ENCORE #61! – Low Level Laser Treatment of Post-Breast Cancer Arm Lymphedema

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry appeared in August of 2015.

After our last visit to the lymphedema clinic and the response of the staff there when my wife asked about a cure, I will now be focusing the “BC Research Right Now!” entries on the subject of lymphedema treatment.

This first entry is NOT something that the clinic we go to has ever offered, and it may be something I suggest we ask for.

It’s called Low Level Laser Therapy or LLLT. Below you’ll find the description of a recent study using it:

“Low level laser therapy (LLLT) (wave lengths 650-1000 nm) is a…therapeutic intervention for treatment of arm lymphedema. [It] can be administered by individuals trained in the use of the device…[and] is believed to stimulate lymphatic movement and lymphangiogenesis (‘the formation of lymphatic vessels from pre-existing lymphatic vessels’, IOW, ‘growing new lymph vessels’); [increase] macrophage activity, and soften fibrotic tissues; improve contractility in the tissues that assist with lymph transport through the lymphatic vessels. These mechanisms increase movement of pooled fluid from the extracellular spaces into the lymphatic system for transport.

“Studies have evaluated the influence of LLLT on lymphedema in breast cancer survivors with mixed results regarding amount of volume reduction and degree of symptom relief...None of these studies reported complications. Although the number of sessions and exposure time to the laser varied across studies, overall results are supportive of the procedure as a lymphedema treatment and demonstrate the feasibility of conducting studies in breast cancer survivors with lymphedema.

“LLLT offers APNs trained in the use of the device an opportunity to directly provide treatment for their patients with lymphedema. Demonstrated successful use [and] could impact current standards of care and treatment delivery by offering alternatives to current treatment, earlier intervention, and increasing access to a pool of providers.

“Based upon the physiological mechanisms of action ascribed to LLLT, the authors of this article theorized that it should reduce lymphatic-associated swelling. The purpose of the pilot study was to examine the impact of [the treatment], as both a stand-alone and complementary treatment for arm volume, symptoms, and Quality of Life in breast cancer survivors with treatment-related lymphedema and to use data obtained in this study to power future studies.”

The hospital we go to has a cancer center with a strong breast cancer component and they are the place where we discovered massage therapy for the reduction of arm volume – what’s known as “manual lymphatic drainage” and includes both home-massage and wearing a compression garment on the arm.

 The results of the study, while not phenomenal or “world-shaking” do, in fact point to the use of LLLT as an adjunct to typical massage and compression treatments: “a 20 minute dose of LLLT when followed immediately by compression bandaging is potentially as effective in reduction of arm volume as 40 minute sessions of MLD or combined MLD and LLLT followed by compression bandaging . This preliminary finding is noteworthy, as the shorter duration of each LLLT session is less burdensome to patients and less time consuming for therapists.”

Less time wasted – that’s an improvement. We’ll have to see if the clinic we go to offers this treatment!

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

GUY’S GOTTA TALK ABOUT #34…The Normality of a Breast Cancer Life

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

So the past 23 days, we’ve had our son, daughter-in-law, and our two grandchildren staying with us on vacation from South Korea where he serves in the US Army.

It brought to mind that despite the fact that cancer was the focus of every thought for some time, other matters – in this case, our family – fill our every waking moment.

To reduce it to its barest bones, cancer might be characterized as death; family as life.

When life is written large – playgrounds; meals out; work thrown in because it has to be there; Mystery Caves and Malls of America and Como Park Zoos and Welcome Home parties and former high schools and other places barely remembered because there were so many – and full of life; it masks death so effectively that it’s easy to forget about it. To ignore it. To act as if it didn’t exist.

Or to fly in the face of death, sneer, then shout whilst shaking your fist, “Despite you, we will LIVE!”

That’s what this time has been like for me.

Thank you, God for the joy these hours and days have immersed us in!

Resource: https://www.cancer.org/cancer/breast-cancer/living-as-a-breast-cancer-survivor.html

Image: http://wrex.images.worldnow.com/images/23784252_SA.jpg

ENCORE #60! – Aches & Pains? or ACHES & PAINS!!!!!?

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry appeared in May of 2015.

I’ll be 58 in a few days and like many folks my age, (besides getting the quarterly invitation to join letter from AARP), I have aches & pains. Sore back, stiff joints, increased fatigue after doing “regular stuff”, pre-diabetic blood sugars, failing eyesight, fading hearing, all the kinds of things we associate with aging.

My wife experiences some of the same things – but there’s a twist now.

When talking about a stiffness here or swelling there, the breast cancer survivor has the added, “elephant in the room” – is the ache or pain caused by breast cancer resurgence or the meds that they have been taking for years?

In other words, are these simple aches & pains, or are they symptoms of the cancer or the anti-cancer drugs, and urge a visit to the cancer clinic rather than the medicine cabinet for some Tylenol? What I think of as ACHES & PAINS!!!!

