Download Possible Complication with Breast Cancer Patients

Oncology Rehabilitation: Web-based Learning for Physical Therapists
Who Provide Rehabilitation to Patients with Breast Cancer
File #5
Complications and Alternatives
Possible Complication with Breast
Cancer Patients
• Lymphedema
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The Lymph System
Jugular vein
Innominate vein
Lung
Heart
Alveolar capillaries
Left atrium
Right atrium
Left ventricle
Right ventricle
Pulmonary veins
Hepatic vein
Basilic vein
Liver
Kidney
Portal vein
Renal vein
Large intestines
Small intestines
Capillaries of
gastrointestinal tract
Inferior vena cava
Femoral vein
Great saphenous vein
Small saphenous vein
Popliteal vein
Anterior tibial vein
Posterior tibial vein
Peroneal vein
VEIN NETWORK
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Lymph System:
A network of the body that makes and
stores cells that fight infection and clears
the tissue spaces of excess fluid and
cells. This system is composed of lymph
vessels, lymph nodes and lymph organs
such as the spleen.
(www.lymphedemapeople.com, 2005)
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Lymphedema
Abnormal accumulation of lymph in the
tissue, causing swelling in the arm or
leg, due to inability of the lymph system
(vessels and nodes) to transport the load
of the lymph to the exits.
(www.lymphedemapeople.com, 2005)
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2 Types of Lymphedema
Primary: caused principally by
underdevelopment of the lymph channel
system.
Secondary: caused by damage to the
lymph channel system, such as infection,
scarring, an accident, radiation therapy or
surgery.
(www.lymphedemapeople.com, 2005)
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Lymphedema Treatment Plan
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Initial evaluation
Patient education and precautions
Exercise program
Compression garments
Compression pumps
Manual massage techniques
Compression Wrapping
REID Sleeve
Pharmacological Treatment
Life Style
(www.lymphedemapeople.com), 2005
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Lymphedema Training
This slide is needed to show some of the training methods used
in the treatment of lymphedema. Courses are intense and expensive.
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Vodder……… 4 wks………..$2000.00
Foldi………… 2 wks……...
2500.00
Carley Smith… 2 wks……. 1000.00
Bergel………… 4-5 days…
500.00
Klose……………..135 hours..2500.00
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Example of training to treat lymphedema
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Pre-requisites: Profession of medical doctors, physical therapists, physical therapy
assistants, occupational therapists, occupational therapy assistants, nurses, athletic
trainers and massage therapists showing proof of 500 hours of training.
Course topics:
– Anatomy, physiology and pathophysiology of the lymphatic system
– Basic techniques and sequences of manual lymph drainage (Vodder technique)
– Indications and contraindications of manual lymph drainage and complete
decongestive therapy
– Treatment of primary and secondary lymphedema
– Lymphedema bandaging techniques for upper and lower extremities
– Remedial lymphedema exercises
– Hygienic skin and nail care for lymphedema
– Measuring and fitting techniques for lymphedema support garments
– Patient evaluation and weekly measuring (circumference and volume)
– Home maintenance and self-treatment for lymphedema
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(Klose Training & Consulting, LLC course description)
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Symptoms associated with breast cancer
lymphedema
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Feeling of tightness in the upper extremity
Rings become tight
Weakness of upper extremity
Aching or heaviness in the arm
(http://www.oncologypt.org/.)
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PREVENT LYMPHEDEMA
• Avoid cuts, Scratches, and Irritations
(Electric razor --cut nails straight across)
• No injections in affected arm.
• Avoid wasps, bees and other insects. (repel)
• Avoid Extreme Temperatures (Hot & Cold)
• Avoid Burns (Sun & Fire)
• Avoid Arm Pressure (Blood Pressure, tight clothing or
jewelry
• Avoid underarm Irritation (deodorant-shave)
• Avoid arm/leg Strain (10# limit--Position every 1/2 hour-Don't cross legs)
• Increased pressure on aircraft can increase swelling.
• Call M.D. with problems (Temp, Red,Swell.)
(www.lymphedemapeople.com, 2005)
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Treatment Sequence
Manual Lymph Drainage & Complete Decongestive Therapy
• #1 Clear inguinal / axillary lymph nodes
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Fill & Clear thigh / upper arm
Clear popliteal / cubital lymph nodes
Fill & Clear leg / arm
Clear inguinal / axillary lymph nodes
#2 Thigh / Upper arm Fill / Clear
Proximal / Middle /Distal(To inguinal/axillary)
#3 Popliteal / Cubital Lymph nodes Fill/Clear
#4 Leg / Arm
Proximal/Middle/Distal. med & lat foot &toes
#5 Finish with clearing to inguinal / axilla
This is just an example to clarify the expertise required to
complete lymphatic massage. Improper techniques can
certainly be harmful to the patient.
