New study shows benefits of compression pumps for lymphedema patients.

Compression pumps are a hot topic within the lymphedema community—I have changed my views on them a few times myself over the years!—but a study published in the Journal of the American Medical Association (JAMA) Dermatology yesterday may help settle some of the debate.

Titled “The Cutaneous, Net Clinical, and Economic Benefits of Advanced Pneumatic Compression Devices in Patients with Lymphedema,” this national study shared important research regarding the benefits of using an advanced pneumatic compression device (specifically the Flexitouch® System by Tactile Medical) on not only the treatment of lymphedema but the overall cost of care as well.

The authors of the study—which include leading experts in lymphedema and public health research from the University of Minnesota, Vanderbilt University School of Nursing, and Stanford University—analyzed 718 lymphedema patients from across the United States over a five-year period, and evaluated clinical events and costs for a 12-month period prior to and during a 12-month period of treatment. The participants included both cancer patients and non-cancer patients.

The study found that, through use of the Flexitouch at-home advanced pneumatic compression treatment, the rate of hospital and physical therapy visits were reduced, thus lowering cost of care. It also defined the following:

-79% reduction in rate of cellulitis episodes among cancer patients (75% for non-cancer patients)

-54% reduction in rate of inpatient hospitalizations for non-cancer patients

-37% reduction in total lymphedema-related costs per patient, excluding medical equipment, among cancer patients (36% for non-cancer patients)

-40% reduction in rate of outpatient hospital visits among non-cancer patients (29% for cancer patients)

-34% reduction in rate of physical therapy visits among non-cancer patients (30% for cancer patients)

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Top Tips for Air Travel With Lymphedema

With the holiday season in tow, an increase in travelers will invade airports all over the country.  we've put together a few tips for those with lymphedema and are planning to travel by air this season.

Cabin pressure during a flight in a plane is less than the atmospheric pressure while on the ground. The decreased pressure in the cabin can cause increased swelling of the limb. If you have had a mastectomy, lumpectomy or radiation therapy you should wear compression garments while traveling by air to reduce risk of swelling.

Air travel is sedentary in nature, normally causing blood and lymphatic circulation to slow.  When you have been properly fitted for a sleeve and glove/gauntlet, it should be tight at the wrist and sit one finger width from the arm pit.

A hand piece or glove should be worn with the sleeve in order NOT to push the fluid into your hand. It is recommended to wear your sleeve 2 hours prior to flight and 2 hours after you have landed. Wearing garments applies to other types of long distance travel such as a car, train, or bus.

Travelers Tips:

-Wear comfortable clothing
-Avoid lifting and carrying heavy baggage
-Take a short walk every 2 hours
-Raise your arm and turn in circles several times
-Wear compression garments while on the trip will help prevent symptoms and swelling
-Drink plenty of liquids, avoid dehydration
-Take sunscreen, insect repellent, and extra non-scented lotion such as Eucerin

If you are in need of compression garments, call our BOC/ABC certified fitter, Kristen Knowles at 713-623-4247.  She specializes in creating customized solutions to increase mobility and decrease lymphedema swelling.

Innovations Target Risk of Lymphedema After Cancer Treatment

By NARA SCHOENBERG | CHICAGO TRIBUNE 

In the past few years, surgeons have made strides in preventing lymphedema, a potential side effect of breast cancer surgery in which a blockage in the lymphatic system causes fluid buildup and swelling in the arm.

By preserving the underarm lymph nodes in patients with less-advanced cancer, surgeons have reduced the lymphedema risk for those patients.

But lymphedema still affects an estimated 10 to 40 percent of patients, depending on the extent of the cancer and the type of surgery and radiation required.

What can be done for patients whose underarm lymph nodes can't be preserved because of the spread of cancer? Or the ones who get lymphedema despite lymph node-saving surgery?

Approaches that may help are being tested and tried at major cancer treatment centers, among them the lymphatic microsurgical preventive healing approach (LYMPHA) surgical technique, which connects lymph vessels to a nearby vein, restoring drainage when underarm lymph nodes are removed. There's also axillary reverse mapping, which seeks to identify and preserve lymph nodes related to arm drainage (as opposed to breast drainage), and highly sensitive L-Dex bioimpedance spectroscopy, which is used to diagnose lymphedema at its earliest stages, when it is most responsive to treatment.

"There are a lot of people working on different things," said Dr. Sarah McLaughlin, a breast surgeon at the Mayo Clinic in Jacksonville, Fla.

