When breast cancer is a part of your life, your body is under siege by both the disease and its treatments. At Premier we examine, evaluate, screen and establish a safe and effective plan of care for individuals who have been diagnosed with cancer.
Through our individualized Breast Cancer Rehabilitation Program, our physical therapists aim to help you:
- Improve your quality of life
- Identify and manage your lymphedema
- Reduce your fatigue
- Increase your strength, endurance, and range of motion
- Assist you in reducing your pain, anxiety and depression
Our therapists work with your doctor to provide specialized treatments for any problems with strength, endurance and range of motion you may have. Read on to learn how Premier Physical Therapy can help you meet the challenges of breast cancer.
LYMPHEDEMA BACKGROUND
Lymphedema is a swelling of a body part usually occurring in the extremities. It can also occur in the face, neck, abdomen, or genitals. Lymphedema is the result of the abnormal accumulation of protein-rich edema fluid in the affected area. Remarkably, even though it afflicts approximately 1% of the U.S. population (nearly 3 million Americans), its serious nature and the problems it creates are poorly understood in the medical community. Lymphedema is classified as either primary or secondary. Primary lymphedema is the result of lymphatic dysphasia. It may be present at birth but more often develops later in life without obvious cause. Secondary lymphedema is much more common and is the result of surgery or is a side effect of radiation therapy for cancer. Secondary forms may also occur after injury, scarring, trauma, or infection of the lymphatic system. Lymphedema has important pathological and clinical consequences. In stage I lymphedema, the swelling consists of protein-rich fluid and may be temporarily reduced by simple elevation of the limb. If it remains untreated, however, the lymphedema causes a progressive hardening of the affected tissues which is the result of a proliferation of connective tissue, adipose tissue, and scarring (stage II lymphedema). Stage III lymphedema is characterized by a tremendous increase in volume, hardening of the dermal tissues, hyperkeratosis, and papollomas of the skin. Infections such a cellulitis, erysipelas, and lymphangitis frequently develop in individuals suffering from lymphedema. Infections are most common in stage II and III lymphedema with each infection contributing to a worsening of the condition making frequent hospitalizations necessary. Lymphedema treatments offered in the United States include surgery, medication, pneumatic compression pump therapy, Manual Lymph Drainage (MLD), and Complete Decongestive Therapy (CDT).
STAGES OF LYMPHEDEMA
- LATENCY STAGE
- lymphatic transport capacity is reduced
- no visible/palpable edema
- subjective complaints are possible
- STAGE I
- (Reversible Lymphedema)
- accumulation of protein-rich edema fluid
- pitting edema
- reducible with elevation (no fibrosis)
- STAGE II
- (Spontaneously Irreversible Lymphedema)
- accumulation of protein-rich edema fluid
- pitting becomes progressively more difficult
- connective tissue proliferation (fibrosis)
- STAGE III
- (Lymphostatic Elephantiasis)
- accumulation of protein-rich edema fluid
- non-pitting
- fibrosis and sclerosis (severe induration)
- skin changes (papillomas, hyperkeratosis, etc.)
MANUAL LYMPH DRAINAGE (MLD)
MLD, a gentle manual technique, is a potent way to activate the lymphatic system, especially when the transport capacity of the lymph vessel is reduced because of prior surgery and/or radiation therapy. However, if carried out as an isolated treatment for lymphedema, the results are very temporary and lasting evacuation of lymph fluid from a congested limb is not possible. Many MLD practitioners have been trained only in basic MLD and are not qualified to treat lymphedema at all. However, MLD alone may be used with much success in many conditions unrelated to lymphedema.
