National Cancer Institute
American Cancer Society
National Comprehensive Cancer Network
p. 85 Understanding Cancer book
National Cancer Institute
American Cancer Society
National Comprehensive Cancer Network
p. 85 Understanding Cancer book
Science has come a long way in treating cancer, but cancer is a word that still causes anxiety for most who receive (or have loved ones who receive) the diagnosis. That anxiety is complicated by several unknowns – starting with understanding what cancer is (in user-friendly terms). Cancer (specifically, breast cancer) is the number one cause of lymphedema in the United States & so finds its way on our blog. This series will address cancer, what it is, how it may be developed, treatments & other related topics.
So, what exactly is cancer? The simple answer is cells multiplying (i.e. dividing themselves) out of control. For a deeper insight, let’s take a look at what happens on a biological level.
Our bodies are made up of cells, many different types of cells which have different functions. For example, there are muscle cells, bone cells, blood cells, skin cells, defense cells, etc. Some cells continue to multiply throughout their life (like blood & skin cells) while others stop multiplying when their type is complete (cells in our nervous system). Normal cells only multiply when they are told to do so by
When a cell is told to multiply, it begins a multi-step process which has “checkpoints.” These checkpoints inspect the cell, ensure it is progressing normally & allow it to continue its development. If a cell is found defective (i.e. several genes have changed or mutated), it will usually self-destruct or it will be removed by other cells (thanks to our immune system). This process is programmed so there is a balance between the cells that multiply & those that die. In cancer, however, this process is defective. Instead of self-destructing or being removed, the defective cell passes through the checkpoints & multiplies at-will. Amazingly & thankfully, this breakdown doesn’t happen very often.
Kumar, V., Abbas, A., Aster, J. (2013). Robbins Basic Pathology (9th ed.), location 1644ff. Pennsylvania: Elsevier Saunders.
Coleman, Norman, MD (2006). Understanding Cancer, p. 28ff. Baltimore: The John Hopkins University Press.
Smith-Gabai, Helene (2011). Occupational Therapy in Acute Care, p. 410. Maryland: The American Occupational Therapy Association, Inc.
Definition1 & Origin
The word “lipedema” comes from the Greek word “lip/o” (meaning fat) & “edema” (meaning swelling). Lipedema is an abnormal proliferation of fat cells & swelling. It may also be called lipoedema. A chronic & progressive condition, this disorder is typically associated with hormonal changes or genetic predisposition & often co-exists with venous disorders & other vascular diseases.
It is found primarily in women & manifests as a symmetrical shape with an increase in fat tissue (similar to the shape of riding breeches) beginning near the waist (the iliac crest region) & extending to the ankles. There are two types: column-shaped & lobular.
Symptoms typically include swelling in the evening or in standing (i.e. orthostatic edema), increased sensitivity to pain, easy bruising, difficulty walking (due to the increased fat tissue), reduced elasticity & increased expandability of the skin & pituitary-thyroid or pituitary-ovarian hormone disturbances.
The proliferation of fat tissue compresses lymph collectors of the superficial lymph system. In lymphangiographic images (i.e. X-ray images), lymph collectors within the fat tissue have a coiled appearance (as opposed to being fairly straight in their path toward the lymph nodes where fluid continues to drain as in normal tissue). This coiled appearance reduces the flow of lymph fluid which causes fluid to “back up” in the affected area. In imaging, malformations are seen in the precursory vessels (lymph capillaries may have bulging areas & initial lymph channels are widened). Lipedema usually has loose connective tissue, so because there is not a lot of skin support, the pressure in the tissues is low which allows fluid to accumulate.3
According to Foldi, the initial cause of lipedema progression is microangiopathy within the area of fat tissue (i.e. a disease of the smallest blood vessels, the capillaries). As a result, blood capillary walls become thick & weak. Consequently, the capillaries become more permeable. They bleed, leak protein & slow the flow of blood. More fluid & proteins enter the tissue space (resulting in edema – as a result of increased hydrostatic pressure – &, ultimately, a greater demand on the lymphatic system). This leads to hypersensitivity of the tissue (people are usually very sensitive to touch). The blood capillaries are also more fragile which leads to bruising with mild trauma.
As lipedema progresses, the constant overload causes lymphatic vessels to develop additional structural changes. Mast cells in the tissue activate fibroblasts which results in interstitial fibrosis & development of lymphedema progression.
