Cancer Rehab,
Lymphoedema Rehabilitation

Detailed physical examination

We carefully analyze your past medical history, current symptoms, family history, and all medications you have been taking in the past, their effectiveness and side effects. X-ray and other imaging studies of your neck and low back spine are usually recommended for an accurate diagnosis and determination of the stage and extent of the pathological changes in your vertebral bodies, tendons, intervertebral disks and corresponding nerve roots.

Electrodiagnostic Study

A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. Nerve conduction studies, along with electromyography, measure nerve and muscle function and may be needed when there is pain in the limbs, weakness from spinal nerve compression, or concern about some other neurologic injury or disorder.
Nerve conduction studies are used mainly for evaluation of paresthesias (numbness, tingling, burning) and/or weakness of the arms and legs. Some of the common disorders that can be diagnosed by nerve conduction studies are: Carpal Tunnel Syndrome, Cubital Tunnel Syndrome, Peripheral Neuropathy, Spinal Disc Herniation, and Ulnar Neuropathy. When done by an experienced physician or electro diagnostician, nerve conduction studies and electromyography are relatively quick (last for 45-60 minutes) and are well tolerated.

Medications

Anti-Inflammatory medications are an important part of the program.
These medications are necessary to control pain and inflammation in the major joints.
Even though these medications are unable to reverse arthritic changes in the cartilages, bony tissue, and surrounding soft tissue, scientific research demonstrates the great importance of non-steroid anti-inflammatory medications in pain and inflammation control. There are several pharmacological groups of medications that we recommend for osteoarthritic patients: Tylenol and Aspirin, non-steroid anti-inflammatory drugs (NSAIDs such as Ibuprofen, Motrin, Naproxen, Aleve), and others. These medications block special inflammatory enzymes called cyclooxygenase (COX-I). This is why they are called COX-I inhibitors. These medications can stop an inflammatory cascade and help with pain, edema, tenderness, and redness. They are effective and potent medications; however, they can upset your stomach causing abdominal pain and even bleeding.

Taking into consideration that our patients are suffering from multiple chronic disorders, we have decided to choose newer medications for our program that are known for high efficacy and have fewer side effects. We will be using COX-II inhibitors, which are similar anti-inflammatory medications with a favorable side effects profile: Celebrex and Mobic (Meloxicam). Recent clinical research studies have demonstrated that Meloxicam is highly effective in patients with different stages of osteo and rheumatoid arthritis.

Steroid medications

For more severe arthritic symptoms, Cancer Rehab, Lymphoedema we may prescribe steroidal anti-inflammatory medications, but those drugs should be taken for a short period of time because of their substantial side effects. We may use oral steroids (Medrol Pack) or inject steroid solutions directly into inflamed arthritic joints. Those medications are highly effective in fast control of acute inflammation, pain and edema. Major problems of steroid medications that they do nothing with natural restoration of arthritic joints, and their frequent use might actually destroy joints tissues and surrounding tendons. One old professor compared the use of steroids medications with switching off a fire alarm in a house that is on fire – no alarm, but the fire continues. In the joint– no pain, but the inflammation goes on.

Pain Medications

Opioids are very potent pain killers and they are also known as narcotic analgesics. Recent research and literature demonstrate opioids are helpful in chronic low back pain in arthritis patients. There are potential side effects with long-term opioid use, such as dependency and side effects. We usually choose longer acting opioid medications in combination with the short acting medications since they stay longer in your system and are more effective for chronic pain problems. Our program has very strict guidelines that require regular urine testing. We ask patients to sign an opioid agreement before we prescribe these medications.

Herbal and natural medications

Our patients often ask about natural alternatives to non-steroid and steroidal anti-inflammatory medications. There are a huge variety of natural alternatives and herbal dietary supplements on the market, but we include only safe and effective natural medications: Chondroitin, Glucosamine, MSM, Microlatin, so-called Joint Formula.
These natural medications are highly effective, provide good pain control, decrease edema, increase lymph flow and have favorable side effect profiles. We also recommend generalized stabilizers, like Gingko Biloba, Guarana, Saw Palmetto and other immune stimulators for joint health.

Laxatives (Balerina’s Tea), water pills, Menopause Essentials are important part of our program.

Topical medications and ointments

Part of the program includes topical ointments which are recommended for application on the skin of Lymphoedema affected arm. These transdermal formulas, called compounding medication, include special ointments prepared by the pharmacy according to a physician’s prescription. They usually contain a combination of non-steroidal anti-inflammatory medications, topical anesthetics, and muscle relaxants. Additionally, we use Chinese American patches, creams and sprays, Capsaicin cream, made from red chili pepper, Lidoderm patches and other topical formulas.

Invasive procedures (injections):

Intra-muscular Steroid Injections, also knownas cortisone shots, are Steroid mixed with a local anesthetic (numbing medication) which is injected directly into the affected muscles of the arm, in the shoulder, elbow and wrists. By using this technique, physicians avoid the potential side effects of steroids when given orally, and increase the efficacy of the medication by delivering it to the exact place where the inflammation occurs. Steroid injections are useful to control symptoms, decrease edema, stimulate new lymph vessels growth and facilitate recovery.

Botulinum Neurotoxins (BoNT) Injections (chemodenervation)

One of the newertreatments for muscular pain, edema, and lymphedema is BoNT intramuscular injections. BoNT are natural bioactive substances, a product of Clostridium botulinum microorganism. There are 2 types of neurotoxins, type A, Botox and Type B, Myobloc. In big doses BoNT might be poisonous, but in small doses prescribed by a physician BoNT is an excellent and safe tool to control muscle spasm and pain.

