Lymphedema
The Function of a Physical Therapist Treating Lymphedema
Lymphedema is progressive chronic swelling usually in extremities, but can occur in the chest, stomach and groin regions. Currently there is no cure for lymphedema, but treatment from a physical therapist is extremely helpful to prevent immobilizing side effects and possible dangerous complications (APTA.org, 2009).
Prompt discovery of limb and / breast lymphedema is key to managing and preventing complication (APTA.org, 2009). In our practice we work closely with physicians and patients to treat lymphedema quickly with minimal to no pain. We use manual lymphatic drainage therapy and begin immediate compression for long term management. Other physical therapy terms used to describe lymphedema treatment are decompression therapy, complete decongestive therapy and complex physical therapy (APTA, org,2009). Complex physical therapy for lymphedema is the gold standard of care and includes: manual lymphatic drainage, compression garments, exercise and education about skin and nail care (APTA.org, 2009). In most cases patients who receive lymphedema therapy see an 80% improvement in just one to two weeks.
Evidence based research has proven success in lymphedema treatment and management using patient education, exercise, compression and lymphedema therapy can stop lymphedema from returning (APTA.org, 2009). Early onset of lymphedema improves outcomes and reduces complications. Patients with breast cancer should be aware of the risk factors and warning signs that include:
Risks
- Overweight or increasing weight during and throughout cancer treatment.
- Lymph node removal
- Radiation therapy
- Infection or blood clot in affected extremity.
Warnings
- Pain and fullness in affected limb
- Tightness in affected limb
- Noticeable swelling in affected limb
- Numbness and tingling in affected limb (APTA.org, 2009).
In conclusion, the role of physical therapist treating patients with lymphedema is to help patients identify lymphedema early to prevent lasting side effects and possible dangerous complications. Currently there is no cure for lymphedema. However, treatment from a physical therapist is highly successful in eliminating lymphedema and preventing reoccurrences.
Sincerely, Sherri Boos, PT, DPT
References
Physical Therapist Play Integral Role in Lymyphedema Prevention, Treatment. (2009). Retrieved from APTA.org, 2009
Role of Physical Therapist in the treatment of Lymphedema. (2009). Retrieved from http://APTA.org
Sleep Health
What is sleep?
Inactivity of the body, but electrical activity of the brain continues in a predictable pattern of brain waves – from slow wave sleep to brain states that mimic wakefulness in 90 minute cycles.
Stage I
Light sleep
REM
Refreshes memory / dreaming occurs
Stage II
Stable sleep /diff to wake
Stage III
Deep sleep, growth hormone released
Sleep restores learning, memory, temperament and regulates hormones.
Average adult needs 7 to 7 1/2 hours each night.
Lack of sleep is defined as frequent daytime sleepiness as a result of sleep deprivation daily for at least 3 months.
Lack of sleep can be unintentional or intentional.
Sleep Disorders:
- Insomnia
- Circaid rhythm sleep-wake disorders
- Sleep-related breathing
- Parasomnias disorders
- Central disorder of hypersomnolence
- Other sleep disorders
Facts about sleep:
34% of US questioned stated less than 7hrs sleep nightly.
25% of US adults report lack of sleep 15 out of 30 days.
50-70 million US adults have sleep or wakefulness disorder.
Poor sleep is a public health concern!
Common causes of sleep disorders:
- Stress
- Occupational worries
- Medical illness
- Loneliness
- Pain
- Bereavement
- Family dynamics
- Financial worries
Health effects of insufficient sleep:
- Decreased immunological function
- Higher risk of chronic disease
- Higher cardiovascular death
- Higher risk of diabetes
- Higher risk of hypertension
- Higher risk of obesity
- Decreased mental performance
- Considerable higher risk in injury and accidents
Inadequate sleep is associated with behavior
- When sleep is inadequate to support sufficient alertness, work routine, and health from decreased total sleep time or fragmented sleep by short term awakenings.
- Lack of sleep syndrome is characterized by increased daytime sleepiness caused by shortened sleep daily for at least 3 months.
3 Most common sleep disorders:
- Insomnia- trouble falling asleep, staying asleep, or waking up early 3 times week for 3 months and affects daily activity.
- Sleep Apnea- respiratory disturbance index > 15 per night with or without symptoms.
