A little more on lymphedema.... From my own experience with mild lymphedema, and that of a few other people I know, stretching can be helpful. Let me stress that this is entirely anecdotal, not based on any medical studies - just my own experience. I have found that stretching can be somewhat helpful for lymphedema. If my shoulder and neck are very tight, I am more likely to start having a little swelling. It just seems that relaxed muscles help everything work a little more efficiently.
So, a few simple stretches: First, you should already be doing neck rolls and shoulder rolls, which not only stimulate the lymph nodes, but also help to stretch tight muscles (trapezius, scalenes).
Chest stretch – arms outstretched: Stretches and opens the chest.
Sit or stand with your arms outstretched to the side at a height that is comfortable. Gently squeeze your shoulder blades together and pull your arms toward the back. If you have limited range of motion in your shoulder, you can begin with your arms down at a comfortable angle. As your range of motion improves, raise your arms out to the side for the stretch, eventually getting them up to shoulder-height.
Side stretch: Stretches the muscles along your side and underarm.
Sit or stand. When first doing this stretch it’s good to sit cross-legged on the floor so you can help support yourself with one hand. Slowly lift your right arm up and over your head toward the left. Keep your shoulders down. Reach only until you feel a slight stretch. Hold for about 10 seconds and return to starting position. Repeat on the opposite side.
Doorway stretch: Stretches chest muscles and the underarms.
Stand in an open doorway with one foot in front of the other. With both elbows bent, place hands at shoulder-height on doorframe. Keeping shoulders back, very gently lean forward into doorway until you feel a slight stretch – only a slight stretch! Take deep breaths and hold for at least 10 seconds. Vary the height of your hands to stretch different parts of the muscles.
Shoulder stretch: Stretches back of the shoulders and shoulder blades.
Bend your right elbow and raise your arm to shoulder-height, so your arm is parallel to the floor. Place your right hand on your left shoulder. Grab your elbow with your left hand and pull it gently across your chest until you feel a slight stretch across the back of your shoulder. Hold for at least 10 seconds and repeat on left side.
And for you lower extremity folks:
Windshield wipers: Stretches the muscles of your lower core.
Lie on your back with knees bent and feet together and flat on floor, with your arms comfortably out to the side. Draw your navel in toward your spine and lower both knees to one side. Keep both shoulders flat on the floor. Hold for at least 10 seconds and bring your knees back up to the center. Repeat on the other side.
Supine hip flexor stretch: Stretches hip flexors.
Lie on your back, one leg extended straight along floor. Flex the foot of the extended leg so your toes point toward the ceiling, and bend the other knee and hold the leg behind the thigh. Draw the bent knee toward the chest and keep the extended leg on the ground. Hold for 10 seconds and release. Repeat on the other side.
Supine hamstring stretch: Stretches muscles of the back of the leg (hamstrings).
Lie on your back with both legs extended along the floor. Lift one leg so knee is directly over you hip. Hold your thigh and straighten leg up toward the ceiling. If this is difficult, you can start by grabbing the ends of a bath towel and placing your foot in the towel. Use the towel to help pull your leg up, making sure you don't lock your knee. Raise it until you feel a slight stretch. Hold at least 10 seconds, and lower. Repeat on the other side.
Standing hip flexor stretch: Stretches the hip flexors (psoas, illiacus).
Stand and take one medium step forward. Keep the back foot flat on the ground and bend the front knee until you feel a stretch at the top of the thigh and across the front of your hip. Be sure to keep your hips facing forward. Hold for at least 10 seconds. Repeat on the other side. This is one of my favorite stretches after sitting for a while (especially after a long commute in NYC traffic). And it's particularly good because it's really effective and you can do it anywhere, even standing on line at the bank.
Again, it's only from personal experience, but it seems that these stretches help make it a little easier for our bodies to work with a compromised lymph system. And besides, we'll just feel better if our muscles aren't tight and knotted up. So relax - and stretch.
