Lymphedema & Physical Therapy

Christina Kuzma, Manager of Business Development at Tx:Team, successfully battled breast cancer this year using physical therapy as an integral part of her treatment plan. She says that the one thing she would have done differently is to start physical therapy sooner. She began therapy the day after surgery with stretches and massages to target her lymphatic system. Despite her success, she thinks that her body would have been better prepared for the pain and stiffness if she had practiced therapy in the weeks leading up to her surgery. These pre-operation exercises are especially important when thinking about post-operation outcomes that can hinder a patient’s success. An example to consider, which often goes undetailed, is Lymphedema. Christina’s symptoms during radiation did not flare to become Lymphedema; however, reports show that having an extensive surgery, such as mastectomy, paired with radiation can increase the odds of facing Lymphedema six-fold.

WHAT’S LYMPHEDEMA?

Lymphedema can occur from any compromise to the lymphatic system; however, Lymphedema is especially common among breast cancer survivors because it can happen when lymph nodes are missing, impaired, or removed. Swelling will ensue if this system begins to have problems draining excess fluids, waste, or toxins from the body. Most commonly in breast cancer patients, the swelling shows in the arm or hand, and sometimes in the underarm, chest, trunk, or back. It can be a very serious, debilitating, and painful problem.

 

To identify Lymphedema, know that it develops gradually; however, early detection is important. Uncomfortable sensations, like tingling or numbness, in any of the listed common areas precedes visible swelling of those parts. Some patients will also report feeling full or heavy, and others report decreased flexibility and tightness. Including a Lymphedema assessment in a routine follow-up visit with a doctor at most, 6 months after surgery, could substantially decrease the physical, emotional, and financial burdens of Lymphedema on breast cancer survivors. Early detection treatment and even a pre-surgical rehab visit can vastly improve your outcome if diagnosed with Lymphedema.

MEET KIM BROWN

Kim Brown is a Tx:Team Physical Therapist at FMH Rehabilitation Crestwood, in Frederick, Maryland. While she did not treat Christina directly, Kim is all too familiar with the diagnosis and treatment for patients just like Christina.

Kim is trained and certified in Lymphedema treatment. Seventy-five percent of her clients are breast cancer patients. Due to the sensitivity of this condition, which balloons the body and causes intense, uncomfortable pain, Kim treats Lymphedema with private and personal care. According to Kim, “Success is defined by the empowerment of patients, with hopes of not only regaining their strength and living pain-free, but also regaining self-esteem and authority over their condition.”

For that reason, education about Lymphedema is a big part of Kim’s job.  “Most patients haven’t tried much besides medication to cope with their pain or persistent disability,” says Kim.  It’s likely that for that reason, many patients arrive thinking that there’s no real opportunity to improve. However, alongside the use of manual therapy and bandaging to heal tissue and reduce swelling, Kim and her team of therapists teach their patients how to exercise and manage their condition on their own.

There are few comprehensive studies conducted on Lymphedema in breast cancer patients, and as a result, Lymphedema can often be brushed over in conversation. Christina Kuzma reports that she only knew about Lymphedema thanks to a co-worker. Otherwise, Lymphedema was only mentioned to her quickly in a doctor’s visit as a potential outcome. Despite this serious lack of information and discussion, you are not an outlier if you experience this swelling and it deserves immediate attention. One study reports that in the first 18 months of recovery from breast cancer surgery, 1 in 10 patients experience Lymphedema. By 18 months, about 30% of patients have, or have had Lymphedema. Irrespective of these odds, it is most important to educate yourself on Lymphedema and keep tabs on the changes in your body as it undergoes intense and stressful circumstances.

LIVE YOUR LIFE, PAIN-FREE

It cannot be said enough how important it is to care for the health of your body and those you love. Circumstances can quickly change and you may feel out of control, but know that living comfortably is within reach. Especially to cancer patients, Kim Brown insists that there is always room for improvement. She says, “Beating cancer isn’t the end of your journey. Don’t accept weakness, fatigue, and pain as a part of your life post-cancer. Talk to your doctor and maintain that your goal is to return to the state that you were in before cancer came into your life.”

Choose Physical Therapy as Your Option

In celebration of Christina Kuzma’s successful fight against breast cancer at the age of 33, Tx:Team brings you Part Three of our weekly series to share her experience making decisions about her treatment.

The month of February was incredibly stressful for Christina. Uncertainty reigned as doctors ordered different scans to assess the lump that she found in her breast. She’ll tell you that the anxiety she experienced then was worse than any part of her treatment thereafter. When she was officially diagnosed with HER2-positive breast cancer, she was able to regain control of her path. She began studying, using research articles, blog posts about others’ experiences with breast cancer, and her coworkers’ expertise in health care to make sense of all the information available. Looking back, the information-gathering period of Christina’s first months with breast cancer was vital to the success that she’s currently experiencing as a survivor.

