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Rocky Mountain Lymphedema Study Group to Meet Thursday, August 11, 2011 at Exempla Good Samaritan Hospital July 20, 2011 Exempla Good Samaritan Hospital in Lafayette, Colorado will be hosting the next Rocky Mountain Lymphedema Study Group on August 11, 2011. Meeting topics will include updates on Lymphedema Awareness Day 2012, sharing of case studies and experiences, and a visit from Dan Frick with Medi USA. Please rsvp by calling 303-425-2314 or email garretsonl@exempla.org. Location details: Exempla Good Samaritan Hospital, 200 Exempla Circle, Lafayette, Colorado, 80026. Conference Rooms A & B- Enter the front door and turn left in the main hallway. The conference rooms are down this hallway and on the right before you get to the coffee shop. Please park in lot 2A near the main entrance. The Lymphedema Treatment Act Has Been Reintroduced to Congress July 13, 2011 It is now very important to send letters to your members of Congress to help support the bill. There are letter templates you can customize and then send to your congress person at the website: http://lymphedematreatmentact.org/ Klose Training Instructor, Jodi Winicour, Recently Published an Article in the National Lymphedema Network Newsletter May 24, 2011 Painful Cording of the Arm
by Jodi Winicour PT, CMT, CLT-LANA
*References and other information regarding this article can be found on the NLN website.
If you have upper extremity lymphedema caused by breast cancer surgery or treatments, you may have experienced a painful and bothersome condition called axillary web syndrome, or AWS. [Figure 1] Unfortunately, most lymphedema certification programs do not have the time to teach the treatment of AWS, which leaves lymphedema patients well treated for their swelling conditions but inadequately cared for regarding their cording. As few as 6% [1] to as many as 72% [2] of women who have had lymph nodes removed from their armpit (axilla) will develop AWS. Considering the pain it causes along with its frequent relationship with lymphedema, knowledge of its characteristics, onset and treatment is necessary to provide safe, holistic care for breast cancer survivors.
AWS characteristics:
AWS has certainly been around since the first radical mastectomies of the early 1900s, but the phrase "Axillary Web Syndrome" was coined in 2001 by Alexander Moskovitz, MD et al. [1] He describes painful cords of tissue that originate in the axilla, run along the inside of the upper arm to the elbow, and sometimes even to the wrist or the base of the thumb. These cords are made more taught by reaching out to the side and frequently can be seen as well as felt. Painful cording typically limits overhead and forward reaching along with elbow and forearm movements which makes activities such as cooking, cleaning, exercise, reaching and dressing difficult or impossible during the more painful stages.
How and when does AWS happen?
Typical onset of cording is 2 to 4 weeks after axillary node removal. [1, 2, 4, 5] Some with AWS have so much pain that it is difficult to use their arm while others feel that stretching and massage techniques are very helpful. Studies consistently report that the AWS will resolve on its own between 3 and 4 months after onset, but therapists who treat AWS have noted it lasting up to 1 year or longer without treatment. Untreated AWS may cause problems during the planning period for radiation therapy in those not needing chemotherapy. If unresolved, the cording can make CT scanning for radiation planning a very painful procedure which can delay the start of radiation therapy. It is much less common to see AWS after chemotherapy is completed, which is typically 3 to 6 months post surgery, but it does occur.
What is the stuff called AWS?
Although there are few tissue samples of AWS that have been looked at under the microscope, we do know that AWS can be hardened and enlarged lymphatic vessels that are filled with lymphatic fluid. This fluid cannot exit the arm normally through lymphatic pathways to the axilla due to lymph node removal. [1, 5, 10] AWS may also be small veins near the skin that are clotted or hardened. [1] In some cases, the webbing is hardened and clotted lymphatic fluid that causes inflammation of the vessels and makes them stick to the fatty tissues of the arm resulting in pain when moving or stretching the arm.
What increases my risk of having AWS?
While weight gain [11,13], obesity [11,13] & higher Body Mass Index (BMI of 25-26 kg/m2 [2,12,13]) have been associated with the onset of lymphedema, a lower BMI of 23[2] and 25.1 [ 3]) have been associated with the onset of AWS. These are confusing findings especially considering that both lymphedema and AWS seem to be caused by the axillary node removal and tissue scarring. Thinner women have both the increased risk of AWS and difficulties with shoulder movement after lymph node surgeries for breast cancer, while their risk for lymphedema should be lower than heavier women. [2, 11, 13]
What can I do about AWS?
While studies written by physician researchers state that AWS will resolve on its own, therapists around the world who frequently treat AWS agree that gentle massage, manual lymphatic drainage techniques and range of motion exercise can accelerate pain relief and tissue healing. Physical therapy may shorten the natural course of AWS to 6-8 weeks. [3] In some cases, the AWS presents with a mild lymphedema of the forearm. While traditional CDT (Complete Decongestive Therapy) techniques may reduce the lymphedema, it may become a chronic condition unless the AWS is treated.