Julie
Sunday, June 29, 2008
Wednesday, June 25, 2008
Some of My Favorite Lymphedema Exercises
To continue with lymphedema.... Here are a few good exercises that can help to prevent or manage lymphedema. They help stimulate your existing lymph nodes and help your body pump the lymph out of the affected area.
First, for either upper or lower extremity edema, begin with the trunk. Lie on your back with knees bent, feet flat on floor. Draw your navel in toward your spine. Keep your arms and shoulders relaxed, and slide your hands along floor while you lift your head and shoulders slightly off the floor. Lower back to the floor and repeat. If this is difficult, there are modified exercises that accomplish the same thing. If you can't raise your head and shoulders off the ground, do a pelvic tilt instead: Lie on your back. Bend your knees, keeping your feet flat on the floor about hip-width apart. Draw your navel toward your spine as you tilt your pelvis and lift your hips slightly off the floor. Slowly return to your neutral starting position. For those of you who have trouble getting down on the ground, there are exercises you can do while sitting. Sit on a flat-seated chair. Draw your navel in toward your spine. Continue breathing while you hold this position for a few seconds. Next, sitting, place your hands on your hips. Draw your navel in toward your spine. While keeping your tummy tucked, rotate your torso 45 degrees to one side, then the other. Return to front. These exercises all help to clear your trunk. The other very important and very easy step is to do some deep breathing. Deep breaths also help your body pump lymph.
For lower body edema, as I said yesterday, keep your legs elevated as much as possible. Point and flex your toes and feet. Rotate your ankles, making little circles with your feet - go both directions. If you don't have trouble getting onto the floor on your back, lie on your back with your feet up in the air and do the point, flex and rotation exercises. Even if you are standing around and can't get your legs elevated, raise up onto your toes (do this both with straight knees and bent knees) and then roll back onto your heals, lifting you toes up. And keep doing some deep breathing!
For upper body, do the same kind of exercises: with your arm up in the air, rotate your wrist, squeeze your hand into a fist, then extend your fingers out. To stimulate the remaining lymph nodes, do some neck rolls and shoulder rolls, especially rolling shoulders to the back. Do shoulder shrugs: Stand with your arms down at your sides. Slowly raise shoulders up toward your ears, like a slow shrug. Lower. You also want to work the back of your shoulders (rhomboids, trapezius, serratus). With your arms at your sides, bend your elbows to 90 degrees. Hold your hands, palms up, slightly wider than your body, keeping elbows at your side. Draw your elbows back and squeeze your shoulder blades together. Or, extend your arms out to the side, at shoulder-height. Bend your elbows 90 degrees so your hands point forward. Keeping your shoulders down, pull your arms toward the back, squeezing your shoulder blades together. And, of course, keep breathing.
If you are at risk for lymphedema, but have not had any problems, doing these exercises periodically can help you prevent the onset of lymphedema. If you are already experiencing some mild edema, these exercises can help you reduce and maintain the lymphedema. And, if you are experiencing some edema, see your doctor or a lymphedema specialist. Don't ignore it - it won't go away by itself!
Julie
First, for either upper or lower extremity edema, begin with the trunk. Lie on your back with knees bent, feet flat on floor. Draw your navel in toward your spine. Keep your arms and shoulders relaxed, and slide your hands along floor while you lift your head and shoulders slightly off the floor. Lower back to the floor and repeat. If this is difficult, there are modified exercises that accomplish the same thing. If you can't raise your head and shoulders off the ground, do a pelvic tilt instead: Lie on your back. Bend your knees, keeping your feet flat on the floor about hip-width apart. Draw your navel toward your spine as you tilt your pelvis and lift your hips slightly off the floor. Slowly return to your neutral starting position. For those of you who have trouble getting down on the ground, there are exercises you can do while sitting. Sit on a flat-seated chair. Draw your navel in toward your spine. Continue breathing while you hold this position for a few seconds. Next, sitting, place your hands on your hips. Draw your navel in toward your spine. While keeping your tummy tucked, rotate your torso 45 degrees to one side, then the other. Return to front. These exercises all help to clear your trunk. The other very important and very easy step is to do some deep breathing. Deep breaths also help your body pump lymph.
