Evidence Update: Lymphedema and Shoulder Pain
TurningPoint clinicians have long been aware that there is a relationship between long-standing lymphedema and shoulder pain and problems. In a study published last month, researchers in Korea examined the relationship between lymphedema and shoulder joint changes in breast cancer patients. Forty-seven breast cancer patients with lymphedema were assessed. The duration of the arm swelling and shoulder pain were recorded. Ultrasound examination of the shoulder joint was performed in all patients to detect any changes in the soft tissue around the shoulder joint. Interestingly, abnormalities were found in 87% of the 47 participants. These changes included thickening of the bursa and small tears in the rotator cuff tendons. The changes tended to be more significant in patients who had lymphedema for a longer period of time. The authors concluded that there is a relationship between shoulder problems and lymphedema and that clinicians should adopt an early management approach for shoulder pain in patients with breast cancer-related lymphedema, http://affectivebrain.com/?attachment_id=5775. TurningPoint’s lymphedema screening program which facilitates early detection and management of lymphedema, along with providing rehabilitation for shoulder issues when they occur, should reduce the impact of lymphedema on long-term shoulder issues. Yang DH et al. The Influence of Arm Swelling Duration on Shoulder Pathology in Breast Cancer Patients with Lymphedema. PLoS One. 2015 Nov 16;10(11):e0142950. doi: 10.1371/journal.pone.0142950. eCollection 2015.
Patient Perspective: Cassandra Wilson
Why me? How? I’m too young! These were the thoughts going through my mind. I had just met a wonderful young lady, a two time cancer survivor, in September 2014, at a radio station engagement who was speaking on cancer and early detection. So she had me thinking, and I decided to check for lumps. I found a lump in my breast almost 2 weeks later, I didn’t want to think the worst so I put it off. Near the beginning of October the lump was still there, so I began to research information on free mammograms because I didn’t have health insurance. I called around and checked into many programs. No one would assist me because they said I was “too young”. I noticed my lump began to get larger. I started a new job and was able to obtain health insurance. In November 2014 I was finally able to see a doctor. My doctor was very concerned about the lump and immediately sent me for a mammogram. For the next 45 days I went through a number of tests and biopsies. On December 24, 2014, I went in and the doctor said “Mrs. Wilson, you have breast cancer.” I thought what a Christmas gift, to be told you have breast cancer. I had just started a new career, things were just starting to work out for our family. Financially, things had finally got back on track and I was so excited. I thought to myself, NO! My doctor had told me that I had Stage lll cancer and the tumor had grown very large. I was told I needed to start chemotherapy immediately, with a mastectomy and radiation following. At this point so many emotions ran through my mind, https://www.cdhfinechemical.com/cdh_data/xanax-alprazolam/. I was completely devastated. I didn’t know what to think or how to feel. I became numb; I had lost hope, and faith. BUT, I heard a strong voice say you are more than a conqueror, you are a fighter, and I am with you. It was God. He hadn’t given up on me; I gave up on him. Through 16 rounds of chemo, a mastectomy, and 28 rounds of radiation, I am proud to say I am STANDING. Through the help and assistance of TurningPoint I am getting range of motion back in my left arm. I am starting to exercise and stretch. TurningPoint offers financial assistance for their programs, which is a blessing. Without this amazing organization and the wonderful services they offer, I don’t know where I would be. I’m glad to say that I made it through, with prayer, hope, faith, and family. I am here today thanking God and giving him all Glory for my total healing.
Evidence Update: Breast Reconstruction and Lymphedema Risk
Patients often ask us if breast reconstruction after mastectomy increases their risk of lymphedema. Several studies in the past suggest that breast reconstruction does not increase lymphedema risk. In a recent study published in October, researchers compared the number of patients who developed lymphedema in three surgical groups: mastectomy alone, immediate expander or implant and immediate reconstruction with autologous tissue (patients’ own tissue, such as TRAM flap). Immediate reconstruction refers to reconstruction performed at the time of the mastectomy. In this study, 616 patients with breast cancer who had a total of 891 mastectomies were prospectively screened for lymphedema and followed for an average of 22 months. Arm measurements were performed preoperatively and during postoperative follow-up using a Perometer like the one used at TurningPoint. For the purpose of this study, lymphedema was defined as 10% or more arm volume increase* compared to preoperative. Researchers controlled for variables that are known to increase lymphedema risk, such as the number of nodes removed, BMI and radiation so that they could compare the groups on the basis of reconstruction procedure alone. The study found reduced lymphedema risk in patients with immediate expander/implant reconstruction compared to mastectomy alone and autologous reconstruction. The mechanism by which immediate expander/implant reconstruction appears to reduce lymphedema risk is not known, and further research is needed. However, based on this study and others, it is safe to conclude that immediate reconstruction does not appear to increase lymphedema risk and, in the case of expanders/implants, may actually decrease lymphedema risk. Miller CL et al. Immediate Implant Reconstruction Is Associated With a Reduced Risk of Lymphedema Compared to Mastectomy Alone: A Prospective Cohort Study. Ann Surg. Oct 10, 2015 [Epub ahead of print] *(Note to TurningPoint patients: In TurningPoint’s model of lymphedema surveillance and management, 10% lymphedema is considered to be moderate lymphedema. When we are measuring you in the clinic, we define lymphedema as an increase of more than 3-5% above your baseline measures and we take into consideration visible swelling and symptoms of lymphedema such as heaviness sensation of the arm).
Nutrition Q&A: Vitamin C during cold and flu season?
Q. Do you recommend taking a Vitamin C supplement during cold and flu season? A. Found in more foods than just citrus! Vitamin C, also known as ascorbic acid is a water soluble vitamin and a powerful antioxidant. Its main role in our bodies is to maintain connective tissue, including bones, blood vessels and skin. During the winter months it is not uncommon for people to supplement with large doses of Vitamin C because they’ve heard it helps prevent catching the common cold. The truth to the matter is, there is no evidence that consuming large amounts of vitamin C (200 mg or greater) reduced the frequency of the common cold. However, there was a tendency for Vitamin C to reduce the severity and duration of colds. I always encourage my clients to get their nutrients from whole food rather than pill form. The RDI for Vitamin C is 75 mg for females and 90 mg for males and these RDI’s can easily be meet simply by consuming fruits and vegetables. We all know oranges are an excellent source of Vitamin C, providing 95 mg in just one orange, but did you know about these excellent sources? Broccoli, 101 mg/cup, Strawberries, 10 mg/berry, Bell Pepper 117 mg/cup, Cauliflower, 55/cup, and Sweet Potato, 39mg/cup, to name a few. Most fruits and vegetables containing Vitamin C are also excellent sources of phytonutrients, which have the added health benefit of preventing cardiovascular disease and cancer, something you miss out on when swallowing a pill. Bottom line, epidemiological evidence suggests that adequate Vitamin C from foods is linked to reduced risk of cardiovascular disease and cancer, so if you’re interested in increasing your Vitamin C intake, head to the produce department at your local grocer instead of the supplement isle.