It seems that there is a certain amount of fatigue that accompanies a woman after successful breast cancer treatment, “Fatigue is a normal response to breast cancer treatments like chemotherapy and radiation therapy, but one-third or more of breast cancer survivors report continued debilitating fatigue long after treatment has ended.”

While the first resource listed below was written before 2011, current research seems to be uncovering even more startling information!

“Pat Christian beat stage 3 breast cancer. But 5 years later, she's still fighting fatigue.  She says, ‘Your body is not the same.  After you go through chemo or radiation, your body is not the same.’ That's why the 57-year old non-profit founder volunteered for a study at Emory Medical School, to see if massage therapy can help breast cancer survivors cope with fatigue.  She was skeptical.  Christian says, ‘When they told me about the treatment, I was, like, right!  I just really didn't think it was going to make a big difference…’”

The fact is that no one told my wife about cancer-fatigue. I’d never heard of it, either.

When we went to a B&B several years ago, part of the package offered a massage session. We took them up on it – my wife had the bath salt and massage, I had the hot rock massage. It WAS fantastic!

But NOW, maybe we need to do it again. We know all about aches & pains and now it appears that ACHES & PAINS!!!! are real. And apparently, those ACHES & PAINS!!!!, clinically identified as cancer-fatigue have a real cause – and a real solution.

We’ll let you know what happens!

[Note: Nothing happened…cancer fatigue continues in ways that are both debilitating and defeating. The fact is that, you just keep moving forward, doing the best you can. The key? KEEP MOVING, NO MATTER WHAT.]

Resource: http://researchnews.osu.edu/archive/cncrfatigue.htm, http://www.myfoxatlanta.com/story/28813519/can-massage-help-breast-cancer-fatigue-emory-researchers-look-for-answers, http://www.breastcancer.org/treatment/side_effects/fatigue

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

BREAST CANCER RESEARCH RIGHT NOW! #53: Lymphedema and Fibrosis

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Every month, I’ll be highlighting breast cancer research that is going on RIGHT NOW! Harvested from different websites, journals and podcasts, I’ll translate them into understandable English and share them with you. Today:

So, I found out something new: the hardening of the skin due to lymphedema is NOT peculiar to breast cancer!

Last month, the following Keystone Symposium was held: “Injury, Inflammation, and Fibrosis: Fibrosis is a common response of many organs to chronic injury and inflammation. This leads to destruction of organ architecture with loss of function. Until recently, there have been no therapies to slow the progression of fibrosis and to maintain normal organ function. Recent advances have provided new insights into the pathogenesis of fibrosis, new drug targets, and new drugs in clinical studies. This conference will bring together basic biologists and translational and clinical researchers to discuss core mechanisms underlying inflammation and fibrosis, to compare and contrast fibrotic diseases, preclinical models, the potential for regeneration and regression of fibrosis, and potential therapies. The interaction between the host genetics, the environment and the microbiome in the pathogenesis of fibrotic diseases will be addressed. Also, non-invasive methods to assess fibrosis including advanced imaging and intermediate biomarkers will be discussed. This conference will be a unique opportunity for investigators who are focused on organ-specific diseases – i.e., medical subspecialists – to participate in cross-disciplinary, multi-organ discussions in order to gain new insights into their research. ”

A brief reading of the papers presented don’t address fibrosis following the removal of lymph nodes due to radical mastectomy, but it appears to ME (remember, I’m a layman – a biology (and chemistry, physics, astronomy, etc.) teacher with about 30 years of classroom teaching experience) that several of the subjects covered seem to me to have lymphedema applications.

I suppose I SHOULD clarify what they’re talking about above: “Long standing lymphedema causes a condition known as fibrosis. As the fluid continually collects in a limb, it becomes hard and dense. With each stage of lymphedema there is also a change in the tissue texture of a limb. Each stage of lymphedema presents additional difficulties and worsening of fibrosis, if treatment is not received. Initially, there is no fibrosis associated with lymphedema. It is also important to remember that the size of a limb (arm lymphedema, leg lymphedema) is NOT an indication of how much fibrosis there is.  I have seen very slightly swollen legs that were as hard as a rock because of late stage fibrosis.”

Surprisingly, I just realized that I have seen fibrosis – it happened to my mother because of her Congestive Heart Failure (CHF). Her legs were essentially normal in size, but had become so rigidly hard (she refuse to do physical therapy, allow her legs to be wrapped, or even, eventually to walk at all…) that lymphorrea – “the light amber colored fluid that drains from open skin areas (wounds) on a lymphodemous limb. It is not normal plasma, but is a protein-rich substance that can lead to serious complications for the lymphedema patient. The composition of lymphorrhea is approximately 1.0=5.5 g/ml of protein” -- leaked from her legs on a regular basis.