For lower body edema, as I said yesterday, keep your legs elevated as much as possible. Point and flex your toes and feet. Rotate your ankles, making little circles with your feet - go both directions. If you don't have trouble getting onto the floor on your back, lie on your back with your feet up in the air and do the point, flex and rotation exercises. Even if you are standing around and can't get your legs elevated, raise up onto your toes (do this both with straight knees and bent knees) and then roll back onto your heals, lifting you toes up. And keep doing some deep breathing!
For upper body, do the same kind of exercises: with your arm up in the air, rotate your wrist, squeeze your hand into a fist, then extend your fingers out. To stimulate the remaining lymph nodes, do some neck rolls and shoulder rolls, especially rolling shoulders to the back. Do shoulder shrugs: Stand with your arms down at your sides. Slowly raise shoulders up toward your ears, like a slow shrug. Lower. You also want to work the back of your shoulders (rhomboids, trapezius, serratus). With your arms at your sides, bend your elbows to 90 degrees. Hold your hands, palms up, slightly wider than your body, keeping elbows at your side. Draw your elbows back and squeeze your shoulder blades together. Or, extend your arms out to the side, at shoulder-height. Bend your elbows 90 degrees so your hands point forward. Keeping your shoulders down, pull your arms toward the back, squeezing your shoulder blades together. And, of course, keep breathing.
If you are at risk for lymphedema, but have not had any problems, doing these exercises periodically can help you prevent the onset of lymphedema. If you are already experiencing some mild edema, these exercises can help you reduce and maintain the lymphedema. And, if you are experiencing some edema, see your doctor or a lymphedema specialist. Don't ignore it - it won't go away by itself!
Julie
Tuesday, June 24, 2008
Raise Your Arms for Lymphedema
I spoke with a friend of mine the other day who has just been experiencing early signs of lymphedema. She's doing the right things: first, she's addressing it, not ignoring it; she's already seen her surgeon; and she's going to consult a lymphedema therapist. She called me for advice; she knows I wear a sleeve when I fly because I've had a couple of flareups in the past.
I told her one of the easiest things she can do is to keep her arm elevated as much as possible. Sleep with it propped up on pillows. (I've always found this a little hard to do because I roll around so much when I sleep. But I figure if I can keep it up at least for a little while it will help.) While sitting around, watching TV or reading, keep the arm up on the back of the sofa or chair, rather than down in her lap. Often throughout the day, she should lift her arm above her head for a few minutes. Jiggle it; the lymph system likes to be jiggled; jiggling helps to stimulate it. The main idea is to keep it up as much as possible. Let gravity help! It's much easier for a compromised lymph system to work when it doesn't have to pump against gravity.
The same principal applies to the legs, it's just a little harder to keep legs elevated. We spend so much time on our feet that it's hard to get off them and get them up. But as much as possible, get your legs up. Whenever you sit, try to prop your leg (or legs) up. And get them up when you sleep.
I was on the phone for a while with my friend. At the end of the call she suddenly exclaimed that I was a miracle worker! While we had been talking, she had been keeping her arm elevated, jiggling it every few minutes. In the course of 20 minutes or so, that had been enough to make a slight difference. The edema wasn't gone, but the puffiness had at least subsided slightly. She said some of the wrinkles were back in her hand. (Who knew it would ever be so good to see wrinkles return to any part of our bodies!) Sadly, I cannot actually claim to be a miracle worker; I'm afraid that goes to the force of gravity. But this is a good example of how simple things can be really make a difference. Raising your limb can't cure severe lymphedema, but it can certainly be useful in helping your body manage early, mild lymphedema.
Julie
I told her one of the easiest things she can do is to keep her arm elevated as much as possible. Sleep with it propped up on pillows. (I've always found this a little hard to do because I roll around so much when I sleep. But I figure if I can keep it up at least for a little while it will help.) While sitting around, watching TV or reading, keep the arm up on the back of the sofa or chair, rather than down in her lap. Often throughout the day, she should lift her arm above her head for a few minutes. Jiggle it; the lymph system likes to be jiggled; jiggling helps to stimulate it. The main idea is to keep it up as much as possible. Let gravity help! It's much easier for a compromised lymph system to work when it doesn't have to pump against gravity.
