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Bellisse® E-Newsletter )
June 2008
In This Issue
  • Wise Words
  • Managing Breast Lymphedema After Breast Cancer
  • Research Alert!
  • Wise Words
  • Susan Says: How to Help Uninsured or Underinsured Patients Afford Needed Compression Garments
  • Wise Words
  • Update Your User Profile
  •   

    Dear Bellisse,

    Spring has "sprung" for most of us - and the fresh start to the year refreshes our minds and hearts, and renews our commitment to the community of truncal lymphedema patients!

    In this issue of our newsletter, we focus on research and resources. Lesli has attended several conferences during the past few months. She returns each time excited and enthused about the increasing recognition of lymphedema of the breast and chest in the medical and research community. In our lead article, Managing Breast Lymphedema After Breast Cancer, Lesli has distilled some of the latest research. And as research is leading to increased recognition of chest/breast lymphedema, there is also an increasing awareness of ways to improve quality of life for those women coping with the condition. We are pleased that the Bellisse® Compressure Comfort® Bra is one element of that improved quality of life.

    At the same time, we are aware of the financial pressures facing most families, and we understand that expenses associated with treating a medical condition can add to those pressures. We have worked hard to stay informed about insurance requirements and to develop tools for patients to access those funds. This information is on our website. This month, Susan offers some helpful ideas for other sources of funds that may be available to you.

    Your suggestions and information are a wonderful source for us and for others who visit our site. If you have research or resources that you'd like to share, please contact us. Thank you for helping us increase awareness of breast and truncal lymphedema.


    Wise Words

    We must not, in trying to think about how we can make a big difference, ignore the small daily differences we can make which, over time, add up to big differences that we often cannot foresee.

    - Marian Wright Edelman

    Managing Breast Lymphedema After Breast Cancer
    Dragonboats on Lake Champlain, VT

    By Lesli Bell, PT

    As early detection, less invasive diagnostics, and better treatments are leading to more long-term survivors, clinicians are focusing on quality-of-life issues after breast cancer.

    One of the most dreaded post-treatment complications of breast cancer is lymphedema. Lymphedema may occur as a result of surgery and radiation of the chest wall tissues. Studies report that lymph nodes are sensitive to radiation therapy and can be traumatized during treatment. The lymph transport system may be impaired by fibrosis of the tissues surrounding the vessels that put pressure on the walls of the vessels. These complications can impede lymphatic drainage and cause lymphedema of the breast, chest and arm.

    With chest and breast lymphedema, fullness and pain may occur in the axillary, infra-axillary and lateral/posterior chest wall as well as the chest or breast tissue. Arm edema may or may not accompany breast/chest lymphedema. Left untreated, the chest/breast lymphedema can progress and a patient runs a significant risk of infection. Early intervention is the key to halting progression or possibly reversing its physical effects.

    Early intervention research is being conducted that includes looking at the use of bioimpedence measurements, volumetric measurements, and patient self reporting. The literature indicates that the risk of breast edema ranges from 15 percent to 80 percent in patients undergoing complete axillary dissection, compared with a risk of 8 percent to 25 percent in patients undergoing a more limited surgical procedure. However, chest and breast lymphedema is under- or misdiagnosed, under-reported, and under-treated. As a result, many patients may experience significant pain and anxiety not knowing they have this condition, which may delay healing or early management.

    Too often women go home after breast cancer treatment without knowledge of appropriate risk reduction strategies or information about early detection of lymphedema of the breast or chest wall. Bras that are too tight, especially around the lower ribcage, may create a tourniquet effect that exacerbates edema and fibrosis. Skin reactions to radiation, including fibrosis and pitting edema, may continue for 12 to 18 months.

    Early intervention treatments can include complete decongestive therapy, chest and breast compression garments such as the Compressure Comfort® Bra by Bellisse®, chipped foam pads, cold or low level light laser, Kinesio® tape, exercise and risk reduction strategies. Lymphedema therapists can help patients determine which of these strategies are appropriate.

    Wearing a non-restrictive bra, avoiding underwires, and wearing appropriate compression can improve the quality of life for these patients, helping them through the post-treatment phase. Sports bras are not appropriate for this population because they may be too stiff, hard to get on and off, and create a tourniquet effect around the rib cage or on the shoulders. Wearing the Bellisse® Compressure Comfort® Bra may result in marked improvement, lessening pain and swelling, and inserting a chipped foam pad into the compression garment or appropriate bra can effectively reduce fibrosis. Greater control of swelling and fibrosis leads to healthier tissues, reducing the risk of long-term problems.

