Lymphedema

In honor of National Breast Cancer Awareness month, I have asked a friend and colleague to write a post about Lymphedema and the importance of Lymphatic Drainage. Kathleen Boyle, PT, LMT, has recently joined me at Slainte Physical Therapy. She is providing an unique blend of Yoga, Physical Therapy, and manual techniques to our clients. We are delighted to have her with us.
Thanks, Kat!

Lymphedema is a swelling in the tissue due to a build up of proteins in the tissue. The lymph system is designed to move bacteria, proteins, and other large molecules from the tissues to the lymph glands where they can be broken down. When a person has a deficit in the lymph system due to scar tissue from injury, surgery, or radiation, or due to removal of lymph nodes or a congenital lack of lymphatic vessels, then these proteins can build up in the tissue and attract water. This can result in increasing swelling over time. This can occur in any part of the body.

One group at high risk for this disorder is women who have undergone surgery and/or radiation for breast cancer. Frequently the treatment can involve removal or radiation of lymph tissue. Many people do not know that after such surgery there are things that can be done to help prevent the onset of lymphedema.

For instance, the pressure changes involved in flying on an airplane can initiate this disorder. A woman who has had breast cancer surgery with removal of lymph nodes or radiation should obtain a compression sleeve to wear any time she is flying. A doctor's prescription is required to obtain the garment. Also, the arm at risk for lymphedema should not be lifting heavy things, like a big suitcase, heavy weights at the gym, or even a heavy purse. Better to carry the purse on the other arm. Care needs to be taken with the hand and arm to avoid sunburn, cuts, and even mosquito bites. Wear gloves to garden and sunscreen outside.

If there has been any damage to lymph nodes or the lymph system of a breast then the arm on that side is at risk. The goal is to avoid any added stress on the lymphatic system for that limb to help avoid development of the disorder. However, if ANY swelling is noted in the arm seek treatment as soon as possible to increase the effectiveness of the treatment. Even if swelling has been present for months or even years, treatment by a trained physical therapist is still very helpful and can greatly improve quality of life.

Treatment has been available in Europe for many years, and over the last few years many more physical therapists in this country have been trained to properly treat this condition. Check to see if your regular therapist has been certified by a reputable organization to treat lymphedema, and if not, seek out a trained therapist. Treatment can include a specialized form of massage to stimulate the function of the lymph system, maximize the function of alternative lymph pathways to drain the area of proteins and fluid. The massage should be accompanied by a wrapping with specific short stretch bandages to provide compression overnight to continue to drain the fluid. These must be applied by a trained physical or occupational therapist to avoid over compression and inflammation. There are specific exercises that can be done with the bandages on. After two to three weeks of treatment many patients will have a reduction in limb size to very close to the size of the unaffected limb. Most of the time a professionally fitted compression garment must be worn daily to maintain the limb in the reduced size, although with very early treatment sometimes a garment will not be needed.

Many patients who develop this condition do not know what it is and many health care practitioners of all types are likewise uninformed. If you have been told in the past that "there is no treatment", or that "you must just live with it", this is incorrect. Please seek out a trained physical therapist. If you have been given a pump to reduce the limb size on a daily basis, please be aware that a compression pump can further damage the lymphatic system if the pressure is too high in any one area and leave you wedded to the pump for life. Seek out a trained physical therapist to assist you.

Haven't Got a Chew

Temporomandibular Joint Dysfunction (TMJ, or, more accurately, TMD) is a syndrome that affects approximately 10,000,000 people in the United States. TMD is a poorly understood collection of symptoms that seem to originate from the temporomandibular (jaw) joint. For years it was bounced around like a hot potato between the dental and medical communities; in some ways, this still happens.

The presentation of symptoms does not necessarily include pain in the jaw, or even the classics: “popping” or “clicking” in the joint. This means that people who suffer from TMJ pain often are undiagnosed, or misdiagnosed. The most common symptom that is not directly related to joint dysfunction, is headache. TMD headaches can be ones sided (mimicking migraines); or two sided (complex migraines, tension headaches, or: we don’t know what is going on, and we need to run many inconclusive and scary tests to rule out the really bad stuff). These headaches are tension headaches, caused from clenching or grinding the teeth, building tension in the temporalis muscles (they are fan shaped muscles on your head; around, above and behind your ears). Tension headaches beginning at the base of your skull can contribute to TMD, and TMD can make these types of headaches worse. If you are prone to migraines, a TMD related tension headache can trigger a migraine. So if your major symptom is headache – you might want to discuss TMJ syndrome with your doctor or dentist. In an article from the Boston Globe: “If Doctors Can’t Help Your Headaches – Should You See a Dentist?” you will read about the benefits of seeking a dentist for help with chronic headaches.

How does Physical Therapy help? Well, in my practice, number one is: POSTURE. If we can’t fix your posture, everything else is palliative. There are many things we do to loosen the muscles, including electrical stimulation, ultrasound, heat, ice, and massage (massage is great, and proven effective for pain relief in TMJ). I have an earlier post on trigger points, which discusses how trigger points work, and mentions the benefits in the treatment of TMD. Trigger Trauma. Still; posture is key. By improving your posture, you take the stress off of the joints; not just off your jaw, it also relieves the stress on your neck and shoulders. Posture training and appropriate exercise also gives you more control of your health.

I was diagnosed with TMD 17 years ago. I am relatively symptom free unless I do something that I know is going to cause me pain, or throw me out of good posture – like wearing high heels. I do it very rarely, for very brief periods of time, and I know that I will pay, but it is a decision that I get to make. I also am in control of my diet. I have not chewed gum in 12 years – the pain that I will deal with for days after is not worth it to me. Carmel, on the other hand, is occasionally worth three days of ice-packs and begging my staff to treat me.

Stress (I mentioned that these are tension headaches, right?) is some what under our control. If you have a lot of stress and tension in your life, you have to get a handle on it. Learn to meditate, and make it a priority. If you are unable control your reactions to the stressors in your life (and yes, keeping your mouth closed, and pretending that things don’t bother you is a reaction,– clenching, remember?), please seek counseling. This is hugely important. Life happens, how you deal with it will determine how negatively it affects you. There is some basic information, and tips on how to deal with TMJ pain at my web-site: Slainte Physical Therapy .

There are factors that affect the joint that we don’t have a lot of control over. Changes in atmospheric pressure can worsen symptoms, especially if your temporamandibular joint has become arthritic. I live in Florida, hurricane season is hard on my jaw patients, and on me. Between the stress involved with the season, and the rapid weather changes, my office gets very busy. At that point it is just symptom relief, and trying to maintain as much of a positive attitude as possible. At least weather is not permanent.