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MONTHLY
OCTOBER 2018
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L et ’ s L earn A bout L ymphedema
THE MOST COMMON BUT OVERLOOKED POSTOPERATIVE COMPLICATION
Vital Care Patients ENTER TO WIN Find the misspelled word in this newsletter and call (623) 544-0300 for your chance to win a $10 gift card! CALL (623) 544-0300 Contest is for past and present Vital Care PT patients only. Lymphedema is a postoperative complication for breast, ovarian, cervical, prostate, and other kinds of cancer. It can stem from the surgical procedures used to remove lymph nodes and/ or radiation therapy, both of which can disrupt For the last 30 years, American women and men have tirelessly fundraised to increase awareness about the most prevalent type of cancer: breast cancer. According to breastcancer.org, 1 in 8 American women will develop invasive breast cancer at some point in her life. Usually, the prevalence of a specific diagnosis leads to heightened societal awareness, and in the case of breast cancer, this is true. But in the case of lymphedema (a common condition associated with the accumulation of lymphatic fluid, consisting primary of water and proteins under the skin due to poor lymphatic transport), knowledge and prevention tactics have remained extremely low despite its alarmingly high statistics.
lymph drainage. It is thought that the greater number of lymph nodes removed surgically, the greater risk there is of developing lymphedema. Affected patients can suffer from extreme swelling, loss of range of motion, and pain. These symptoms typically affect the limbs, trunk, internal organs, genitalia, head, and neck. When Andrea McWhorter realized the prevalence of this condition, she looked into our community here in the west valley and found that there was a lack of providers to help people with lymphedema and a strong need for education and awareness within this community and nationwide. She encouraged me to pursue a certification in lymphedema therapy. And in 2016, that is exactly what I did. During my last two years specializing in lymphedema, I have had the opportunity to work with so many strong and driven patients. I have learned so much about their desire to fight, learn, and live. Lymphedema patients are truly inspiring. Although lymphedema can affect both men and women, it can stem from a variety of health issues. A vast majority of my patients suffer from secondary (not congenital) lymphedema due to lumpectomy or mastectomy procedures. This can entail radiation treatment and/or the removal of breast tissue, nodes, or the entire breast to prevent the cancer from metastasizing (spreading). During the recovery process, patients conduct their own research or join help groups, and this is when some patients discover their risk for developing lymphedema. All on their own! For this reason, Andrea and I are actively working hard to go beyond the treatment by focusing on preventative measures and spreading awareness and education in the community.
Another aspect that I want to mention in association with lymphedema is axillary web syndrome (AWS), also referred to as “cording,” which is another common postoperative complication that, like lymphedema, is not talked about enough. AWS looks like cords. It is usually located in the armpit area but can spread to the chest or down the arm as well. This disorder may develop due to a disruption of the lymphatic system, node removal, and/or trauma. Cording
“I have learned so much about their desire to fight, their desire to learn, and their desire to live.”
is present 1–5 weeks post-surgery and can sometimes resolve on its own. Axillary cording can also be present months after surgery. AWS is painful and can limit range of motion. Without treatment, AWS can cause further impairments such as frozen shoulder, poor posture, and altered movement patterns. AWS is sometimes overlooked; however, with an evaluation from a certified lymphedema therapist, we can provide you with the tools necessary for the resolution and self-management of axillary web syndrome. awareness about lymphedema, a condition that is just as common but does not get the attention that patients need and deserve. My hope is to educate patients, families, and the community to raise awareness. If lymphedema is detected early, it is less costly to the patient and keeps the disease from progressing. Although there is no cure for lymphedema, there are ways to manage the common pathology. –Michelle Garza, DPT, CLT Because October is Breast Cancer Awareness Month, I wanted to take the time to raise
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D o Y ou or S omeone Y ou L ove N eed to S chedule a M amm EARLY DETECTION SAVES LIVES
October is Breast Cancer Awareness Month. Organized, in the National Breast Cancer Foundation’s words, to “honor those at every step of the breast cancer journey.” The annual observance has also served to educate the public and raise funds for research. Learn more about this deadly but survivable disease, and find out how you can help.
increases with age. Most risk factors, such as age, gender, and family history, cannot be changed. However, research shows that exercising regularly, maintaining a healthy diet and weight, and minimizing alcohol consumption may reduce your chance of developing the disease. Hormone replacement therapy (HRT) may also place you at higher risk.