The same principal applies to the legs, it's just a little harder to keep legs elevated. We spend so much time on our feet that it's hard to get off them and get them up. But as much as possible, get your legs up. Whenever you sit, try to prop your leg (or legs) up. And get them up when you sleep.
I was on the phone for a while with my friend. At the end of the call she suddenly exclaimed that I was a miracle worker! While we had been talking, she had been keeping her arm elevated, jiggling it every few minutes. In the course of 20 minutes or so, that had been enough to make a slight difference. The edema wasn't gone, but the puffiness had at least subsided slightly. She said some of the wrinkles were back in her hand. (Who knew it would ever be so good to see wrinkles return to any part of our bodies!) Sadly, I cannot actually claim to be a miracle worker; I'm afraid that goes to the force of gravity. But this is a good example of how simple things can be really make a difference. Raising your limb can't cure severe lymphedema, but it can certainly be useful in helping your body manage early, mild lymphedema.
Julie
Saturday, June 21, 2008
Exercise during Chemo and Radiation
I talk a lot about starting your exercise program slowly and building up your strength over time. This is a great principal, but the reality is, while you're in chemo. or radiation, building up might not be what you can really do. Depending on how your treatments affect you, maybe all you can expect is to maintain your fitness level, or even just minimize your decline. There is so much variety in treatments, and everyone reacts differently, it's impossible to make blanket statements about what to expect. All of us who have been through it know: there really is no way to predict. It's like some weird, mysterious adventure that we figure out as we go along.
I kept working out all through my treatments, but after 6 cycles of Adriamicyn (I don't know if I've spelled that correctly), what I could do in a workout was vastly different that what I could do at the start. But I kept doing as much as I could, and I tried to push myself a little, doing just a little more than what was comfortable. Yes, sometimes I would get frustrated by how little I could do, but mostly I was happy to be doing something. Exercising, even just a short walk, was something positive that I could do almost every day. My strength and stamina definitely declined, but it declined so much less than if I had done nothing. And my recovery after treatment was finished was easier; other survivors I knew were shocked at how quickly I regained my strength.
So, keep walking, biking, lifting weights, whatever you like to do. You may be able to completely maintain your strength; you may even be able to build your strength. But if you do get weaker, don't be frustrated. You are still benefiting from your exercise, you just won't see the obvious benefits that a healthy person would. Modify your exercise routine to fit how your body is reacting to treatment. Modify as much as you need to, but keep trying - it's well worth it.
Julie
I kept working out all through my treatments, but after 6 cycles of Adriamicyn (I don't know if I've spelled that correctly), what I could do in a workout was vastly different that what I could do at the start. But I kept doing as much as I could, and I tried to push myself a little, doing just a little more than what was comfortable. Yes, sometimes I would get frustrated by how little I could do, but mostly I was happy to be doing something. Exercising, even just a short walk, was something positive that I could do almost every day. My strength and stamina definitely declined, but it declined so much less than if I had done nothing. And my recovery after treatment was finished was easier; other survivors I knew were shocked at how quickly I regained my strength.
So, keep walking, biking, lifting weights, whatever you like to do. You may be able to completely maintain your strength; you may even be able to build your strength. But if you do get weaker, don't be frustrated. You are still benefiting from your exercise, you just won't see the obvious benefits that a healthy person would. Modify your exercise routine to fit how your body is reacting to treatment. Modify as much as you need to, but keep trying - it's well worth it.