As stated in the 2014 blog, lipedema is often misdiagnosed as obesity. Sometimes it is diagnosed as lymphedema as well. Imaging can be used (indirect lymphography would likely show prelymphatic channels to be large pools among other changes) but it is not necessary.7
Lipedema is underdiagnosed4 & usually misdiagnosed as obesity. Patients are generally told they are fat & need to lose weight. Unfortunately, because lipedema cannot be “dieted away,” efforts to lose weight are unsuccessful. Some people may develop obesity as well due to frustration of unsuccessful dieting attempts & eventually develop a more sedentary lifestyle.3 It is interesting to note, some studies suggest not only does obesity contribute to the development of lymphedema but lymphedema can contribute to the development of fat tissue. 5, 6
Note: Dyslipidemia is not the same thing as lipedema. Dyslipidemia is an abnormal amount of lipids (like cholesterol &/or fat) in the blood & is frequently a result of diet & lifestyle.
1 Medical Terminology
2 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 374-376. Germany: Urban & Fisher.
3 Lymphedema Management Comprehesive Guide (location 8661)
5 Zampell JC, Aschen S, Weitman ES, et al. Regulation of adipogensis by lymphatic fluid stasis: Part I. Adipogeneis, fibrosis, and inflammation. Plast Reconstr Surg. 2012;129:825-834. (Vodder Review article)
6 Aschen S, Zampell JC, Elhadad S, Weitman E, De Brot M, Mehrara BJ. Regulation of adipogenesis by lymphaic fluid stasis: Part II. Expression of adipose differentiation genes. Plast Reconstr Surg. 2012; 129:838-847.
7 Foldi, M, Foldi, E. (2006). Foldi’s Textbook of Lymphology (2nd ed.), p. 423. Germany: Urban & Fisher.
The Women’s Health & Cancer Rights Act (established in 1998) requires most group health insurance plans which cover mastectomies to also cover breast reconstruction & associated treatment costs (such as lymphedema). But changes still need to be made. Medicare does not cover compression for lymphedema (& consequently many other insurance providers do not cover compression). As a result, the compression supplies needed during & after treatment are often not available for patients who require them but cannot afford them. Consequently, mobility becomes more difficult & self-care independence is reduced while lymphedema becomes worse with chronic infections, tissue changes & repeated hospitalizations. However, you have an opportunity to make a difference! Please contact your congressmen. We’ve made it easy for you below (simply click on the link).
Contact your congressmen by visiting: http://www.capwiz.com/lymphedematreatmentact/issues/alert/?alertid=68841626&type=CO
Find out more about the Lymphedema Treatment Act by visiting: http://lymphedematreatmentact.org/about-the-bill/
Sigvaris began as a Swiss dress & fabric shop in 1877 by a family called Ganzoni. One of the family sons (Werner Ganzoni) headed up the Swiss business while a brother (Paul) opened a shop in France. In 1924, they opened their own production company in Saint Louis (a European town bordering Germany & Switzerland) & in 1926 they reinvented themselves with finer rubber yarns & wider elastic fabrics. This latter transition yielded belts, suspenders, socks, stockings & stocking suspenders. In 1928, Ganzoni purchased a stitching company in St. Gallen, Switzerland. After several uncertain years due to WW I & II, in 1947 a son (Peter), took over business. In 1961, the first medical compression stocking based on latex was introduced under the name “Sigvaris.” The elastic band-weaving portion of business was sold & a concentrated effort was placed on medical compression stockings in order to stay afloat. Medical compression proved to be their best asset, & they have continued to expand not only in Europe but overseas as well.
Sigvaris manufacturers four categories of compression which include medical, well-being, sports & arm sleeves. Their focus is primarily on venous disorders but venous disorders can develop into lymphedema, so their compression can be beneficial for some lymphedema patients. Their products are ready-made & come in ready-made compression grades. For more information regarding Sigvaris & their products, visit: http://www.sigvaris.com/usa/en-us.