- Restless leg syndrome-painful legs causing overwhelming urges to move legs during inactivity
Quantity verses Quality:
- Quantity- hours of sleep per night.
- Quality – number of times awaken from sleep and percentage / duration and type of sleep stages entered REM verses NREM
How much sleep do we need?
- Sleep need is different for everyone and across the lifespan it changes.
- 6 to 8 hours is sufficient for most adults.
- Healthy people may feel refreshed with 6 to 10 hours.
Sleep intervention techniques:
- Sleep hygiene education
- Exercise
- Stimulus control
- Reducing sedentary rest
- Relaxation
- Positioning for rest
- Weight control
- Progressive relaxation
- Cognitive behavior therapy
- Medication – antidepressants, ADHD meds, corticosteroids, thyroid hormone, high blood pressure meds, contraceptives, pain relievers containing caffeine, diuretics and diet pills
- Medical appliances
- Mindfulness sleep induction
Positive lifestyle changes to restore your sleep facilitates daily recovery and promotes improved health:
- Go to bed and get out of bed at the same time daily
- Avoid screen activity before bed
- Drink caffeinated drinks in in AM only
- Get out of bed if you cannot sleep after 20 min and return when sleepy
- Avoid alcohol
- Avoid smoking in PM
- Make your bedroom cozy, quite and cool
- Weight reduction if overweight
- Exercise on regular basis but not 2 hours before bedtime
- Eat a light snack (food with tryptophan)
- Use bed only for sleep and sex
- Avoid daytime napping
- Mouth exercise to stop snoring and improve sleep
- Weighted blanket
- Sleep temperature 67-69 degrees
Natural sleep remedies that do work need 4 essential ingredients:
Melatonin
Magnesium
Theanine
5 essential herbs for sleep health
- Valerian
- Passionflower
- Lemon balm
- Hops
- Chamomile
#1 Nocurest Advanced sleep support 5 out 5
#2 NaturesWellness Natural sleep aid 3 out 5
#3 SourceNaturals NiteRest 3 out 5
#4 NowFoods Sleep Sleep 2 out 3
#5 Somnis Natural sleep aid 2 out 5
Newest natural sleep aid
#6 RediNite
Sherri Boos, PT, DPT
References
Clark, D., Lein, D., & Morris, D. (2017, July 17). Integrating Sleep Health in Physical Therapy Clinical Practice.
Sleep Disorders & Problems – National Sleep Foundation. (n.d.). Retrieved from https://sleepfoundation.org/sleep-disorders-problems
Clarifying Women’s Health
Women’s health is much more than just treating lady parts or pelvic floor complications. Physical therapist address women’s health conditions from infancy through geriatric years focusing on specific women’s health needs.
Clarifying Women’s Health:
I have provided women’s health care for years and find many people including women are confused about women’s health care. The definition of women’s health is providing specific care during the entire life cycle for women’s issues including: incontinence, pelvic dysfunction, osteoporosis, breast cancer, lymphedema, fibromyalgia and other diseases that differ for women than men (Wojciechowski, 2009).
Kristie C. is a patient of mine and is an avid female runner that I admire and appreciate. Kristie has ran 9 marathons all over the world including Ethiopia in 2015. She suffered a right knee injury requiring meniscal repair with osteoarthritis debridement. As a result of her injury and lack of post-op rehabilitation she gained 60 lbs and began suffering additional complications of depression, anxiety and chronic pain. As a women’s health therapist I was able to treat Kristie’s knee, but also considered her complete lifestyle and surpass traditional knee rehabilitation to meet her goals of resuming running. Meeting Kristie’s running goals resolved her depression, anxiety, weight gain and chronic pain. Returning women or any patient to their previous lifestyle or passion, like running marathons is a true blessing.
Another example of women’s health is a patient of mine that was diagnosed with breast cancer resulting in several lymph node removal with lumpectomy. As a result of lymph node removal she suffered with lymphedema in her arm making her job as a hairstylist and being a grandmother difficult. Treating her lymphedema, shoulder range of motion and shoulder strength allowed her to return to full function using her arm as a hairstylist and playing with her grandson again.