Soft tissue techniques for cording include very gentle tissue "bending" or "traction" techniques applied along the taut cord in a comfortable position of stretch. Localized thumb and whole handed MLD techniques along the cording is also useful. Do combine active stretching with massage techniques to further improvements and do not be surprised if a "pop" is heard along the cording during your gentle treatments or during stretching. This "pop" will usually ensure immediate pain relief during movement but can also lead to lymphedema on rare occasions. Please avoid being overly aggressive (causing pain) during your treatments as this can cause an inflammatory reaction that may increase the lymphedema risk of your affected arm.
Knowledge of safe and effective techniques to hasten the resolution of AWS is necessary in the treatment of those recovering from breast cancer treatments and arm lymphedema. Hopefully reading this article will help to ease you or your patients' discomfort and increase your awareness of the treatments that are available.
Jodi Winicour PT, CMT, CLT-LANA
Longmont United Hospital, Longmont, Colorado.
Jodi is a full time clinician specializing in the treatment of lymphedema and cancer related dysfunction. She also is a Lymphedema Certification and Breast Cancer Rehabilitation Course instructor for Klose Training & Consulting.
Contact her at: Jodi@KloseTraining.com
Klose Training & Consulting to Hosts Klose Lymphedema Conferene 2011 in Estes Park, CO, October 27 - 29, 2011. Klose Training & Consulting, a lymphedema therapy and education company, will be hosting the Klose Lymphedema Conference at the Lake Shore Lodge in Estes Park, CO, October 27-29, 2011. The conference will provide opportunities for lymphedema professionals to network and update their medical knowledge for the practices of lymphedema treatment and care. The keynote speaker for the lymphedema conference will be Professor Ethel Földi, MD, Medical Director of the world renowned Földi Medical clinic in Hinterzarten, Germany. Professor Foldi is a leading expert in the diagnosis and treatment of patients with lymphedema. There will also be a very accomplished faculty to offer informative lectures on cutting edge topics in lymphedema treatment. "Our main objective in hosting this conference is to offer lymphedema practitioners opportunities to connect and collaborate with other professionals of the industry," said Founder and Executive Director of Klose Training & Consulting, LLC Guenter Klose. In addition to the conference events, there will be 2 Pre-Conference Workshops: Breast Cancer Rehabilitation with Jodi Winicour, PT, CMT, CLT-LANA and Jobst-Elvarex Advanced Training with Guenter Klose, MLD/CDT Certified Instructor, CLT-LANA. Lymphedema practitioners will participate in round table discussions and lectures to gain advanced knowledge and hone their skills for lymphedema treatment. Conference sponsors will be providing displays and educational materials that have the most current product developments in lymphedema treatment. “Many lymphedema therapists feel challenged by frequent referrals for ‘evaluation and treatment’ of patients with non-specific edema/ lymphedema” said Jan Weiss, PT, DHS, CLT-LANA. “The Klose Lymphedema Conference will provide presentations essential to enhance understanding of evaluation and treatment of these patients. A faculty of renowned practitioners in the field of Lymphedema will present a stimulating array of topics eagerly sought by lymphedema practitioners wishing to advance their skill level.” Klose Lymphedema conference 2011 is offered to medical professionals, including specially trained and certified Physical, Occupational or Massage Therapists. For more information about the Lymphedema Conference, visit www.kloseconference.com. For more information or to RSVP for the October 27 - 29, 2011 Klose Lymphedema Conference, visit the Klose Conference website or call Sheila Tallmon at Klose Training at 303-245-0333.
Contact:
Sheila Tallmon 303-245-0333
LANA Spring Exam Dates Monday, April 25 - Saturday, May 14, 2011 Applications must be postmarked no later than Saturday, April 2, 2011 to be considered for Spring, 2011 LANA Fall Exam Dates Tuesday, October 11 - Saturday, October 29, 2011 Applications must be postmarked no later than Saturday, September 17, 2011 to be considered for Fall, 2011 Next Rocky Mountain Lymphedema Study Group Meeting Date: TBD at Exempla Good Samaritan Medical Center 200 Exempla Circle, Lafayette, CO 80026 (Just off Hwy 287 and Northwest Parkway) Please expect additional details per email. American Physical Therapy Association (APTA) – CSM New Orleans, LA February 6 - 13, 2012 Lymphedema Awareness Day Exempla Good Samaritan Medical Center 200 Exempla Circle, Lafayette, CO 80026 (Just off Hwy 287 and Northwest Parkway) March 3rd, 2012 10:30am-4:00pm Please call 303-245-0333 or e-mail us for more information. American Occupational Therapy Association (AOTA) – National Convention
Indianapolis, IN April 26 - 29, 2012 National Lymphedema Network (NLN) – International Conference Dallas, Texas September 2012 | | | |
