker Bain office in Gig Harbor.  She will talk to anyone who has questions about one of the most underrated medical procedures I know – surgery to get relief from the pain and weight of oversize breasts.   

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

to get relief from the pain and weight of oversize breasts.

Among other advantages, the PATHOS study showed a 26% decrease in exacerbations for moderate – severe COPD!  The Symbicort    SYMBICORTR TurbuhalerR            inhaler has to be bliss for those COPDers able to use it.   

I’ve used Foradil Aerolizer (Formoterol Fumarate Inhalation Powder) for years.  The Fulmarate ingredient seems to make it a relative of Symbicort        SYMBICORTR TurbuhalerR                and it is the single inhaler I take (of three) that noticeably helps me breathe easier.

Best of all is the promise shown in the PATHOS study:

“Dr. Kjell Larsson, Professor of Respiratory Medicine at the Karolinska

Institute in Stockholm said: “So called ‘real world’ studies, such as

PATHOS, together with randomised prospective studies, play an important role

in answering questions about the value of medicines in delivering better,

cost-effective healthcare to patients. These findings can help physicians

and the healthcare community to understand disease patterns and create a

fuller picture of treatment effects and what patients are experiencing.”

The only side-affect/warning I can find  might be for asthma patients.

http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=77788

http://www.4-traders.com/ASTRAZENECA-PLC-4000930/news/AstraZeneca-plc-Real-w

orld-study-comparing-commonly-prescribed-COPD-medicines-shows-choice-of-trea

-16558063/ …thanks to Linda W EFFORTS <www.emphysema.net> 

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

Spring 2013

p class=”MsoNormal”

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.

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 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.

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 

Xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx 

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.

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.

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

“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

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

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Keep extremity clean and dry.

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Apply moisturizer daily to prevent chapping/chafing of skin.

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Attention to nail care; do not cut cuticles.

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Protect exposed skin with sunscreen and insect repellent.

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Use care with razors to avoid nicks and skin irritation.

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

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

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

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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

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

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

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

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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.

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Wear non-constrictive jewelry and clothing.

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

IV. Compression Garments should be well-fitting.

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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.

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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