LympheDIVAS is a family-owned company based in Massachusetts with a unique start-up story. The founder was a woman named Rachel who was diagnosed with Stage 3, triple negative breast cancer just before her 35th birthday. She had no family history of cancer aside from her 98-year-old grandmother who developed ovarian cancer late in life. Because of the nature of triple negative cancer, her treatment options were limited. 19 lymph nodes had been removed from her axilla during the diagnosis phase, & she went through chemo & radiation. After her first radiation treatment, she developed lymphedema & went to see her physician who prescribed a compression sleeve. Rachel was dismayed that the sleeve looked like a boring, beige medical garment & was just as uncomfortable with the heavy, hot, thick fabric. Her doctor challenged her to make a better sleeve &, so, she set out to do just that. Unfortunately, Rachel passed away at the age of 37 but her family has maintained her legacy by continuing & growing her business focused on providing a compression sleeve that was a medical, gradient compression yet more fashionable & comfortable with the lighter, breathable, moisture-wicking fabric.
LympheDIVAS has three primary garments: A sleeve, a gauntlet & they recently came out with a glove. Each of these are latex & silicone-free with a silky-feel to them – more like sports compression than medical compression. They come in Class 1 (20-30 mmHg) & Class 2 (30-40 mmHg) compression, are circular-knit & come in 5 colors with over 100 different print patterns to choose from. Additionally, they contain aloe vera for a moisturizing-effect.
To find out more, visit www.lymphedivas.com.
BiaCare is a medical compression company based in Michigan. They were founded approximately 10 years ago with a mission to create high quality garments that are affordable. One way they achieve more affordability is by not having sales reps on staff. Because of that, they may not be as well-known as some of their competitors, but they still compete with their selection of lymphedema & wound/vascular compression as well as their own bandaging products. We’ll overview a few of their products in this blog.
1. ChipSleeve with OverSleeve: A non-compressive, channeled chipped-foam liner (which can also be used under bandaging) increases compression to an arm, full leg or foot to knee length with the added OverSleeve for a total of 15-20 mmHg compression. This is suited for mild edema & is a ready made item but they will sell a custom option in 2016.
2. CompreSleeve: A substitute for bandaging, this sleeve has Velcro closure with a removable loop at the top for easier donning & comes in lengths for a full arm & foot to knee length. Compression given is 20-30 mmHg.
3. MedaFit: A sleeve for the arm, full leg or foot to knee length, this is the most durable fabric & highest compression garment provided at 30-40 mmHg. As with the CompreSleeve, this is a Velcro-closure compression with a removable Velcro attachment at the top for easier donning. Another helpful feature to this garment is a removable foam liner (made of a moisture-wicking fabric) which can be taken out to be washed. This garment may be paired with the MedaHand or MedaGlove with an OverSleeve. They also have a unique Dorsal Pocket Glove which contains a pocket on the back of the hand for foam inserts to prevent fluid refilling or break up fibrosis (15-20 mmHg).
SPECIAL “NITCHE” PRODUCTS
1. Biker shorts & capris with an optional length extending into the trunk & abdomen. 10-15 mmHg. Sizing goes up to 5x or custom-shorts can be made.
2. ChipPads for head/face, neck, breast/chest & genital areas.
3. Cotton liners or liners made with anti-microbial silver (silver liners contain 10-15 mmHg).
4. TheraBra (comparable to the Bellisse post-mastectomy bra) which has a foam-insert pocket each side or a drain tube option. This front-closure bra also has Velcro shoulder straps for easy removal & wide, soft elastic band to prevent it from sliding up while also providing 20 mmHg compression.
WOUND CARE / VENOUS PRODUCTS
1. CompreFit: Inelastic/non-stretch, 2 or 4-piece Velcro garment (knee-high or thigh-high) which provides 30-40 mmHg in the leg & 20-30 mmHg in the foot. A strap extender option allows an additional 10 cm of circumference compression, for a total of 75 cm around the calf. This garment has been Medicare-approved for those with a venous ulcer using code A6545-AW & is latex-free.
2. CompreFlex Lite: Low-stretch, 2 or 4-piece Velcro garment (knee-high or thigh-high) which provides 30-40 mmHg. A best-seller, this garment has also been Medicare-approved & is latex-free.
3. CompreBoot: Velcro foot piece which can be paired with the above items & has 20-30 mmHg compression.
4. CompreBoot-Lite: Velcro Foot piece which can be paired with the above items & has 10-15 mmHg compression. Because of the thin material, it fits easily into most shoes.
BiaCare carries their own line of bandages which are manufactured in Germany (like their competitors Lohmann & Rauscher or BSN Medical). Their lines are called BiaForm & IsoForm. They also sell liners, tubular compression (BiaGrip), elastic gauze, tape & foams.