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Contraindications to lymph massage
• Acute swelling due to clot blocking a major
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vessel (Thrombosis) Could move clot to lung =
Pulmonary Embolism.
Untreated Cancer with METS = Spread Ca cells
Bacterial Infection may spread with lymph
Radiation scar. Wait 5 wks, after medical
treatments. Fragile
No intense abdominal work during menstruation,
pregnancy or abdominal complaints.
(Carriere, 1991)
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Nutrition
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The following slides are not to
replace a nutritionist or make you a
healer, but rather to make you aware
of options that may become
questions presented by your patient.
If you have a question, refer to your
team members.
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Nutritional Goals:
• Maintain healthy weight
• Low fat / Low cholesterol diet
• Control daily calories
• Increase fiber in diet
• Eliminate salt and food additives
• Prevent or correct deficiencies
(Dollinger, 2002)
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• Diet history
• Calculate nutrient intake
• Anthropometric measurements
• Lab tests
• Functional measurements
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Healthy Diet
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Eat a variety of foods.
Maintain a healthy weight.
Choose diet low in fat, saturated fat, and cholesterol.
Choose diet of vegetables, fruits and grain.
Use sugar only in moderation.
Use salt only in moderation.
Alcohol only in moderation.
(U.S. Government Dietary Guidelines)
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Variety of Foods
(Food Pyramid)
• Bread,cereal, rice and Pasta
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(6-11 servings per day)
Vegetables (3-5 servings per day)
Fruit (2-4 servings per day)
Meat, poultry, fish, dry beans, eggs, and nuts
(2-3 servings per day)
Milk, yogurt and cheese
(2-3 servings per day)
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Calories needed:
• Active...............2,000+ calories / day
• Sedate...............1,600 calories/day
• Very Active.......2,400+ calories / day
• Calculate daily calories:
• Intake factors:
• Sedentary = 1.2
• Moderate = 1.4
• Active =
1.6
• Body weight X 10 X activity factor = daily calorie intake
(www.hopkinsbreastcenter.org, 2006)20
Diet
• Linked to Colon, Breast, and Prostate Cancers.
• The American Cancer Society reports that diet
modifications which decrease fat and increase fiber
consumption have the potential to decrease cancer.
• The American Institute for Cancer Research developed 50
Nutritional Tips, including such categories as: *Tips for
Eating More Fruits, Vegetables and Grains. *Hints for
Skimming the Fat. and *Ideas for Healthy Living.
(www.cancer.org, 1999)
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Nutritional Problems associated with
Cancer Patients
• Chewing and swallowing problems.
Example: Mouth and throat pain or lesions due to
medical interventions.
• Blockage of food passageways in some part of
the digestive system.
Example: Tumors
• Altered taste perception.
(Jennings-Dozier, 2002)
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• Possible signs of nutritional problems:
• Nausea / Vomiting
• Anorexia
• Mouth Dryness
• Mouth Sores
• Diarrhea
• Constipation
(Jennings-Dozier, 2002)
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Holistic Alternatives
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HOLISTIC ALTERNATIVES
• Chinese medicine
• Yoga
• Biomedicine
• Vitamin Therapy
• Acupuncture
• Touch/Massage
• Metaphysical
Approach
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The benefits of alternative
medicine programs are unknown
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(Slide permitted by the American Cancer Society)
Many will reach for an alternative
method, if they can afford the program.
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(Slide permitted by the American Cancer Society)
No harm with some alternatives
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(Slide permitted by the American Cancer Society)
Healing
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(Slide permitted by the American Cancer Society)
Surgery without cutting
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(Slide permitted by the American Cancer Society)
Alternatives may be acceptable as
long as they are safe and routine
procedures are completed.
Understand that alternative methods
can cost the patient greater than
$10,000 per week.
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Recurrence
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Be aware of possible recurrence
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(Slide permitted by the American Cancer Society)
Time out Test
• No test here.
• Just make sure you review the lymphatic information, to avoid
complications. Realize that there are therapist who only work with
lymphedema, it is certainly a specialty. Help your patient avoid
treatment from someone who does not have creditable skills.
Avoiding problems is the best way of dealing with this system.
• As for nutrition, do not take the place of a nutritionist, but be aware
of possible complications.
• As for Alternative Methods, suggest you patient stay on the medical
path as well.
• Recurrence is always a possibility, so keep patients aware of the
benefits of early detection by following their physicians programs.
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