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Dear Bellisse, Spring is here again in Vermont (finally!), and it is time to think about new growth, warm weather and what we are going to do for our summer vacations! It is important to protect your skin when enjoying the out-of-doors, so be sure to use sunscreen. Of course, you've heard that advice before - but it's especially important if your skin has been exposed to radiation. Our article on Radiation Recall discusses a post-radiation complication that many may not know about, and that can be aggravated by sunburn. We hope you will find this information helpful. The late winter/early spring has been busy for Bellisse. Here are some of the highlights: Lesli had the opportunity to visit the breast cancer clinical treatment center at the National Naval Medical Center in Bethesda, MD and National Institutes of Health which is across the (very wide) street. The facilities are incredible and the research that is being done there is truly amazing. There are brilliant doctors, therapists, and scientists working tirelessly to discover cures and treatments to improve life for all of us. One project involves studying lymphedema in breast cancer patients using highly sensitive measurement tools to determine changes pre-breast cancer treatment and post-treatment. We are pleased to provide their latest published research later in this newsletter - including results showing that a subset of patients appear to have had their early lymphedema reversed! NIH plans to do more research on breast edema pre- and post-breast cancer treatment. We hope this moves forward and we thank those who are pursuing this important subject. Susan Tessier, Director of Sales and Service, conducted in-services for several of our Preferred and Premier Dealers in the Northeast region. Each time we do a Bellisse in-service we are struck by the enthusiasm and encouragement we receive from health care providers and dealers alike. Lymphedema of the trunk and breast is still under-recognized and appropriate post-operative compression for breast cancer survivors is too rarely considered - even though almost all agree that it improves comfort and quality of life and may help speed tissue healing. More recently, we attended the Essentially Women (EW) Buying Group's Conference in St. Charles, MO. For the fourth consecutive year, Lesli was a guest lecturer. She spoke on Compression vs. Support and When Do You Need Which. Susan conducted a class for the EW dealers titled Who Needs a Little Extra Support - How to Fit, Submit and Market the Bellisse Compressure Comfort® Bra. Back at the Bellisse office, Trudy Haire, Customer Service Representative, provides unwavering support to the lymphedema patients, healthcare providers and medical suppliers who call us with orders and product questions. Trudy knows the importance of getting the proper fit of the Compressure Comfort® Bra, and due to her efforts more and more dealers carry a wide array of sizes through the Bellisse Preferred Dealer Program. We also had the opportunity to share the efforts of our friend Bob Weiss with you recently. He is tirelessly working to bring the awareness to Medicare of the garment and supply needs of lymphedema patients. Thanks to all of you who wrote letters on behalf of this effort! We all hope that Medicare will take notice and make code changes so that lymphedema patients can get the garments and supplies they need covered. We hope that this newsletter finds you all well and looking forward to summer. Thanks to the many of you who write to us and tell your stories - we love to hear from you so please keep in touch!
An optimist is the human personification of spring. -- Susan J. Bissonette
by Nicole Gerghich, MS, PT, President Oncology Section, APTA, and L.A. Pfalzer, PT, PhD, University of Michigan-Flint What is "radiation recall"? Radiation recall is when the effects of radiation suddenly recur months or years after radiation treatments have stopped. Radiation recall may resemble a severe sunburn in the area of the previous radiation. The skin may become pinkish or reddish and warm. It may also re-initiate fibroblastic activity or thickening of the skin which may be similar to the original skin reaction of radiation. These symptoms may initiate or aggravate lymphedema in the tissues, sometimes requiring short term treatment of Complete Decongestive Therapy to reduce symptoms. What causes radiation recall? These skin reactions are most commonly associated with antitumor antibiotics. However, it has also been reported that patients using St. John's Wort may self induce this condition. In patients who consider herbal medicinal products, the risk of increased cutaneous side effects after radiotherapy may be increased. So far the mechanism for the increased post radiation sensitivity is unclear. It is wise to discuss any use of herbal remedies with your doctor before you use them. What can be done to treat radiation recall? Treatment of radiation recall is symptomatic. Occasionally secondary infections may occur and will need to be treated. Sometimes corticosteroids are be used in order to allow continuation of the offending antitumor drug. Lymphedema therapy and or compression may also be indicated. What can I do to reduce the risk of inducing radiation recall (or manage a recurrence)? Skin that has received radiation should always be protected from the sun. Stay out of the sun, and avoid tanning beds. If you must be in the sun use protective clothing and sunscreen with SPF 30 or higher over previously radiated skin. Re-apply every 30 minutes if you are in the sun. Avoid heat treatments to the radiated area, including thermal ultrasound and moist hot packs. You can soothe the itching and burning by putting a cool, wet compress over the affected area. Report any skin irritation or changes to your doctor or nurse. Consider Lindi Skin Cooler Roll and Lindi Skin Cooler Pads during radiation or if there are radiation recall symptoms. These are hydrous sheets which contain aloe to help soothe and green tea for its antioxidant activity. Lindi Skin Coolers help to hydrate and instantly cool radiated, burned or sensitive skin. Both the Lindi Skin Cooler Roll and Lindi Skin Cooler Pad are non-adhesive, so they can be removed without causing further trauma to already irritated skin. Lindi Skin has created a wonderful line of skin care products created for sensitive skin that is undergoing chemotherapy and or radiation. These products are dermatologist tested and recommended by many doctors for their patients during and after cancer treatments. Go to www.lindiskin.com for more information and for stores that carry their products. PLEASE NOTE: Doctors recommend treatment area to be clean prior to each radiation treatment. Please consult your physician for his/her specific instructions. Lindi Skin Coolers are intended to be used 2 to 3 or more times daily AFTER each treatment. Intense hydration from Lindi Skin coolers is beneficial for increasing moisture level to affected site. Good skin maintenance is important to mitigate skin reaction from the onset of treatment.