Julie
Tuesday, June 17, 2008
Hiking with a Sleeve
It's been wickedly hot and humid for June here in New York (when we're not having violent thunder storms). Over the last few days I've had a chance to get out on some nice hikes in the woods by my house. I've been careful to wear my compression sleeve while hiking. Since I only wear it as a precaution, I sometimes have to remind myself to put it on before I go hiking. It's something I've learned from experience. I have had a couple of lymphedema flair-ups in the past - nothing too serious; I was able to get it under control in a few days with exercises to encourage drainage and by keeping my arm elevated. But since then, I wear a sleeve as a precaution when doing higher risk activities, like long flights or being up at high altitude. When I hike, I normally get a little puffy, especially when it's hot and humid. After my surgery, I started going on short hikes at first, just to see how my arm would react. I learned to take short breaks to elevate my arm, maybe do some backward circles with my arms out to the side, or raise my arm and jiggle it to encourage my body to pump the lymph out of my arm. Now, I wear my sleeve and glove when it's hot and humid, but still do a few arm circles. Unfortunately, it is an ongoing issue - it doesn't go away, but it is quite possible to manage. I would rather have to remember to wear the sleeve and elevate my arm than not go out for a hike.
It is important to start slowly, even if you've been very active in the past. You need to see how your body will react now. Do a little at a time, and slowly increase the duration or intensity. Even if it takes a little adjustment (wearing a sleeve, if necessary, or taking breaks to elevate the limb), it's worth it to get out and get some exercise, doing something you enjoy.
Julie
It is important to start slowly, even if you've been very active in the past. You need to see how your body will react now. Do a little at a time, and slowly increase the duration or intensity. Even if it takes a little adjustment (wearing a sleeve, if necessary, or taking breaks to elevate the limb), it's worth it to get out and get some exercise, doing something you enjoy.
Julie
Friday, June 13, 2008
Walking for Leukemia Patients
Reuters Health (www.reutershealth.com) reported on tuesday that a walking program may improve fatigue in acute myelogenous leukemia (AML) patients who are undergoing chemotherapy. The findings were based on a study by Dr. Yeur-Hur Lai and colleagues of National Taiwan University in Taipei which was published in the May issue of the Journal of Pain and Symptom Management. Dr Lai's team randomly assigned 22 hospitalized patients undergoing chemotherapy to a walking group or control group. The walking group walked 12 minutes per day, 5 days per week for 3 weeks.
Researchers reported that the walking group had lower levels of fatigue, distress, anxiety, and depression than the control group. A significantly greater increase in the 12-minute walking distance was also seen in the walking group.
"Taken together, our preliminary findings suggest that a brief exercise-driven program, such as the walking exercise program, should be started at the beginning of chemotherapy to decrease chemotherapy-related fatigue," Dr. Lai's team concluded. "Standardizing the walking exercise program as part of a chemotherapy-related care model should be feasible and encouraged to improve cancer-related fatigue experiences." (J Pain Symptom Manage 2008;35:524-534)
Researchers reported that the walking group had lower levels of fatigue, distress, anxiety, and depression than the control group. A significantly greater increase in the 12-minute walking distance was also seen in the walking group.
"Taken together, our preliminary findings suggest that a brief exercise-driven program, such as the walking exercise program, should be started at the beginning of chemotherapy to decrease chemotherapy-related fatigue," Dr. Lai's team concluded. "Standardizing the walking exercise program as part of a chemotherapy-related care model should be feasible and encouraged to improve cancer-related fatigue experiences." (J Pain Symptom Manage 2008;35:524-534)
Thursday, June 12, 2008
The Need for Better Support for Young Adult Survivors
A new study published in "Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer", finds that there is a need to improve support services for adolescent and young adult cancer survivors. The findings were released on Pubmed.gov. Carried out at the School of Social Work, University of Southern California (www.usc.edu), and headed by researcher Brad Zebrack, the study examined the supportive care needs and preferences of young adult cancer survivors, aged 18-39 at the time of the study. These survivors completed an online survey, answering questions about information and supportive care services. More than 60% expressed a desire for age-appropriate cancer information, information about diet, exercise, nutrition, infertility information, mental health counseling, and camp or retreat programs for young adults. However, more than 50% indicated that their needs for information and services had been unmet. Unmet needs were more likely in younger respondents or of poor physical health and less advanced in work or school.