But as much as researchers would like to see advances in this area, she said, it's important to wait until new approaches are backed up by reliable data.

"It just takes time," she said.

At NewYork-Presbyterian Hospital/Columbia University Medical Center, surgeons are seeking to replicate the results of a promising Italian study, in which researchers at the University of Genoa attempted to prevent blocked drainage after lymph node removal by allowing lymph vessels to drain into a nearby vein. In the Italian study, published in 2011 in the Annals of Surgical Oncology, 4 percent of the women in the LYMPHA group had lymphedema at six months after surgery, compared to 30 percent of the women in the control group.

The NewYork-Presbyterian pilot study started in January.

"We've performed this on about seven patients, and so far, it looks very, very good," said Dr. Sheldon Feldman, chief of breast surgery at NewYork-Presbyterian. The procedure takes less than an hour, and the technique is quite simple, he said: Lymphatic vessels are basically attached into a stump of a branch of a nearby vein.

Axillary reverse mapping, in which an injection of dye is used to identify the lymph nodes that drain the arm, as opposed to the breast, for the purpose of preserving the arm lymph nodes during surgery, is being used at some large cancer centers.

Early detection of lymphedema is the aim of L-Dex bioimpedance spectroscopy technology, which uses a small electronic current to detect volume change.

"The longer lymphedema is there, the tougher it is to treat, so the idea is to have a very sensitive tool which could be used to detect very subtle changes in volume in the arm - before it's apparent to the patient, before it's apparent to the doctor," Feldman said.

"That's what this bioimpedance spectroscopy can do."

Extensiveness of breast cancer surgery linked to risk of lymphedema

Breast cancer survivors who have extensive surgery are four times more likely to develop arm lymphedema. According to a new study, the extensiveness of surgery to treat breast cancer proportionately increases the risk of developing the debilitating disorder.

According to the lead author, Tracey DiSipio, PhD, from Queensland University of Technology in Brisbane, Australia, women who had undergone an axillary lymph node dissection, which is an invasive surgery to remove lymph nodes under the arm, were four times more likely to experience swollen or disfigured arms compared with women who had received a sentinel lymph node biopsy. The study was published in The Lancet Oncology.

"Arm lymphedema is typically characterized by swelling in one or both arms, causing pain, heaviness, tightness, and a decreased range of motion," DiSipio said. "The appearance of the swollen or disfigured arms provides an ever-present reminder of breast cancer and often contributes to anxiety, depression, and emotional distress in affected women."

DiSipio said the study, a systematic review of the incidence of arm lymphedema after breast cancer, also found that the condition is diagnosed in one in five women (21.4%). She explained, "This is a significant research finding and provides us with the most accurate incidence rate to date. Until now the incidence rate has been reported as anywhere from 0% to 94%. With this information we can explore whether lymphedema rates differ between breast cancer survivors."

The study also pinpointed a number of risk factors linked to arm lymphedema. Risk increased with a lack of regular physical activity and with a high body mass index. DiSipio said, "These factors are potential targets for future prevention strategies or for more effective management of the disorder."

DiSipio said the results of the study added weight to calls to integrate prospective surveillance of arm lymphedema into standard breast cancer care.

"Currently there are no standardized practices when it comes to detection and treatment of arm lymphedema," she said. "Given most patients present with the arm lymphedema within the first 2 years after breast cancer, more frequent surveillance throughout this time is recommended."

If you or a loved one is undergoing breast cancer treatment, call 713-623-4247 to schedule a free consultation with our ABC/BOC certified compression garment and mastectomy prosthesis fitter.  Kristen and our team will develop a customized approach to helping you maintain your mobility and comfort during and after your cancer treatment.

Blood Test May Allow for Early Diagnosis of Lymphedema

From Oncology Nurse Advisor

Levels of a set of proteins circulating in the blood may accurately flag the presence of lymphedema, which currently is difficult to diagnose before the onset of physical symptoms.

At present, the only known way to diagnose lymphedema, an often painful inflammatory condition caused by radiation therapy for cancer, is by means of physical inspection. But by the time the main symptom of swelling of one or more limbs is detectable, the condition may be difficult or impossible to reverse with available treatment options, explained Stanley G. Rockson, MD, senior author of the study describing the new blood test, in a statement from Stanford University Medical Center in Stanford, California. Rockson is a professor of cardiovascular medicine at Stanford University School of Medicine.