    For More Information

    • Ariel IM, Resnick MI, Oropeza R: The effects of irradiation (external and internal) on lymphatic dynamics. American Journal of Roentgenology, Radium Therapy & Nuclear Medicine 1967; 99(2):404-414.
    • Clarke D, Martinez A, Cox RS, Goffinet DR: Breast edema following staging axillary node dissection in patients with breast carcinoma treated by radical radiotherapy. Cancer 1982; 49(11):2295-2299.
    • Clarke D, Martinez A, Cox RS: Analysis of cosmetic results and complications in patients with stage I and II breast cancer treated by biopsy and irradiation. Int J Radiat Oncol Biol Phys 1983; 9(12):1807-1813.
    • Early Diagnosis and Treatment Intervention for Lymphedema. Abstract presented at May 2007 surgical oncology conference. NL Gergich, MPT(1), MPH(2); LA Pfalzer, PT, PhD(3); PW Soballe, MD(1) and CL McGarvey, DPT, MS(4). (1) Breast Care Center, National Naval Medical Center, Bethesda, MD, FA Washington; (2) University of Maryland School of Medicine, Baltimore, MD; (3) University of Michigan-Flint, Flint, MI; (4) National Institutes of Health, Bethesda, MD, Physical Therapy Dept. 9. Journal: Nurs Res. 2003 Nov-Dec; 52(6): 370-9.
    • Early signs of the clinical adoption of a pre-emptive care approach to Lymphoedema using ImpediMed technology by a US Hospital. Reprint of a January 2008 news release issued by Lancaster General Hospital in Pennsylvania in the USA.
    • Lenzi M, Bassani G: The effect of radiation on the lymph and on the lymph vessels. Radiology 1963; 80:814-817.
    • Meek A: Breast radiotherapy and lymphedema. Cancer 1998; 83(12) [Suppl]:2788-2797.
    • Predicting breast cancer-related using self-reported symptoms. Armer JM, Radina ME, Porock D, Culbertson SD.
    • Ray GR, Fish VJ: Biopsy and Definitive Radiation Therapy in Stage I and II Adenocarcinoma of the Female Breast: Analysis of cosmesis and the role of electron beam supplementation. Int J Radiat Oncol Biol Phys 1983; 9(6):813-818.

    For more information and links, go to www.bellisse.com

    Lesli R. Bell, PT, CLT-LANA, is executive director and owner of Timberlane Physical Therapy in South Burlington, Vt., and the developer of the Compressure Comfort® Bra by Bellisse.®

    Research Alert!
    Researcher helping women with lymphedema

    Exciting findings have been published in the latest issue of Cancer magazine. The paper, entitled "Preoperative assessment enables the early diagnosis and successful treatment of lymphedema", was prepared by several of our colleagues in the APTA Oncology section. The article discusses research showing that early intervention with compression, followed by use of compression during high-risk activities, eliminated the incidence of lymphedema during the trial period for this cohort. We are excited that this type of research is being pursued.

    To read the abstract, follow this link...

    http://www.ncbi.nlm.nih.gov/pubmed/18428212?ordinalpos=&itool=EntrezSyst

    Wise Words

    I am only one, But still I am one. I cannot do everything, But still I can do something. And because I cannot do everything I will not refuse to do The something that I can do.

    - Edward Everett Hale

    Susan Says: How to Help Uninsured or Underinsured Patients Afford Needed Compression Garments

    In this age of shrinking insurance allowables, we are finding that insurance companies are offering less coverage for many needed quality-of-life garments. In light of that reality, we'd like to share with our readers some other alternative sources of funding to help patients get the garments they need.

    Create a comprehensive list of local Breast Cancer Funds available in your area.

    Once you have invested a little time to do this, it becomes a handy future reference to help many needy patients find resources they didn't know were available to them.

    Here's how:

    1) Search the internet for national breast cancer organizations and inquire if they have local affiliates with funds. Here are a few links to get you started:

    2) Search the web for state or local organizations that may have breast cancer funds available. Here are some ideas to start your search:

    • Cancer Foundations
    • Breast Cancer Funds
    • Breast Cancer Coalition organizations
    • Regional hospitals, community health care centers, breast & cancer centers
    • Local organizations such as Knights of Columbus, Elks, men's & women's groups
    • Local indigent care programs through local municipalities
    • Churches and other faith based organizations
    • Create your own fund through alliances with local breast cancer or lymphedema support groups and area businesses. Raise your own funds, perhaps by hosting an Open House fundraiser at your business during National Breast Cancer Awareness Month.

    No breast cancer funds available or the patient isn't income- qualified?

    3) Medical suppliers could offer patients a payment plan, or tell patients about CreditCare.com , which is a commercial organization that offers loans to patients who need medical procedures not covered or insufficiently covered by insurance. http://www.carecredit.com

    4) A patient can often call on family or friends for help with obtaining a medically-needed or a quality-of-life item that she cannot afford - but she may be so overwhelmed that she overlooks this option. Family and friends are often delighted to be given an opportunity to help, and they will rarely let a patient down. After all, we all ask "What can I do for you?" when cancer or illness strikes someone - and this gives friends and family the chance to do something wonderful!

    Wise Words

    There is a wonderful mythical law of nature that the three things we crave most in life -- happiness, freedom, and peace of mind -- are always attained by giving them to someone else.

    - Peyton Conway March

    Update Your User Profile

    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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