Contrary to popular myths, breast cancer is not caused by milk, microwave ovens, cellphones, caffeine, plastic cutlery, or deodorants.
BREAST CANCER IS EXTREMELY COMMON.
ANNUAL MAMMOGRAMS ARE FREE.
According to the NBCF, 1 in 8 American women will be diagnosed with breast cancer at some point in their lives. It is the second leading cause of death in women (behind heart disease). A breast cancer diagnosis is not a death sentence, however. Thanks to research and ongoing education, there are over 3.3 million breast cancer survivors in the U.S. today.
Early detection is the biggest factor in breast cancer survival. There’s some debate among researchers and insurance companies over the “right” age to begin screening, but most sources agree that women should begin to get regular mammograms in their 40s (and earlier if they have a family history of the disease). The Affordable Care Act (ADA) requires all health insurance plans to cover the cost of annual mammograms for women age 40 and older, and there are many organizations devoted to providing free mammograms to uninsured individuals.
WHAT CAUSES BREAST CANCER?
Breast cancer is caused by damage to cells’ DNA. It’s most common in women over the age of 40, though approximately 2,500 men in the U.S. are diagnosed each year as well. The risk of breast cancer
S uccess S tories OUR CLIENTS SAY IT BEST
In October of 2017, I had my annual mammogram, and the doctor found two types of cancer (ductal and lobular) in my left breast. The surgeon removed my left breast and 11 lymph nodes. When they removed the lymph nodes, I knew that that there was a chance that I would acquire lymphedema. Several months later, my left arm and hand began to swell. I started to look for a lymphedema therapist to treat my problem. I went to my primary care physician, Dr. Balangue, who recommended that I go to Vital Care Rehab for lymphedema treatment. At my first appointment with Michelle Garza, PT, DPT, she explained to me how we would treat my lymphedema. She measured both my arms and hands for a comparison. I was also given educational materials regarding lymphedema to help me understand it further. Prior to my first appointment, I did not know anything about lymphedema and lymphedema management.
At the next appointment, we started treatment. The massage was gentle and felt good. We used a compression pump and temporary bandages to wrap my arm and performed some exercise. After each session, my arm was getting smaller and smaller. I had to have my arm wrapped after each session to keep my arm from accumulating lymphatic fluid and to maintain my status. I was wrapped from my fingertips to my shoulder; however, several weeks later, my left arm was the same size as my right arm. I have had a total of eight visits and am now transitioning to phase two of my treatment. Michelle has ordered me a compression sleeve and glove that I will have to wear the rest of my life. I am so pleased with my results! Thank you, Michelle and Vital Care, for giving me my life back.
– Judy Laffin
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YOU CAN MAKE A DIFFERENCE.
Visit Donate.nationalbreastcancer.org/ to learn how to help. The NBCF funds cancer research, works to provide free mamograms to low-income women, and serves as a resource for patients and their families. Many cities also have local organizations in need of donations and volunteers.
HOWWE DIAGNOSE AND TREAT LYMPHEDEMA To continue the focus on generating awareness about the prevalence of lymphedema, our team here at Vital Care Physical Therapy wants to get more education out to our readers. We specifically want to share the diagnosis and treatment methods that Michelle Garza, our certified lymphedema therapist, uses when working with lymphedema patients. The recommended treatment for lymphedema really depends on the patient’s progression or which stage their lymphedema has reached. The level of swelling exponentially grows depending on the amount of protein-rich fluid buildup in the limb. If the patient’s swelling is classified at Level I for example, the lymphedema can be reversible with proper treatment. This is why awareness and subsequent prevention is of the utmost importance. The treatment that Dr. Garza uses to reduce swelling and manage pain is referred to as complete decongestive therapy (CDT), which is an intensive program that combines many different treatment approaches, including bandaging, compression garments, manual lymphatic drainage (MLD), exercise, and self-care. CDT has two main phases. Phase I consists of reducing the accumulation of lymph in the arm, hand, or other part of the upper body to reduce visible swelling. Although treatment plans are tailored to the individual, Phase I CDT generally involves seeing your lymphedema therapist as prescribed for sessions that include MLD, short-stretch compression bandaging, and exercise. Phase II CDT is about maintaining the results of the initial intensive phase on your own. Although individual treatment plans vary, you can expect to stick with Phase II for the rest of your life. This part includes getting fitted for and wearing compression sleeves and garments, then learning how to put them on correctly and properly care for them. Because patients wear these compression garments all day every day, our therapists work with them to make sure they find the best possible fit and to ensure compliance. If you want more information about lymphedema, complete decongestive therapy, or compression garments, please feel free to reach out to us here at Vital Care Physical Therapy at 623-544-0300.
