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A physical therapist recalls how one of her patient’s with prostate cancer hated exercise when he first came to visit her, but then his mindset changed once he realized his lymphedema started to get under control.
At the time, I doubted he’d return for a second physical therapy appointment. John was in his 70’s and had been diagnosed with prostate cancer. He became my favorite and most inspiring patient.
His prostate and many lymph nodes had been removed, followed by radiation and anti-testosterone drugs. He wasn’t told he had a lifetime lymphedema risk.
Unfortunately, cancer had spread throughout his bones. After both legs swelled, he was referred to me. He was tired, weak and embarrassed about his huge legs, which occasionally leaked lymphatic fluid.John was also overweight and feisty. I teased him and we began the evaluation. He needed education and encouragement to improve several treatment-related problems.
John’s cancer-related swelling had progressed up both legs, into his groin and abdomen, worsened by his disease, weight, and weekly chemotherapy and steroids. Initially, he didn’t love exercise or compression socks, but as his lymphedema improved, he became convinced. We enjoyed working together, joking around while he and his wife learned lymphatic massage and exercise.
The lymphatic system is a critical part of our immune system. Lymph nodes drain lymph fluid from the body back up to the heart. White blood cells in lymph nodes fight infection and cancer. Obesity, radiation and infection increase lymphedema risk. Newer research demonstrates a likely inflammatory trigger (like diabetes) along with lymph node removal. Once lymphedema occurs, there’s no cure. It’s imperative to diagnose and treat promptly.
Unfortunately, many physicians lack sufficient training in lymphedema, leading to late diagnosis.Beginning swelling is often missed; instead, “large” swelling prompts specialist referral. It’s critical to identify early “small” arm or leg swelling and begin treatment before it worsens.
Lymphedema is dreaded by breast cancer survivors. But it’s not just their risk. It’s swelling that occurs in thousands of patients with cancer, such as those with head and neck cancer; prostate cancer; uterine cancer; colon cancer; lymphoma; sarcoma and melanoma. Lymphedema isn’t inevitable; many lifestyle changes reduce risk. Lymphedema treatments include skin care, bandaging, garments, massage and exercise. We should educate patients by adding a cancer-lymphedema certified physical therapist to every oncology team.
Months later, John dropped in. He was attending a local Livestrong exercise program three times a week, wearing compression garments and admitted, “exercise is more fun than I thought it’d be.” John proudly exclaimed, “I’ve lost 30 pounds, look at my legs,” and then quietly said, “You know, I’ve never felt better in my whole life.”
We both teared up. His cancer was worse, and he needed ongoing aggressive chemotherapy — he had every reason to feel terrible. Yet, losing 30 pounds and building strength improved his life. He hadn’t given up, instead he learned how to be healthy despite his terrible disease.
John died two years later from his prostate cancer. He lived longer and better by managing his lymphedema and increasing his strength and endurance. It takes a team to improve the lives of cancer survivors, including physical therapists trained in cancer and lymphedema.
Andréa Leiserowitz is a board-certified oncologic physical therapist in Oregon. Her expertise is in cancer, exercise and end-of-life issues.
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