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Welcome, This past month, October, was Breast Cancer Awareness Month, and the media was full of stories about breast cancer. The good news is that as a result of this attention, millions of people are gaining greater awareness about breast cancer and its incidence (211,000 new cases will be diagnosed this year), treatment and prognoses. But some important information isn’t getting through. Specifically, we haven’t seen one article yet in the popular media that mentions truncal lymphedema as a side effect of breast cancer treatment. (If you see such a story, please let us know about it!) We are seeing, thank heavens, a lot of information about breast cancer detection and treatment – but much less about prevention. Since we at Bellisse think that prevention is the best medicine, we’re going to try to redress that balance a little bit in this newsletter by including some prevention tips from Dr. Andrew Weil. Breast Cancer Awareness Month also has a questionable side – the over-commercialization of the month and its original intent by some companies who use it to promote their own interests over those of BC awareness. In “Think Before You Pink”, we point out some of the pitfalls to avoid when you support breast cancer research through consumer purchases. On the positive side, Breast Cancer Awareness Month has helped highlight some really important advances in breast cancer treatment. We at Bellisse hope that passing on this information might help current breast cancer patients – and maybe even their health care providers – suss out all the best possible treatment avenues. With best wishes,
I've learned that whenever I decide something with an open heart, I usually make the right decision.
– Maya Angelou, when asked on her 70th
birthday
“Think Before You Pink” is a campaign by Breast Cancer Action (BCA) to alert consumers to what they call “pinkwashing”: conspicuously-advertised corporate support of breast cancer that is more about generating good publicity and increasing profits than it is about helping the cause. When you “follow the money” from these corporate campaigns, problems arise. Some companies tell consumers that the money will be used “in the fight against breast cancer”, but they don’t give details on where the money is going and what exactly it will be used for. And, in many cases, the amount donated per product is so small that it would make more sense for consumers to just write a check directly to a breast cancer organization instead of buying the product. For more information on the “Think Before You Pink” campaign, check out the Breast Cancer Action site. We at Bellisse are not offering the above information as opinion or statement. We just like to raise the questions, start the discussions about commercialization, the potential for trivialization, and/or the ways in which health activism evolves. What’s effective? What’s not? What are your thoughts?
Bellisse co-founder and Jogbra inventor Lisa Lindahl recently learned about a great breast cancer fundraiser that focuses totally on helping women. The 2005 Art Bra Project calendars and notecards feature photographs of twelve fanciful and beautiful bras created by women artists. 100% of the proceeds from the sales of the calendars and notecards, plus the money raised by a traveling exhibit of the bras, goes directly to breast cancer research and support. The Art Bra Project is the brainchild of the Way to Women’s Wellness Foundation, an all-volunteer grassroots organization dedicated to promoting breast cancer awareness and women’s health issues. The new 2006 Art Bra Calendar, which will support heart research, is already available at wtww.org. If you would like to support breast cancer research, you can still do so by buying 2005 notecards (perhaps they would make interesting and unusual holiday cards!).
Bellisse co-founder Lesli Bell, PT-CLT/LANA, was asked to speak twice at the Fall Medtrade Expo convention in Atlanta. Her presentations were titled: “Breast Cancer and Truncal Lymphedema – Cause and Effect: What is New in the Post Operative/Treatment Complications for Cancer?” and “Compression Garments for Lymphedema: A Clinician’s View of New Developments in the Field” Both presentations were very well attended and many good questions and different points of view were raised. Lesli also reports that the understanding of this post-breast-cancer complication has vastly improved over the last three years. At this conference there were only a couple of people who asked, “What is truncal lymphedema?” What a difference from when Bellisse launched the Compressure Comfort® Bra for Lymphedema in 2002! Bellisse and Juzo Academy were scheduled to present a class in Miami in the beginning of November, but because of the hurricane this will need to be rescheduled for a later date. Our best wishes for recovery go out to all those affected in South Florida during this trying season.
At several recent conferences, physicians and lymphedema treatment professionals have suggested that lymphedema of the upper extremities (i.e. the arms) actually starts at “the root of the limb”. To those of us who understand breast and truncal edema, this makes perfect sense, because the root of the limb is the TRUNK! Dr. Christian Schuchhardt (a specialist in lymphedema, hematology, oncology, lymphology, and a medical doctor at the Pieper clinic in Germany) recently spoke at a conference in Montreal and reported, among other things, that “lymphedema starts at the root of the limb”. Dr. Peter Mortimer (Professor of Dermatological Medicine, St. George's Hospital Medical School and the Royal Marsden Hospital, London) was the keynote speaker at the last National Lymphedema Conference in Reno Nevada in October 2004. Dr. Mortimer reported that with advances in breast- conserving therapy, he was seeing much less “big” arm edema than he used to, and that breast and truncal edema were now more common and of greater concern. Drs. Horst Weissleder and Christian Schuchhardt note in their book Lymphedema Diagnosis and Therapy that they have observed that “the incidence of arm edema following breast cancer therapy depends on the extent of surgical intervention, the number of nodes removed, the amount of radiation given, and the patient’s age and weight”. They also report that lymphedema of the remaining breast is on the increase. In particular, they observe that slight, chronic edema nearly always occurs in the soft tissue that is not able to offer much resistance to edematization. If unchecked, this mild edema may then progress through all the stages of lymphedema” – another example of the need for a preventative approach.