Noting that the biological events underlying lymphedema may be present for 5 years or more before physical symptoms indicate the presence of the disease, Rockson's group studied skin-biopsy samples from 63 persons with lymphedema and 27 healthy subjects in an attempt to discover protein analytes that could distinguish diseased tissue from healthy tissue. The researchers focused on genes that were more actively engaged in the generation of their respective protein products in lymphedema vs healthy tissue, eventually narrowing the field to six overproduced proteins through statistical modeling.

Each of the six proteins is associated with at least one of the hallmark features of chronic lymphedema: accumulation of fibrous deposits, stimulation of fat-cell activity, inflammation, and lymphatic-vessel formation. Although none of the six proteins alone was predictive of lymphedema, in aggregate their presence at certain levels and in certain ratios appeared to serve as a biomarker for the condition.

Because levels of these proteins rise early in the course of lymphedema, the biomarker panel could lead to earlier identification of lymphedema risk or onset and earlier treatment that might ease the effects of the condition or even reverse its course.

When Rockson's team evaluated the validity of the biomarker panel using blood samples from an additional cohort of 36 adults with lymphedema and 15 healthy adults, the test was nearly 90% accurate in distinguishing persons with lymphedema from healthy subjects.

If you are a cancer survivor, or are currently undergoing cancer treatment and need help with lymphedema treatment, custom compression garments or lymphedema support groups, contact our team at Ricky Knowles Hair & Wellness at 713-623-4247 and schedule a free consultation.

Vibration Exercise Improves Your Lymphatic Health

With every beat of the heart, subtle vibrations are sent through the body, the movement stimulating a higher degree of circulation and a higher level of overall health. Because this movement is conducive to achieving a healthier circulatory system, among others, it has been recreated throughout the cultures and ages of history in an attempt to heal illnesses and improve the overall quality of life. A practice that has been utilized for thousands of years, vibration exercise is said to amplify the effects of the vibrations made each time the heart beats. These vibrations produce a level of blood flow that is uninterrupted, allowing oxygen and other important substances to circulate freely. By constantly pumping blood through the many systems of the body, the modern vibration exercise machine also promotes the drainage of the lymphatic system, which acts as a network of pipes that pushes toxins out of the body.

Moving the various fluids of the body requires power, which is only achieved through muscle contractions (such as the contraction of the heart when it pumps). The vibrations created by a vibration exercise machine create small muscular contractions. This forces the fluids through the body in a way that is efficient, constant, and gentle enough not to cause any harm while being forceful enough to discard toxins and other potentially dangerous buildup.

Individuals that cannot get rid of their toxins are more prone to illness and do not feel as healthy as those whose lymphatic systems are capable of draining regularly. Exercise is certainly one way to achieve a high level of lymphatic draining, but not everyone has the ability (either physically or practically) to indulge in a great deal of physical activity. For this reason, whole body vibration, facilitated by a machine, is able to help combat the effects of a sedentary lifestyle and rid the body of the toxins that it has stored. This being said, individuals that don't have time for extensive exercise can greatly benefit from whole body vibration.

In addition to acting as a catalyst for lymphatic drainage, a vibration exercise machine also sparks the activity of the lymph nodes, which are key components of the immune system. Therefore, the movement allows individuals to both rid their bodies of toxins that they already possess and prevent them from contracting illnesses from new ones.

Another benefit, which many individuals enjoy, is weight loss. Though the loss is not drastic, using a vibration exercise machine allows the lymphatic system to push stored fats out of the body, resulting in a healthier, leaner figure. This smaller figure can also be attributed to the decrease in cortisol, which is a known agent of belly fat, due to an increase in serotonin.

The benefits of vibration exercise, particularly to the lymphatic system, have been enjoyed by people from several cultures over thousands of years. Modern medicine will most likely continue to study this technique and analyze its many effects on the body, but as the research is conducted individuals will continue to utilize the therapy and take advantage of their healthier circulatory and lymphatic systems.

Have questions about Lymphedema or need to schedule a free consultation with our custom compression garment fitter?  Email Kristen at kristen@hairandwellness.com

What Treatments Are Available for Lymphedema?

Unfortunately, there is no cure for lymphedema. However, with early intervention and proper treatment, the condition can be controlled and minimized, allowing the individual to lead a full and normal life.

Treatment begins with a physicians referral to a lymphedema trained massage therapist. The therapist performs a thorough evaluation to determine a baseline of the individuals sensation, pain, range of motion, strength, skin integrity, and extent of swelling.

A treatment plan to decrease the swelling and improve the individuals ability to function may include:

• Lymphatic manual drainage, or MLD, is a specialized lymphatic "massage," to move the extra lymph fluid through intact lymphatics and create new pathways for the lymph fluid to flow.
  