Useful links and information: Cancer Treatment Review. 2005 November; 31(7):555-70. Epub 2005 September 15 Radiation Oncology 2006; 1: 32. Published online 2006 September 1. DOI: 10. 1186/1748-717X-1-32.
Authors: NL Stout Gergich, MPT and PW Soballe, MD, Breast Care Center, National Naval Medical Center, Bethesda, MD LA Pfalzer, PT, PhD, University of Michigan-Flint, Flint, MI CL McGarvey, DPT, MS, National Institutes of Health, Bethesda, MD, Physical Therapy Dept Recently an important abstract was presented at The Society of Surgical Oncology conference in Washington DC. This abstract is entitled "Early Diagnosis and Treatment Intervention for Lymphedema". The researchers at NIH and The National Naval Medical Center's Breast Care Center looked at all women newly diagnosed with breast CA. These women were seen pre-operatively for evaluation of their strength, arm motion and limb volume. All women were then followed post-operatively, every 3 months for 2 years to monitor them for changes in their limb volume, strength and arm motion. Before surgery, in healthy women, there can be a volume difference of 1-3% between normal arms. Therefore, it is of the utmost importance that to accurately measure for lymphedema, measurements must be taken pre-operatively to know what each patients "normal" limb volume is. Both arms were measured at each visit throughout the study. When patients in the study showed a >3% or 100 ml increase in their limb volume as compared to their pre-operative measurement, they were given an off-the-shelf sleeve to wear daily and were followed up again in 4 weeks. In the majority of these women, the change in volume did not present as visible swelling, however many of the patients reported a feeling or sensation of heaviness and aching in the limb. These patients showed signs of sub-clinical lymphedema at an average of 8 months post operatively. When patients returned in 1 month for their follow up, with this intervention 100% of the patients involved in the study had a reduction in their limb volume back to near baseline measurement. These patients were then advised to continue to wear the sleeve ONLY at high risk times (exercise, heavy lifting or exertional activities). These patients were then followed up again 4 months later and did not demonstrate a recurrence of the increased limb volume when using the compression sleeve only with exercise and exertional activities. Conclusions from the original abstract:
This is an important preliminary study because this is the first time a sample of women seemed to have a complete reversal of early onset lymphedema with support of the affected extremity with an off the shelf sleeve. The sleeve was worn for a relatively short period of time as soon as the upper extremity started to show signs of swelling. This is also the first study to quantify "sub-clinical" lymphedema that is associated with the sensory changes known to precede the onset of visible Stage I lymphedema . The question becomes: can lymphedema be reversed if the limb, chest wall or congested lymphatic vessels are supported very early on? As early as when a patient reports a feeling of heaviness? 2.3 million women are survivors of breast cancer. Secondary lymphedema occurs in approximately 33% of women after axillary lymph node dissection and radiation therapy and 14% after sentinel lymph node biopsy and Radiation Therapy. LE impacts quality of life; range of motion, strength and function.
The Bellisse Insurance Tool Kit is Specially-Designed to Help You Succeed in Obtaining Successful Medical Reimbursements When Bellisse attended the Essentially Women Buying Conference, we learned that although our dealers are experts at billing mastectomy products, many feel challenged and confused about how to bill for specialty compression products like the Bellisse Compressure Comfort® Bra. We heard your requests for help, and we've created a comprehensive Insurance Tool Kit to help make your submissions easier and more successful. This tool kit contains useful information, documentation, and advice.
Need more help? Call us at 1-877-273-1683 - we will be happy to help in any way we can!
Here are a couple of links that intrigued us recently: Are You Confused About Breast-Cancer News? MSNBC columnists try to make sense of the most recent breast cancer research. http://www.msnbc.msn.com/id/18134141/site/newsweek/from/ET/
Chemotherapy Fog Is No Longer Ignored as Illusion This Health magazine article suggests that the medical community is starting to take a more serious look at the cognitive side effects of chemotherapy.
You don't get to choose how you're going to die. Or when. You can only decide how you're going to live. Now. -Joan Baez Rejoice in the things that are present; all else is beyond thee. -Montaigne
This newsletter contains articles that we believe will be of general interest to the Bellisse community of lymphedema patients, their family and friends, and their health care providers. Sometimes, however, we have news and links that are of interest to only one of these groups. To be sure that you are you are in all the categories that interest you, please click on the "Update my profile" link at the very bottom of this newsletter. As always, Bellisse will not share your information with anyone else.
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