In conclusion, BiaCare is a small company with big potential. All their lymphedema & venous compression products can be machine-laundered & dried & come with a 6-month warranty. You can learn more by visiting BiaCare.com.
Peninsula BioMedical is a company started in 1996 by Dr. Tony Reid. Dr. Reid is a medical oncologist who recognized his patients were developing lymphedema. He furthered his education by attaining a second degree in vascular medicine & invented the ReidSleeve to help his patients. Peninsula BioMedical has gone on to design several more compression products & a few ancillary items. The compression products include sleeves for the arms & legs which use chip foam to provide pressure to both high & low points. While all their products were designed to be worn at night &/or to reduce or eliminate the need for bandaging, they do offer a daytime garment called The Jazz. They also offer a reduction product called the ReidSleeve. Their non-elastic compression product lines for upper & lower extremity include:
– The Jazz: A slim, lightweight product designed for daytime wear
MILD to MODERATE LYMPHEDEMA
– OptiFlow Comfort Sleeve: Similar to the ReidSleeve Classic but lighter & cooler with an optional Power Sleeve to increase compression; extends to the wrist with a separate hand piece
– Comfort Plus: Uses a denser foam than the OptiFlow & extends to the base of the fingers
– Opera: Similar to the OptiFlow designs but lighter & slimmer still (made for the upper extremity only)
– OptiFlow RM: A less expensive, ready made option to the above items; a foot piece can be ordered as well
MODERATE to SEVERE LYMPHEDEMA
– OptiFlow EC: Designed to reduce bandaging steps, this sleeve is typically worn under bandages but it can also be used as a liner during pump use
– OptiFlow SC: Containing 8-10 mmHg, this sleeve is made to be worn during pump but it can also be worn at other times & with an outer “Power Sleeve” for increased compression
– TheCinch: A Velcro brace designed to be applied outside the OptiFlow EC, eliminating the need for bandaging
– The ReidSleeve Classic: A Velcro sleeve reduction product with a soft foam core that provides gentle, gradient pressure; a pressure gauze can be used to measure the amount of compression applied
One unique feature for this company is they have a refurbish program for their ReidSleeve Classic garment. After the first year, this garment can be refurbished (i.e. refitted for a reduced cost). If a garment needs resized within the first year, however, the initial refitting is done without cost. In either case, the garment must be washed or a cleaning fee will be applied. For more information, visit www.reidsleeve.com.
A competitor & predecessor to Solaris, JoViPak also makes nighttime compression garments & all products are made in the U.S.A. However, one unique feature is they provide post-operative compression, too.
Founded in 2000 by Joann Rovig, a cancer survivor, JoViPak has an inspirational beginning. Joann had just finished training to become a massage therapist when she learned she had cancer & would likely develop lymphedema as a result of treatment. Recognizing there were not many lymphedema therapists in the United States & none in the northwest, she decided to educate herself by going to the Vodder School in Austria. After opening a clinic to treat others, she found her patients were overwhelmed with self-bandaging. She came up with a chipped foam sleeve to reduce the steps in bandaging & JoViPak was born.
JoViPak products include sleeves, liners & post-operative chest compression & are divided into areas of the body as follows:
Head & Neck
Leg & foot liners & compression including a rehab line (with Velcro) for acute injuries & easier donning
Genital pads & all-purpose pads to improve lymph flow as well as to break down fibrosis
Find out more at www.jovipak.com/ or visit www.ltscompression.com.
Solaris is a compression competitor with a few unique aspects. For one, they are based in the United States. For another, they sell a readymade flat-knit garment. And last, they were founded by a therapist who treated lymphedema patients. Who better to understand patient needs than a therapist?
Located in Wisconsin, Kathy Weatherly (occupational therapist) opened Solaris in 1998 when she was looking for products which made bandaging easier & were more useful for her patients. She came up with the Tribute night garment & then developed the Readywrap & other product lines they make today. Kathy is still active in her company, providing support to DME providers & educating others about lymphedema.
Products include day & night sleeves, bandaging sleeves, Velcro options, hose/sleeves & fibrosis aids. Most products can be readymade or custom. The major lines are:
Find out more at www.solarismed.com/products or visit www.ltscompression.com.