Many times women’s health focuses on women during menopause, for things like urinary incontinence and constipation or in younger women with diagnoses of pelvic pain and / or sexual dysfunction (Wojciechowski, 2009). However, pelvic floor diagnoses are not the only conditions women are affected with more than men. Women also are more often diagnosed with rotator cuff tears, shoulder impingement, shoulder adhesive capsulitis, carpel tunnel, osteoarthritis, rheumatoid arthritis, fibromyalgia and lupus (Wojciechowski, 2009). All injuries and diseases affect women differently than men and physical therapist should be aware of the differences even if they don’t treat gynecological and obstetric care (Wojciechowski, 2009). Not only do women recover and heal differently than men they also have heart disease signs and symptoms differently (Wojciechowski, 2009). For example, women usually complain of difficulty breathing, nausea and vomiting, fatigue, back pain, shoulder pain and jaw pain (Medline, 2014).
In conclusion, treating the pelvic floor is a huge part of women’s health physical therapy for condition such as post-surgical complication after c-section, episiotomy, hysterectomy, sexual dysfunction, bowel and bladder disorders. In addition, women’s health physical therapy is treating all women’s health conditions throughout their life cycle for their specific needs and differences.
Respectfully,
Sherri Boos, PT, DPT
References
Wojciechowski, M. (2009). Women’s Health: It’s More Than You May Realize. PT in Motion 7. Retrieved from http://www.apta.org/PTinMotion/2009/11/Feature/WomensHealth
Women’s Heart Disease: Heart Disease Risk Factors. (2014). Retrieved from https://medlineplus.gov/…/winter14/articles/winter14pg26-27.html
Total Knee Arthroplasty
Total knee arthroplasty aka total knee replacement is a surgical procedure that has proven success relieving pain for people who suffer with knee difficulties from an injury, degenerative disorder and inflammation (Klein, 2006). In the United states alone over 300,000 total knee procedures are performed and these numbers increase as younger people need a total knee replacement (Klein, 2006). A total knee replacement procedure is a difficult surgery to recover from and should be taken very seriously. The complication are: severe pain, bruising, swelling, blood clot, temporary and permanent paralysis, infection, numbness and even death.
There are several things that help a person’s total knee outcome a success: good physical health and strength, weight, flexibility, education about the procedure and expected loss of function and nutrition to improve healing. Pre-habilitation is program that our facility offers to encourages your success after this procedure. Pre-habilitation is usually just a few visits to educate you about the produce, nutrition, possible loss of function, strengthen specific muscles and stretch tight muscles and joints.
Klein, L. J. (2006, October 18). Total Knee Replacement (CBM 2003-2). Retrieved from https://www.nlm.nih.gov/archive/20061214/pubs/cbm/tkr.html#110
Sepsis Awareness Month
Sepsis is a dangerous illness overpowering your immune reaction to infection (Sepsis Fact Sheet – National Institute of General Medical Sciences, 2017). Your body reacts to the infection using your immune system to produce chemicals to fight off infection. This causes an extensive amount of inflammation throughout the body. As a result of this response secondary complications can happen and tissue damage including internal organs can die. Over 15 million individuals acquire sepsis yearly in the United States and 250,000 die annually (Get Ahead of Sepsis – Know the Risks. Spot the Signs. Act Fast, 2017).
Early identification, quick care and avoiding infection is vital. Anyone can get sepsis and most all infection can cause sepsis (Sepsis Fact Sheet – National Institute of General Medical Sciences, 2017).
Signs and symptoms of sepsis include:
* Delirium and / or incomprehension
* Difficulty breathing
* Fast heart rate
* Fever, chills
* All over body pain and aches
* Moist and sweaty skin
(Get Ahead of Sepsis – Know the Risks. Spot the Signs. Act Fast, 2017.)
Patients and family should be proactive to avoid infections, know the signs of sepsis and act fast if sepsis is suspected (Get Ahead of Sepsis – Know the Risks. Spot the Signs. Act Fast, 2017).
References
Get Ahead of Sepsis – Know the Risks. Spot the Signs. Act Fast. | Features | CDC. (n.d.). Retrieved from https://www.cdc.gov/features/get-ahead-sepsis/index.html
Sepsis Fact Sheet – National Institute of General Medical Sciences. (n.d.). Retrieved from https://www.nigms.nih.gov/Education/Pages/factsheet_sepsis.aspx