Two recently published articles discuss the incidence of breast and truncal lymphedema following breast cancer treatment. In “Breast Lymphedema After Breast-Conserving Treatment”, (Roenkae et al) and “Lymphedema of the Arm and Breast in Irradiated Breast Cancer Patients” (Goffman et al), researchers evaluated the risk of breast, truncal, and arm lymphedema in patients treated for breast cancer. Depending on the study, the risk of lymphedema was found to be between 10% and 30% for groups given sentinel node biopsies. Both studies observed that SNB patients had a lower risk of breast, trunk, or arm lymphedema than patients who underwent more extensive axillary treatment, but that it was still a prevelant problem. In Roenkae et al, subcutaneous edema, as diagnosed by ultrasound, was as much as 69%-70% in axillary clearance patients. Both studies also noted that the likelihood of lymphedema depended in part on BMI (i.e. weight) and the site of surgery.
In a 2001 article in Rehabilitation Oncology, Sara Stalker, PT/CLT-LANA, reported that it can be difficult to diagnose truncal lymphedema if lymphedema is not also present in the upper extremities. She also notes that like arm edema, truncal lymphedema is typically asymmetrical. Without lymphedema in the extremities as an indicator, Stalker recommends looking for other symptoms when evaluating a patient for truncal lymphedema. Most importantly, she notes that while some postoperative swelling is expected, what distinguishes this normal edema from lymphedema is the persistence of symptoms and the presence of tissue changes (such as fibrosis). Other symptoms of lymphedema may include:
Stalker also notes that Complete Decongestive Therapy (CDT), which has been applied with great success to peripheral lymphedema, is also highly effective for truncal lymphedema, and can increase comfort, level of function, and overall satisfaction with surgical outcomes. She recommends the same combination of CDT and compression for truncal lymphedema as is traditionally used for lymphedema of the extremities. In particular, she recommends using a compression bra to increase patient comfort and prevent reaccumulation of lymph fluid. (emphasis added)
With the above recommendation in mind, Bellisse is committed to helping women get the right fit for the Compressure Comfort® Bra for maximum comfort and benefit. We achieve this through our “Fit Kit” and Fitting Seminars. Bellisse’s popular Fitting Seminars demonstrate to health care professionals and retailers:
Retailers in Bellisse’s Preferred Dealer Program have a “Fit Kit” with Compressure Comfort® Bra samples in seven core sizes. The fit kit helps patients get the right fit the first time – a win-win for both patient and dealer! Click here for a list of Bellisse Preferred Dealers in your area who can help you or your patients get the correct fit for the Compressure Comfort® Bra. Click here if you are a retailer who would like to become a Bellisse Preferred Dealer!
I just got back from the Medtrade Expo, where I had a great time meeting the health care professionals and patients who use the Compressure Comfort® Bra. They asked me a lot of questions – here are some of my answers!
What is the “variable track option” on the
Compressure Comfort Bra?
Can I get insurance coverage for the
Compressure Comfort Bra?
I’ve had a mastectomy. What kind of prosthesis
can I use with the Compressure Comfort Bra?
Susan Tessier is Bellisse’s Customer Service Manager.
Part of our continuing series on alternative healing Dr. Andrew Weil is a Harvard MD who has become one the leading proponents of integrative medicine. As Dr Weil defines it on his website, integrative medicine “takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.” Although Dr. Weil continues to value conventional medicine, his approach to healing includes good nutrition, herbal remedies, and self-calming and awareness practices. And, like most alternative practitioners, Dr. Weil emphasizes wellness and prevention. On his website, Dr. Weil recommends the following lifestyle measures for preventing breast cancer: Exercise for at least 30 minutes on most days. Studies have shown that regular activity at this level is protective against breast cancer, possibly because it reduces body fat, which in turn lowers circulating estrogen levels. Eat organic and hormone-free food as much as possible. This will reduce your exposure to xenoestrogens, which are synthetic chemical compounds that have estrogen-like activity. Xenoestrogens include common pesticides, industrial pollutants and hormone residues in meat, poultry and dairy products. Focus on detection. All women should perform a monthly self-exam. Women under forty should have a clinical breast examination at least every three years; women over forty or who are at increased risk for breast cancer should have an annual breast examination and mammogram. Eat healthy fats. Olive oil is associated with reduced breast cancer risk, and omega-3 fats (found in cold-water fish, flax seeds, and walnuts), are associated with inhibiting breast tumor growth.
Eat 8- 10 servings of vegetables and fruit each day. Fruits and vegetables are high in cancer-protective phytochemicals. Drink green tea, which is linked with lower incidence of many kinds of cancer. Eat a high-fiber diet that includes ground flax seed. High-fiber diets, and especially high-lignin diets, may reduce the risk of breast cancer by increasing the excretion of estrogen from the body. Eat one serving of whole soy foods each day. Despite recent concerns about the mild estrogenic effects, no studies have linked soy consumption with increased risk of breast cancer – and soy contains many cancer-protective substances. Minimize your consumption of alcohol. Even in small amounts, drinking alcohol is associated with increased risk of breast cancer. Supplement with folic acid, vitamin D and antioxidants, all of which are linked to a reduced risk of breast cancer. These nutrients should also be present in your diet. Please note that the above information is provided as a matter of interest only, and should not be considered a recommendation or endorsement of any particular treatment.
Concern should drive us into action and not into a depression. – Karen Horney To live a creative life, we must lose our fear of being wrong. – Joseph Chilton Pearce
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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