H omemade M arshmallows
INGREDIENTS
• 3 packages unflavored gelatin • 1 1/2 cups granulated sugar • 1 cup light corn syrup
• 1/4 teaspoon kosher salt • 1 tablespoon pure vanilla extract • Powdered sugar, to coat
DIRECTIONS
Inspired by foodnetwork.com. 5. Dust a nonmetal baking dish with powdered sugar and spoon mixture into dish. Smooth mixture, top with more powdered sugar, and let stand uncovered overnight. 6. Cut into squares, decorate, and serve. 1. In a mixing bowl, combine gelatin and 1/2 cup cold water. Let sit while you make the syrup. 2. In a small saucepan over medium heat, combine sugar, syrup, salt, and 1/2 cup water until the sugar dissolves. 3. Raise heat to high and bring syrup up to 240 F, using a candy thermometer to check for temperature. 4. With an electric whisk on low speed, slowly whisk syrup into gelatin mixture. Switch speed to high and whip for 15 minutes, until very thick. Fold in vanilla after whipping.
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I nside 14545 W. Grand Ave., #108 Surprise, AZ 85374 Learn About Lymphedema PAGE 1
THIS ISSUE
October Is Breast Cancer Awareness Month
Success Stories PAGE 2
Homemade Marshmallows
How We Treat the Most Common Postoperative Condition PAGE 3
The Birthplace of Halloween PAGE 4
THE REAL HALLOWEEN TOWN
Fans of Halloween don’t need to look far to find somewhere to celebrate their favorite holiday. There are festive parties all over the world, from New Orleans to London, but if you really want to embrace the spirit of Halloween, there’s no better destination than the birthplace of the holiday: County Meath, Ireland. Every year in Boyne Valley, the residents of County Meath throw a month-long Halloween celebration. The Spirits of Meath Halloween Festival attracts thousands of guests from all over the world, and while this festival has only been celebrated since 2009, many of the traditions observed here date back to ancient times. The ancient Irish weren’t trick-or-treating or visiting haunted houses on Oct. 31, but they were celebrating the pagan holiday Samhain. Over 3,000 years ago, this Celtic festival was born in Meath and marked the end of the harvest. Samhain was celebrated with bonfires, offerings to fairies, and other rituals meant to keep evil spirits away. Many of these customs carried through the centuries and inspired Halloween traditions that are still practiced today. Today, Meath celebrates Oct. 31 with a blend of spooky thrills and traditional Samhain practices. The Spirits of Meath Halloween Festival starts with the lighting of the first torch fire of Samhain in Athboy, which
kicks off a month of fun activities. If you like your Halloween extra spooky, the scream park, Farmaphobia, is waiting for you. And if you’re not a fan of screaming your head off, you can check out the Halloween-themed Spookling Afternoon Tea for fresh-baked treats and spirited conversation. The motto of this all-ages festival is “Fun by Day; Frights by Night,” meaning all the really scary ghosts wait until after sunset to come out. There are plenty of ways to celebrate Halloween, from carving jack-o’- lanterns and eating chocolate to running for your life through a haunted corn maze. And in County Meath, you can celebrate Halloween in every possible way. For more info, visit www.Discoverboynevalley.ie/whats-on/ spirits-meath-halloween-festival-2018.
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