This study clearly shows the need for increased and enhanced services for young adult survivors throughout care, from diagnosis to after-treatment survivorship. I believe most cancer care facilities can do a much better job of supporting this group of people.
This is, in fact, partly why I started Life-Cise.com and Stay Fit Stay Strong. The support group nearest to me was largely filled with women in their 60s and 70s. While I enjoyed meeting many of these women, I found that many of my concerns were really not so relevant to their lives. Of course, primarily we all wanted to survive, but I was also dealing with fertility issues and blistering menopausal symptoms. I remember talking to a woman in her late 70s who was a 10-year survivor. While it was heartening to think that she had survived so long, if I lasted that long it would put me only into my mid-40s (a thought I found rather daunting). But mostly, I was a very active woman and wanted to remain so. I found that most of the exercise programs available at the time were clearly geared for older adults, people who were already less mobile and deconditioned. So, I found my own way, and in the process became interested in helping other survivors get and stay fit.
Around the country, there are now more support groups for younger adults and cancer exercise programs are also increasing. This is a very good thing. But still, many cancer care centers can do more for their younger and more active populations. If the programs available in your area don't really address your issues, push them. Keep after them to provide you what you need.
Julie
This study clearly shows the need for increased and enhanced services for young adult survivors throughout care, from diagnosis to after-treatment survivorship. I believe most cancer care facilities can do a much better job of supporting this group of people.
This is, in fact, partly why I started Life-Cise.com and Stay Fit Stay Strong. The support group nearest to me was largely filled with women in their 60s and 70s. While I enjoyed meeting many of these women, I found that many of my concerns were really not so relevant to their lives. Of course, primarily we all wanted to survive, but I was also dealing with fertility issues and blistering menopausal symptoms. I remember talking to a woman in her late 70s who was a 10-year survivor. While it was heartening to think that she had survived so long, if I lasted that long it would put me only into my mid-40s (a thought I found rather daunting). But mostly, I was a very active woman and wanted to remain so. I found that most of the exercise programs available at the time were clearly geared for older adults, people who were already less mobile and deconditioned. So, I found my own way, and in the process became interested in helping other survivors get and stay fit.
Around the country, there are now more support groups for younger adults and cancer exercise programs are also increasing. This is a very good thing. But still, many cancer care centers can do more for their younger and more active populations. If the programs available in your area don't really address your issues, push them. Keep after them to provide you what you need.
Julie
Tuesday, June 10, 2008
Exercising Men Less Likely to Die from Cancer
A new study from the Karolinska Institutet, a Swedish medical university, found that men who exercise often are less likely to die from cancer than men who don't. The study looked at physical activity levels and cancer risk in over 40,000 men, aged 45 - 79. During the seven year study, men who walked or cycled for 30 minutes a day or more had a 33 % increase in survival from cancer than the men who exercised less. The researchers published their findings in the British Journal of Cancer (N Orsini, CS Mantzoros och A Wolk. Association of physical activity with cancer incidence, mortality, and survival a population-based study of men. British Journal of Cancer, 27 May 2008).
Friday, June 6, 2008
Exercise Improves Treatment Adherence
I recently attended a webinar on cancer and exercise, hosted by the Clinical Exercise Physiology Association, an affiliate society of the American College of Sports Medicine. (Yes, there are such things as "webinars". And I must say, I rather like the idea of attending a seminar while sitting on my couch in pajamas.) One of the points made in the presentation was the importance of exercise for treatment adherence. A Canadian study by Courneya, Segal, Mackey, et al., found that exercise, specifically resistance training, during adjuvent chemotherapy in breast cancer patients had a positive effect on adherence to the treatment protocol (J Clin Oncol. 2007 Oct 1;25(28):4396-404. Epub 2007 Sep 4). This is highly significant because all of us want optimal outcomes from treatment, and our best chances for that are by sticking to the prescribed treatment regimen. Exercise, especially weight training, can help adherence to the treatment regimen which can improve the chances of optimal outcomes. That means weight training might help you stick with your treatment plan which, in turn, might improve your chances of beating this disease!
Julie
Julie
Subscribe to:
Posts (Atom)