Back to the Symposium: While none of the papers  is currently available, I’ll be looking for them in the coming months and waiting to see if any of the research is being applied. While my area of interest is fibrosis of the limbs, it’s clear that fibrosis can happen to the heart, liver, kidneys, skin (in a condition that an old friend of mine had called scleroderma), and bile ducts.

In particular I’ll be looking to see if any of this new information…leaks…into the field of lymphedema of the extremities: MicroRNAs as Potential Therapeutic Targets in Fibrotic Diseases, Mitochondrial Priming by Matrix Stiffness Sensitizes Myofibroblasts to BH3 Mimetic-Induced Apoptosis in Scleroderma Fibrosis, Multistep Cancer-Associated Fibroblast Activation: A Notch/CSL-Gli Regulatory Axis, Cellular and Molecular Heterogeneity of Fibroblast Responses in Mouse Model of Dermal Fibrosis, Molecular Signatures of Collagen-Producing Cells in Multiple Models of Pathologic Tissue Fibrosis.

We shall see!

Resources: https://www.keystonesymposia.org/17c8, http://www.lymphedemapeople.com/thesite/lymphedema_fibrosis.htm

Image: http://sirh.org/wp-content/uploads/2013/06/lymphedema.jpg

ENCORE #59! – What The Heck Does “Metastasize” MEAN?

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry appeared in February of 2015…

We got news a few days ago that a friend of mine with skin may have had a site that it had metastasized to.

With a swelling knee, he went to the doctor. Fearfully, he reported that the clinic was afraid that his cancer had spread. He underwent a full day of blood tests, ultrasounds, and had fluid withdrawn from the area as well.

While the upshot is that his skin cancer HAD NOT SPREAD (hallelujah!), it got me to wondering.

I did a series of articles on metastatic breast cancer a few years ago – two of them are the most read on the blog. My own recent brush with skin cancer has made me very aware of the possibility of my own cancer spreading.

So I did some reading. The type of skin cancer that I had has a microscopically small chance of metastasizing. My friends type does in fact spread.

How EXACTLY does breast cancer, skin cancer, and other kinds of cancer spread? “By

metastasizing, dummy!”

“Yeah, yeah, yeah,” I would reply. (I’d also make a smart aleck remark about the Beatles.) “But HOW does it spread? How do cancer cells get from the skin to the knee or from the breast to the bones? Do they just pack up their little twisted chromosomes, wave to their family of twisted cells, and head on our into the Wide World of the body they’ve coopted for their evil intent?”

So, I did my research, starting (and I ONLY start here, I use the primary sources shortly afterward!) with Wikipedia.

Wiki defines metastasis as “the spread of a cancer or disease from one organ or part to another not directly connected with it.”

Hmmm…while that’s simple to understand, it doesn’t bring me any closer to WHAT happens. I don’t understand! Turns out, neither does the medical community, exactly: “Metastasis is a complex series of steps in which cancer cells leave the original tumor site and migrate to other parts of the body via the bloodstream, the lymphatic system, or by direct extension.”

When DOCTORS say the steps to metastatic cancers spreading, it often means that they don’t know exactly what’s happening. Great – that should be the next Great Discovery, “How To Stop The Spread Of Cancer Cells”…

So, here goes.

“Cancer occurs after a one single cell in a tissue is progressively genetically damaged to produce cells with uncontrolled proliferation.” The question I have is WHAT is it that does the genetic damage? With over a hundred different cancers, the list is probably just as long. There ARE things we know of that can damage cells on a genetic level – the ultraviolet rays of sunlight can damage cell genes, switching on the cell to grow uncontrollably. This, naturally, leads to skin cancer.

The chemicals in cigarette smoke (which contains 7000 (!!!) DIFFERENT substances) are mostly harmless. But of those several thousand, seventy are known to damage the genetic components of cells – plus the RADIATION that tobacco plants pick up and concentrate in their leaves. The obvious end result here is lung cancer.

Other chemicals in the environment, as well as carrying a family history of different kinds of cancer also damage cells and create the “runaway effect” that characterizes ANY cancer.

So WHAT happens then?

Cells grow out of control resulting in a tumor. In the case of my own skin cancer, simple removal of the offending (or affected) area stops the cancer. Monitoring over the rest of my life will be a part of every checkup from now until the day I die. In my wife’s case, chemicals specifically targeted to annihilate breast cancer cells were introduced to her body after the source of the cancer cells – breast tissue – was surgically removed in a double mastectomy. She is now cancer-free, as is the wife of a good friend of mine and one of my colleague teachers. Again, monitoring over the rest of my wife’s life will be a part of every checkup and physical.

The effort to first destroy the SOURCE of the cancer and then destroy those cells wherever they may have “landed” using chemicals, radiation, and physical excision of tissue is doctors stop the spread of cancer.

Next time around, I’ll be delving deeper into this whole concept of METASTASIS...

Resource: http://en.wikipedia.org/wiki/Metastasis

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg