THE WELCH COMPANY
440 Davis Court #1602
San Francisco, CA 94111-2496
415 781 5700
rodwelch@pacbell.net


S U M M A R Y


DIARY: March 6, 2006 09:27 AM Monday; Rod Welch

Millie increased symptoms lymphedema; schedules more physical therapy.

1...Summary/Objective
2...Lymphedema Symptoms Increase Swelling Discomfort Left Arm
3...Physical Therapy Lymphedema Schedule Personal Treatment on 060314
4...Lymphadema Documentation from Kaiser Physical Therapist...
........General Precautions for Those at Risk for Lymphedema
5...Diet is discussed on page 7...

ACTION ITEMS.................. Click here to comment!

1...Surgeon should review the record of mastectomy surgery on 051021 for
2...If you have lymphedema, it is important to be bandaged when

CONTACTS 

SUBJECTS
Symptoms Lymphadema Rise Left Axilla Swells Discomfort Cord-like Bul

0703 -
0703 -    ..
0704 - Summary/Objective
0705 -
070501 - Follow up ref SDS 5 0000, ref SDS 4 0000.
070502 -
070503 -
070504 -
070505 -
070506 -
070507 -
070508 -
070510 -  ..
0706 -
0707 -
0708 - Progress
0709 -
070901 - Lymphedema Symptoms Increase Swelling Discomfort Left Arm
070902 -
070903 - Follow up ref SDS 5 MW8J, ref SDS 4 MW8J.
070904 -
070905 - On 060217 the doctor examined the left axilla and seemed to find
070906 - reduced swelling compared with examination on 060106, and indicating
070907 - that lymphedema may not have occurred, or that the exercise Millie is
070908 - doing helps reduce symptoms. ref SDS 5 T56K
070910 -  ..
070911 - Millie said today that within the past day or so, symptoms have
070912 - increased.
070914 -  ..
070915 - Examination seemed to show that swelling is somewhat greater than
070916 - observed on 060217, however, this is pretty subjective.  If sewlling
070917 - is greater than on 060217, it still remains significantly less severe
070918 - than originally observed on 060106.
070919 -
070920 -     [On 060328 symptoms improve shown by slight decrease in
070921 -     measurements of left forearm. ref SDS 9 HO7F
070923 -  ..
070924 - Swelling, however, is not the main problem.
070926 -  ..
070927 - Millie raised her arm above her head, pointing her hand straight up
070928 - vertically toward the ceiling.  This movement demonstrated how a
070929 - "cord" like line of tissue suddenly protrudes and extends from the
070930 - approximate location of swelling in the left axilla, and gradually
070931 - wraps around the arm at the elbow, and tapers off above the knuckles
070932 - of the left hand.  This "cord" has the appearance of a slight but
070933 - noticable rise in the skin, as though a power cable was beneath the
070934 - skin.
070936 -  ..
070937 - Millie said that when her hand is raised straight up, there is some
070938 - discomfort in the axilla region of swelling.
070940 -  ..
070941 - The left hand and left forarm above the wrist appear somewhat swollen
070942 - compared to the right hand.
070944 -  ..
070945 - Millie has been working out with weights the past month.  She said
070946 - these are 5 or possibly only 3 pound weights.  She does curls, bench
070947 - presses, and overhead presses.  These weights do not seem enough to
070948 - cause an impact of any kind, but should be reviewed by the doctor
070949 - with respect to treatment for lymphedema.
070951 -  ..
070952 - Millie went to exercise class, and then visited a therapist at Kaiser
070953 - for treatment of lymphedema.
070954 -
070955 -
070956 -
070957 -
070958 -
0710 -

SUBJECTS
Lymphedema Physical Therapy Left Axillary Group Session Received Pub

1303 -
130401 -  ..
130402 - Physical Therapy Lymphedema Schedule Personal Treatment on 060314
130403 -
130404 - Millie returned from treatment for lymphedema at Kaiser Park
130405 - Shadelands Clinc in Walnut Creek, on referral from the primary care
130406 - physician, reported on 060217. ref SDS 5 UQ4J
130408 -  ..
130409 - She met with...
130410 -
130412 -                        Physical Therapy Specialist
130414 -  ..
130415 - Turns out this was a group physicial therapy session.  Millie
130416 - presented recent developments of worsening conditions.  Mary, the
130417 - therapist, indicated that increased severity requires personal
130418 - treatment.  She scheduled Millie for a personal therapy session on
130419 - 060314 0800.
130420 -
130421 -        [On 060308 lymphedema symptoms increase, report at work.
130422 -        ref SDS 6 0001
130424 -         ..
130425 -        [On 060314 physical therapy treatment and new guidance for
130426 -        lymphedema; begin regimin of personal massage treatments to
130427 -        reduce swelling left arm. ref SDS 7 Q05H
130429 -         ..
130430 -        [On 060328 symptoms improve shown by slight decrease in
130431 -        measurements of left forearm. ref SDS 10 HO7F
130433 -  ..
130434 - Surgeon should review the record of mastectomy surgery on 051021 for
130435 - clues that may explain why lymphedema has occurred within a few months
130436 - of surgery.  Lymph nodes were removed during surgery on 020312 for the
130437 - purpose of evaluating scope of cancer. ref SDS 1 7V61  For 3 years
130438 - there were no or possibly very minimal symptoms.  The incision scar
130439 - for surgery on 051021 seems to extend toward the left axilla.  On
130440 - 051027 the surgeon advised that lymph nodes were not removed, and this
130441 - decision was made despite recommendations for further disection, on
130442 - the grounds of avoiding lymphedema. ref SDS 3 LI3K  Could something
130443 - else have occurred during surgery that aligns with acceleration of
130444 - symptoms following surgery?
130446 -     ..
130447 -    [On 060417 physical therapyst finds improvement, and explains that
130448 -    removal of lymph nodes during surgery on 051021 may have triggered
130449 -    increased symptoms of lymphedema. ref SDS 11 2Z9M
130451 -  ..
130452 - Might improved health and vigor leading to increased exercise, as
130453 - reported on 060217, ref SDS 5 Y642, be causing increased symptoms of
130454 - lymphadema?  Could vigorous exercise without a bandage on the left arm
130455 - cause symptoms of lymphedema to rise, per below? ref SDS 0 Q155
130457 -  ..
130458 - On 051021 there was discussion that lymph nodes were not removed.
130459 - ref SDS 2 QU5I  On 051027 the doctor seemed to confirm this
130460 - understanding. ref SDS 3 UW6U
130461 -
130462 -
130464 -  ..
130465 - Lymphadema Documentation from Kaiser Physical Therapist...
130466 -
130467 - Title...
130469 -         ..
130470 -        General Precautions for Those at Risk for Lymphedema
130471 -
130472 - Page 3 has instructions for exercise...
130473 -
130474 -        1.  Use caution wtih repetitive movements, especially those
130475 -            against resistance.
130477 -             ..
130478 -        2.  Light to moderate exercise on a daily basis is recommended.
130479 -            If starting a new exercise program, ease into it gradually.
130480 -            Do not overdo it!
130482 -  ..
130483 - This seems to fit Millie's regemin, per above. ref SDS 0 Q04F
130485 -  ..
130486 - Kaiser General Precautions... continue...
130487 -
130488 -        3.  Walking, swimming, or water exercises are recommended.
130490 -             ..
130491 -        4.  If you have lymphedema, it is important to be bandaged when
130492 -            exercising.
130494 -  ..
130495 - What is the scope of "bandaged"?  Does this depend on severity of the
130496 - problem?
130497 -
130498 -               [On 060320 letter to primary care physician reports
130499 -               research showing bandage should be worn during exercise;
130500 -               lymphedema may have accelerated because exercise was
130501 -               performed without bandage for several months prior to
130502 -               notce. ref SDS 8 EU40
130504 -  ..
130505 - Kaiser General Precautions... continue...
130506 -
130507 -        5.  If the limb begins to ache or feel tired, rest and elevate
130508 -            the limb if possible.
130510 -  ..
130511 - This seems conflicting with the record of increased symptoms from
130512 - elevation. ref SDS 0 Q08F
130514 -  ..
130515 - Kaiser General Precautions... continue...
130516 -
130517 -        6.  Avoid heavy lifting or carrying heavy items, such as a
130518 -            brief case or suitcase, with your arm hanging down at your
130519 -            side for a long period.
130521 -             ..
130522 -        7.  Deep tissue massage, reflexology, Rolfing, Shiatus, and
130523 -            swedish massage should be avoided on the affected areas.
130524 -
130526 -  ..
130527 - Diet is discussed on page 7...
130528 -
130529 -        Generally, Millie seems in compliance with this guidance, that
130530 -        says eat normally to maintain weight and to exercise.
130531 -
130532 -        Guidance to drink a lot of water is already part of Millie's
130533 -        lifestyle.
130534 -
130535 -
130536 -
130537 -
130538 -
130539 -
130540 -
130541 -
130542 -
130543 -
130544 -
130545 -
130546 -
1306 -