COMPLETE DECONGESTIVE THERAPY (CDT)
CDT is a combination of MLD, bandaging of the affected areas, remedial exercises, and skin and nail care. CDT is divided into a two-phase program that initially involves an intensive treatment phase and is then followed by a maintenance program continued by the patient at home. Carried out with great care and consistency by a certified lymphedema therapist, CDT is the treatment of choice for chronic extremity lymphedema. Even in advanced lymphedema, CDT achieves excellent results with no side effects. Because CDT is labor intensive, time-consuming, and requires patient compliance, many patients have difficulty committing to the program at first. However, because the results of CDT are always superior to those achieved with all other treatments, increasing numbers of patients are undergoing CDT treatment and are consequently able to maintain the reduction of their limbs through diligent participation in a home maintenance program. Because CDT is fairly new in the United States, staff training and treatment standards vary from clinic to clinic. For a lymphedema therapist to be fully competent in treating lymphedema using CDT, it is vital that the CDT training consist of the four components of CDT: (1) basic and advanced MLD, (2) lymphedema bandaging, (3) remedial exercises, (4) skin and nail care. The therapist must also have a complete understanding of the anatomy, physiology, and pathophysiology of the lymphatic system, the treatment of primary and secondary lymphedema, the indications and contraindications of CDT, and the proper measuring techniques for lymphedema support garments. Furthermore, lymphedema therapy should not begin unless the patient has been examined and diagnosed by a board-certified physician who understands lymphedema and its complications. Once the diagnosis of lymphedema has been confirmed and treatment has begun, the progress must be monitored by the physician. Whereas the clinical diagnosis of lymphedema can most often be established without invasive testing, and electrocardiogram before the treatment begins and during the course of treatment is sometimes necessary to ensure safe treatment for each patient. Lymphangioscintigraphy (LAS), CT scans, and MRIs are also recommended for lymphedema patients before starting CDT. The physician will be able to decide and inform the patient about the necessity of such procedures at the time of consultation. Because of the complications associated with lymphedema, the involvement and supervision of a qualified physician is essential for safe and effective lymphedema therapy.
PATIENT TESTIMONIALS
“I was extremely weak from chemotherapy. Through Eric Mason’s guidance, expertise, and understanding of my needs, I was able to gain strength. Eric is an ultimate professional and personable at the same time. He’s a MIRACLE WORKER!”–Barbara B.
“Three weeks after my last chemotherapy session, I developed lymphedema in my left arm. I really wanted to be seen immediately to prevent it from developing further. I couldn’t believe that I was able to get an appointment with Premier that afternoon. Had I gone to P.T. at another provider, I would have had to wait 2 ½ weeks. Also I was going to fly to visit my daughter in just three days so it was important to me to learn self lymphedema massage and drainage so I could help prevent further swelling from flying. I also appreciated that I could call and speak with Sheryl or anyone else there and they were all in the same place, as opposed to having to call central scheduling in some remote office far from where my P.T. would take place. I loved the friendly, caring, loving atmosphere at Premier. I was sort of scared when I first went in because I didn’t really know what I was up against with lymphedema, and Premier really helped put me at ease. They were a wealth of information. They gave me multiple print-outs and discs on lymphedema massage and visualization. They were so knowledgeable and really worked hard to get me better.”
–Terry M.
In July of ’09, I showed up at Premier’s door as a breast cancer patient having recently had a bilateral mastectomy. Radiation was looming in the near future. My therapist, listened to my concerns: a possibility of lymphedema, my ability to have full use of my left arm and shoulder, and my hopes for future reconstruction. Then, they went to work. They worked with me throughout my radiation treatments, and afterwards, helped to prepare my skin for future reconstruction. The exercises and massage they employed for lymphedema prevention and arm and shoulder strength and mobility were extremely beneficial. They also gave me the tools I needed to continue my therapy at home, including lymphatic massage. I have absolutely no doubt that Premier made all the difference in whether or not I could continue a normal life after my mastectomy. My energy level improved. I had a more positive outlook on the future. I could continue using my left arm with only minor restrictions. As a teacher, these matters were of utmost importance to me. Throughout my therapy, I felt comfortable with Premier’s friendly, professional manner. I am grateful for the quality of concern and care for the “whole person,” the expertise and professionalism I received. I liked Premier’s vast knowledge about breast cancer and lymphedema and also the phenomenal treatment I received on a one-to-one basis. Also, I was given the tools necessary to continue treatment at home
–Mary J.