• Compression bandaging to reduce swelling.
  
• Exercise to improve functioning of the lymphatic system, range of motion, and strength.
  
• Establishment of a good skin care program to decrease the chances of infection.
  
• Recommendation of a compression garment and instruction for wear and care.
  
• Thorough patient education regarding all of the above to promote independence with self-management of lymphedema.

Not all therapists have received special training to treat lymphedema, so it is important to select a therapist that is qualified to treat individuals suffering with the condition. At Ricky Knowles Hair & Wellness, we have several qualified therapists who have been trained and certified to treat lymphedema.  We have a BOC, ABC certified garment fitter, who is constantly troubleshooting to find clients the best solution in compression garments.  Our team would be happy to help you develop a customized plan to help you improve your mobility. Our insurance specialist will even submit your claims and serve as your patient advocate, ensuring that you receive your full insurance benefits.

For more information, or to schedule an appointment, please call 713-623-4247.

I Just Finished Breast Cancer Treatment, Am I at Risk for Lymphedema?

Women who have undergone breast cancer surgery and/or radiotherapy are particularly at risk for developing lymphedema.  An individual who has had any type of breast cancer surgery or therapy is at risk of developing lymphedema. The National Lymphedema Networks 10 Precautions for Women at Risk of Lymphedema include the following:

1. Do not ignore any slight increase of swelling in the arm, hand, fingers, neck, or chest. Call your doctor. The sooner treatment begins, the more effective it will be.
   
2. Never allow an injection, needle stick, or blood pressure cuff in the affected arm. Breaks in the skin allow infection causing bacteria to enter. Pressure on the arm may damage existing lymphatics.
   
3. Avoid heavy lifting with the affected arm. Never carry heavy handbags with over-the-shoulder straps. Be especially careful lifting children and groceries. Do not lift more than 15 pounds at a time as excessive weight lifting can place a burden on the lymphatic system.
   
4. Do not wear tight jewelry or elastic bands on the affected arm/hand as these may obstruct the lymphatics.
   
5. Avoid injuries to the arm such as cat scratches, cuts, sunburn, insect bites as these may serve as a portal for bacteria to enter and cause infection.
   
6. Avoid extreme temperature changes when bathing, washing dishes. Stay out of the sauna and hot tub. Keep the arm protected from the sun. Temperature changes may lead to increased swelling.
   
7. Wear gloves while performing gardening or housework. This will prevent any type of minor injury that could result in increased swelling.
   
8. Maintain a healthy diet and lifestyle. Light exercise is beneficial.
   
9. Wear well-fitted supportive bras that are not too tight and without wires. Avoid a heavy prosthesis. These may put extra pressure on the collarbone and shoulders.
   
10. Wear a compression sleeve in airplanes, as the change in pressure may  increase the risk of swelling. Remember to drink plenty of water.

For more information about breast cancer treatment and lymphedema, contact Kristen at 713-623-4247. She is a certified BOC, ABC custom garment fitter and can help you find the right compression garment for your needs.

Is it OK to exercise with lymphedema?

Yes, exercise is safe and beneficial for individuals with lymphedema, as long as a few standard guidelines are followed.

1. Always wear your compression bandages or garments when exercising – Compression garments help to move your lymph fluid from your limbs, trunk or face.  Without the garments, lymph fluid will collect in the affected area and increase swelling.
   
2. Get clearance from your doctor – As always, it’s a good idea to discuss your exercise goals with your physician and to make sure that you are in good overall health before starting an exercise program.
   
3. Start slowly – Your exercise program should include stretching, strengthening and endurance.  Some good examples of exercise programs are: Yoga, walking, swimming or cycling.  It is NOT advised to engage in high-speed activities like tennis, water skiing or football.
   
4. Hydrate – Hydration is super important to maintaining a healthy body, and even more important for people with lymphedema, as it aids in your body’s ability to expel lymph fluid.
   
5. Pay attention to your body – It is important that you feel good after exercising!  If you notice increased swelling, then you will want to choose a different activity for that day (i.e. swim instead of walk).

We want to assist you in reaching your exercise goals.  With our dedicated staff on your team, we can ensure that your custom compression garments will support you in your exercise program.

