Discover and read the best of Twitter Threads about #nln2019
Most recents (14)
Antoine Louveau of @ClevelandClinic closing out the conference with a presentation on lymphatics of the brain: "We have to start caring about this lymphatic system."
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Neurological disorders are extremely prevalent, extremely expensive, and there are limited therapies and treatments for what are often lifelong battles with large side effects.
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The brain is the most metabolically active organ of the body - how does it remove its waste?
A few years ago, evidence was found of the gymphatic system. The glymphatic system is not really a structure but rather a concept.
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A few years ago, evidence was found of the gymphatic system. The glymphatic system is not really a structure but rather a concept.
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Carmen Recupero begins a presentation on the applications of neuro-lymphatic therpay... ðŸ§
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A link between lymphatics and the brain has been suspected, but now there's research backing it up: "Treating lymphatic health in the body is not an arm and a leg."
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Cheryl Brunelle from @MassGeneralNews is here now to discuss prospective screening for breast cancer-related #lymphedema. Re: establishing new guidelines - "This is just the beginning of a discussion that will progress over the next year or so."
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Screening for #lymphedema should begin at pre-operative visit, and continues every time they see their oncologist. Patient education is key so they can be vigilant of symptoms themselves: "Changes can be subtle. We want them to call as soon as their arm is 'different.'"
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When taking objective measurements, whether it's a tape measure or a BIS device, it's important to have protocol: "It's not only a tape measure that has potential for human error."
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Ann DiMenna of @MarkhamLymphCtr is on stage to talk about empowering patients to self-manage their #lymphedema: "When ppl are just told what to do without a full explanation of why or considering the person in a holistic way - they stop!"
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Help create body self-awareness with patients, so when they're home working on their self-management, they're working to achieve the same effect/feeling as they get in clinic. Mental imagery and visualization of lymph fluid flowing can help, too.
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Explain the intent. Plan the work, work the plan - self-management should be done with intention.
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.@DrDhruvSinghal from @BIDMChealth Lymphatic Center is on stage now: multidisciplinary approach to #lymphedema care is a necessity, not a luxury. BIDMC's center includes lymphatic therapy, lymphatic medicine, body imaging, lymphatic surgery, and nuclear medicine.
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The center runs a patient symposium every year to get the patient perspective, helps make program more patient-centric and really makes them a part of the team. (Love to see this!)
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Within the center are 3 clinics: lymphatic surgery clinic, lymphedema treatment clinic, and lymphatic medicine clinic. Every week the entire team gets together to discuss cases and make decisions as multidisciplinary team.
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Amy Rivera of @NinjasFightLE is up!! Her presentation is titled "The Power of Positivity: Learning How to Walk Again"
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@NinjasFightLE With a dramatic photo of her severely swollen pre-op leg behind, Amy begins: "I had a dream for 20 years that I was 'normal,'" she says. "The biggest dream I had... was to wear jeans."
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@NinjasFightLE Years of misdiagnosis and lack of answers left her without treatment. Amy's right leg was 200% larger than her left.
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Erica Demarch is speaking about incorporating sensory integration and movement strategies into exercise for #lymphedema.
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Research on balance in the #lymphedema population is expanding: "The new research that's coming out is exciting, but there's still gaps."
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Restricted movements change movement patterns - forced movement comes at the cost of coordination.
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Go, @LymphieStrong, go! Veronica is talking about her Facebook group, the Lymphedema Running and Fitness Club, which helps lymphies around the world get support & motivation to #movethatlymph 💙👟
This isn't clinicians telling patients to exercise - "this is PATIENTS telling patients to exercise." This is support.
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"We're not focused on weight reduction - we're focused on LYMPH reduction."
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Cheryl Brunelle is discussing the need for standardization in lymphedma diagnosis and definition: before talking about diagnosis, we need to talk about measurement.
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Most tools used for measurement are exactly that: tools. They're not diagnostic. There's also opportunity for variables, i.e. human error.
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Subclinical lymphedema is swelling not yet evident despite impaired lymph transport, subtle alterations in tissue fluid / composition, and changes in subjective symptoms.
This is a risk factor for BCRL but does not always progress. Do we treat this? "Yes."
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This is a risk factor for BCRL but does not always progress. Do we treat this? "Yes."
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Kathleen Francis is on now to discuss multi-causal lymphedema: usually there's no definite hereditary pattern.
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There's a complicated association between obesity and #lymphedema: obesity causes increased deposition of adipose tissue; conversely, lymphedema causes increased deposition of fat tissue in affected limb - a vicious cycle.
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Adipose tissue produces hormones and inflammatory modulators that increase inflammation around lymphatic vessels and decrease lymphatic contractility.
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Open discussion between panelists and audience on updating precautionary guidelines for #lymphedema.
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"We need to get clear on what the definition of #lymphedema is, otherwise we're going to be over-treating and over-worrying [cancer] patients."
-Nigel Bundred, professor of surgical oncology, Manchester University NHS Foundation Trust
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-Nigel Bundred, professor of surgical oncology, Manchester University NHS Foundation Trust
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Wei Chen, professor & attending surgeon from @ClevelandClinic, offers metaphor as a precautionary note on randomized clinical trials: "We've all had good Chinese food and bad Chinese food. The same recipe by different chefs will taste different. Same goes for trials."
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Thomas asked patients what guidelines they had been given to avoid developing #lymphedema & got wide range of answers. Lots of confusion & uncertainty re: guidelines. Lives are limited due to fear: "These people don't even HAVE lymphedema. They HAD breast cancer."
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The degree to which these patients alter their lives is "upsetting," says Thomas as she shares quotes from patients sharing their experiences. Their fear comes from clinicians giving conflicting guidelines, most not backed with (updated) evidence. #nln2019
Kathryn Schmitz is here to talk about the changing precautionary guidelines re: #lymphedema and exercise: "There's a lot of potential harm in telling people to be LESS physically active."
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Advice against overuse of an affected limb is important, however it's often misinterpreted to mean avoid ALL activity. This can de-condition the arm & increase potential for injury, overuse, and lymphedema onset. #nln2019
Schmitz asks how many are using Strength After Breast Cancer program in their clinical practice (supervised resistance / weightlifting) - majority of room raises hands. Schmitz is thrilled! #nln2019
Radiation oncologist Alphonse Taghian on the stage to discuss evidence for precautionary measures for #lymphedema, opens with quote from Herman Suit, MD: "We discuss science not to make a convert of one another, but to further our own understanding of the truth."
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When precautions become harmful: oftentimes fear of #lymphedema is not innate to cancer patients, but taught via the admonishes to "avoid, avoid, avoid" in precautionary measures provided by clinicians.
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"Does it look like this patient has any fun in life? How can you expect a mother, a grandmother, not to pick up their children?"
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