At this point, we’d like to pause Christina’s story to talk about the research behind Christina’s decision to forego opioids in her treatment plan. Opioids are medications that can help manage pain, such as that caused by cancer and its treatment, by blocking pain signals from injured nerves to the brain. They vary in strength and form. In the first blog post of this series, Christina revealed that the side effects of opioids were the primary reason for her decision to opt out of using them as part of her treatment plan. The temporary and limited pain relief that they could provide was not worth relying on them. This was about deciding to be cautious with the risks and committing to a plan that was reliable and effective.

HOW RISK-TAKING DEVELOPS INTO CRISIS

Christina believes strongly that “addiction doesn’t discriminate.” The composition of opioid analgesics is similar to that of morphine and heroin and they act on the same parts of our brain, so they intrinsically present an abuse and addiction risk. There has been awareness of this risk for decades, but opioids continued to be prescribed because it was believed that the drugs’ benefits outweighed the risks. Numbers now show that the rates of addiction and accidental death from opioid overdoses have turned that risk into a crisis.

The severity of the opioid crisis is underwritten by the drastic increase of written and dispensed prescriptions, the greater social acceptability of using medications, and aggressive marketing by pharmaceutical companies. Between 1991-2014, the number of opioid prescriptions has tripled. In 2016 alone, 214 million opioids were prescribed- that’s a prescription for every 2 out of 3 Americans. Of course, opioid prescriptions are often only one part of the pain management plan proposed by a provider. For breast cancer-related pain, opioids are not considered the first line of treatment. And yet, the number of opioid prescriptions among breast cancer patients has surged similarly, becoming a normalized method for pain relief.

While opioid medications will reduce pain for a short period of time, they are predictably dangerous as extended methods of pain relief. A 2016 survey by the Washington Post-Kaiser Foundation released its findings: 34% of survey respondents who had taken opioids for at least 2 months said they had become addicted or chemically dependent, while 54% of opioid users’ household members surveyed said they thought the opioid user would struggle to discontinue use. Furthermore, opioid overdoses currently account for 2/3 of drug overdoses, which are now the leading cause of accidental deaths in the United States. In 2016 alone, roughly 115 Americans died every day from opioid overdoses. These staggering statistics should cause providers to be extremely cautious when prescribing pain medication and focused on the long-term health of the patient.

TALK TO YOUR DOCTOR ABOUT A RELIABLE PLAN

Anxiety surrounding the pain management process can factor in to a patient’s decision-making. Pain, especially cancer-related pain, is very real. Fearing this pain, an opioid medication’s appeal for quick relief cannot be underestimated. Furthermore, especially in older breast cancer patients, there is a high correlation between the number of patients extending the use of opioid pain relievers and those who also use medication for anxiety or depression. This information indicates that opioids, when mishandled, will likely perpetuate the physical and mental pain for which they are prescribed. To avoid dependence on a medication that is unreliable, talk to your doctor about other options for pain relief. Be your own advocate and speak honestly about the concerns you have and the research you have done. Most importantly, consider the long-term health of your body and the quality of life that you desire.

A NATIONAL SOLUTION

The American Physical Therapy Association (APTA) developed a national campaign, #ChoosePT, to bring awareness to physical therapy as an effective and safe treatment for pain. This is about avoiding the risk of creating a bigger life problem while trying to care for your body. On the front page of the #ChoosePT site, APTA writes, “When it comes to your health, you have a choice. Choose more movement and better health.” While treating the pain of a current problem, physical therapy will strengthen the body and reduce the risk of developing other chronic conditions in the future.

The Centers for Disease Control and Prevention (CDC) has also recognized the epidemic of our current environment of opioid use. As the national health protection agency, the CDC released a set of guidelines in March 2016 for prescribing opioids in the United States. Within the guidelines, the CDC writes, “Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.” There are multiple health treatment cases cited where opioids could have been significantly reduced or avoided altogether. Additionally, “there is high-quality evidence that exercise therapy (a prominent modality in physical therapy) improves function immediately after treatment and that the improvements are sustained for at least 2-6 months.”

When Christina Kuzma was diagnosed with breast cancer in February 2018, she was determined to save her life and preserve her health. She spent a lot of time that month researching the pros and cons of each known method for treatment. The best thing that you can do if you find yourself in a similar situation is to find a treatment plan that you are confident in and commit to that plan. To inform yourself on the topics we have covered, please include these sites and research articles in your own study:

America’s Addiction to Opioids: Heroin and Prescription Drug Abuse

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

Move Forward. ChoosePT