Let us know if you have any questions or concerns about your treatment options.  Our certified lymphedema specialists will be happy to answer your questions about how we can help you or someone you know who have lymphedema.  Call today at 713-623-4247, or email us at Kristen@hairandwellness.com

Top 10 Lymphedema Tips for the Summer

1.  Increase fluid intake, mostly H2O
By increasing your daily water intake, you are telling your body that it has plenty of reserves and as a result it will release fluid out of your body.  If you are not a fan of drinking water, try flavored waters.  Crystal lite offers on-the-go packets, available in delicious flavors such as kiwi-strawberry, cherry pomegranate and raspberry peach.

2.  Try and stay as cool as possible
At times staying cool may seem impossible in 90+ degree weather.  Use fans to help circulate air conditioning while indoors.  Also store plastic bottles of water in the freezer for easy access to cold water when you travel outside.

3.  Avoid tight restrictive clothing
Opt for lightweight, loose-fitting cotton clothing.  Cotton clothing will keep you cooler than those made out of synthetic materials.

4.  Avoid severe sunburns

I like sunscreen products that good for sensitive skin, affordable, waterproof and offer UVA and UVB protection.  Banana Boat Baby Tear-Free Sunblock  SPF 50 is $10 for 8 ounces, Bull Frog Water Armor Sport 50+ is $9.99 for 6 ounces,  Beach Defense Water + Sun Barrier Lotion SPF 30 & 70 is $10.99 for 6.7, or Hydrosport Sunblock Spray SPF 30 by Aveeno is $8.99 for  5 ounces are all great options.

5.  Always use insect repellent
Protecting your skin from insect bites is another top priority during the warm summer months.  Avon carries a strong defense against mosquitos, gnats, ticks, sand flies and other biting insects.  Skin So Soft Bug Guard Plus Picaridin Aerosol Spray is $7.99 for 4 ounces of protection.  Another good option is Deep Woods Off! Deep Woods Insect Repellent V, 25% DEET, 6 oz for $7.49.  This insect repellant is a reduced DEET product that works well.  It sprays upside down too!   Be sure that you apply insect repellent over your garment.

6.  Try and avoid high sodium foods
Restrict your daily salt intake to between 1,500 – 2,300 mg per day.  Also avoid processed foods as they typically contain a lot of sodium and preservatives.

7.  Protect your handsWhen working in the yard or gardening try and wear glove to protect your hand with upper body edema.  Choose a work glove with a suede leather palm for heavy-duty protection.

8.  Exercise Smart
When exercising outdoors try and do this not in the middle of the day, instead opt for early morning or after sunsets.  Exercise for shorter periods of time, take breaks at regular intervals and always wear compression on the affected limb, unless you are swimming, as water resistance acts as natural compression.

9.  Protect Your Feet
With lower body edema it is a good idea while at the beach wear water shoes as to avoid cuts and scrapes.

10.  Travel Prepared
If possible, talk to your doctor and get a prescription for antibiotics in case of infections.  Also, remember if you are flying, drink plenty of water and make sure you wear your day time compression garments, as the decreased air pressure in the airplane’s cabin may increase your swelling.

For more tips, contact Kristen, our BOC, ABC Certified compression garment fitter at kristen@hairandwellness.com.

Manage Lymphedema and Edema During the HOT Houston Summer

Lymphedema and chronic swelling patients have it especially rough during the HOT Houston summer. That’s why we work with our patients to offer cooler compression alternatives and tips.  I’m realistic when it comes to edema management during the summer and understand that patients need relief, not only from their edema, but from the heat.  So, I advocate using less aggressive garments during the heat of the day, and then wearing a lightweight night-time garment in order to keep the swelling under control.

Cooler Custom Garment Alternatives

One option for upper body edema is LympheDIVAS arm sleeves.  These arm sleeves are made with moisture-wicking technology, which pulls sweat away from the body.  They are also infused with aloe vera so that the arm stays moisturized and cool.  LympheDIVAS arm sleeves come in a variety of fun patterns and colors too.

A good option for a night time garment during the summer heat is the Tribute garment.  This garment is ideal for any type of edema (upper body lymphedema or lower body lymphedema).   It also has a wicking material and the foam multi-directionally pushes into the skin to move the fluid while you sleep.

Exercise Alternatives

Another thing I really encourage all of our patients to do is get into a pool.  Why?  Well, first, you do not have to wear garments and second, the water acts as a natural compression to the limbs.  It is also the best exercise for anyone as it takes the strain off of your joints.

If you would like more information about our custom garments, please call me at 713-623-4247.  We want to work with you to stay cooler in the summer heat while managing your lymphedema!

Have a question?  Contact me at kristen@hairandwellness.com