Recent research has proven that using Bont off label are useful in lymphedema treatment, lymph nodes recovery and edema resolution. The usual chemodenervation procedure takes 15-30 minutes, depending on the amount of arm edema, followed by ice application for half an hour. The injections are not painful and are well tolerated. The effect of pain relief and muscle relaxation lasts for 2-3 months, with injections repeated as needed.

Prolotherapy

Prolotherapy is a rejuvenating injection therapy that helps to accelerate the collagen synthesis inside impaired muscles, ligaments and restores affected arm tendon’s elasticity. The idea of this therapy is that an injection of a proliferant solution inside the impaired structures (in order to rejuvenate the ligamentous tissue), stimulates stem cells and naturally stabilizes the joint.

Prolotherapy is an ancient method that was actually proposed by Hippocrates and developed in this country by Dr. George Hackettt and Dr. Gustav Hemwel. Both physicians have actively been promoting prolotherapy for 60 years in their Chicago- based clinic.

This method might be used in patients with severe allergies and patients who don’t tolerate traditional medications well because of side effects or gastro-intestinal discomfort. Prolotherapy might be a good adjunctive therapy to intra-articular steroid shots, non-steroidal anti-inflammatory medications, and becoming more and more popular in cancer Rehab and Lymphoedema treatment.

Platelet Rich plasma, Stem Cell Therapy and blood injections.

Platelet Rich Plasma, Stem Cell Therapy and whole blood injections are different types of so-called “regenerative therapy”. They use the body’s most basic “raw materials” (blood, blood fractions, and stem cells) to grow or regenerate new cells that the body needs. Stem cells are “undifferentiated” or “unspecialized” cells, meaning that they are “blanks” that can be developed into another type of cell that is required to repair or replace damaged tissue. In the musculoskeletal field, stem cell therapy can stimulate the formation of new bone, cartilage, tendon, ligaments, fat, and fibrous connective tissue and is an important part of our program. A lot of patients are reluctant to take chemically-based medications and favor homeopathic alternatives. Blood and blood fraction injections are very popular in Europe and have been used for ages there. Today those procedures are becoming increasingly popular in the USA.

Exercise, chiropractic manipulations, massage

Proper exercise performed on a daily basis is an essential part of Cancer Rehab, Lymphoedema management.
Exercise, done carefully and regularly, helps build and preserve muscle strength, decrease edema, keeps joints flexible, and protects them from further damage. Isometric exercises (non-movement exercises) can help strengthen muscles around joints and reduce wear and tear. Chiropractic doctors use gentle chiropractic manipulations in order to restore and maintain range of motion in major joints. We also recommend stretching programs that benefit muscles in order to maintain flexibility and range of motion. Massage improves the blood flow and decreases pain. Joints need to move to remain healthy and well lubricated.

Braces, sleeves and other assistive devices.

In our clinic you can find a wide variety of braces, canes and other assistive devices that help with better pain control and provide mechanical support of the joints. Orthotics, braces and new propylene sleeves can help support joints and decrease wear on cartilage. Temporary use of crutches, canes, walkers, or a wheelchair may be helpful for some patients.

Physical and occupational therapy.

Physical and Occupational Therapists who collaborate with our clinic work to help people with arthritis and make their life easier. Treatment includes muscle strengthening and range of motion exercises. You will also learn ways to control pain without medications. The occupational therapist will focus on obtaining maximum independence and minimizing recurrence through education and treatment techniques.
They will also be paying special attention to trunk stabilization, general conditioning, and safety of ambulation.

Acupuncture

Acupuncture is a useful part of the program. It helps to relieve pain, stress, stiffness, edema and facilitate lymph vessels regrowth. Acupuncture helps to find right balance for each person, and our medical providers will be happy to assist you in establishing pain free health.

Physical modalities

Depending on your preference, heat or ice will be used for your Cancer Rehab, Lymphoedema pain.
Ice or heat is typically applied 3-4 times a day for 10-15 minutes. Heat may be applied in our clinic in many forms including warm packs, paraffin baths, electric TENS units, or ultrasound. Cold therapy will utilize ice packs, frozen bags of peas and corn or a wet towel that has been placed in a freezer. We are well equipped with different ultrasound devices, microwave machines, and diathermy. Also, ultrasound and phonophoresis with different medications might be used.

Weight management.

It is very important to maintain a healthy weight while treating Cancer Rehab, Lymphoedema. Research all over the world has demonstrated that a reduction of weight can significantly decrease the impact on impaired joints and arm lymphoedema. This is an important part of our program and includes a combination of a healthy diet, appetite suppressants, and aerobic exercises for weight reduction and maintenance. We may use special medications recommended by the FDA for weight control like Xenical and Meridia, or herbal formulas and Botox injections for cravings control. We offer fat melting injections and body wraps.

Multidisciplinary Chronic Pain Program

It is important to develop multidisciplinary chronic pain programs for individuals who have failed all other types of treatment. Pain affects these patients physically, psychologically, and socially. The goal of a multidisciplinary chronic pain program is to educate the patient about Cancer Rehab, Lymphoedema pain, physiology and anatomy, improve coping skills, provide help with aerobic conditioning, endurance, and strength, treat depression and other underlying medical conditions, eliminate inappropriate medications, initiate appropriate medications and assist the patient in establishing realistic goals and maintain treatment goals.

Behavioral health is a crucial part of the chronic pain program. Clinical psychologists are experts closely involved in the chronic pain program to help the patient to improve coping and treatment of underlying depression, sleep disorders, anxiety, and post-traumatic stress disorders. Research supports that there is a close relation between perception of pain, depression, sleep disorder, anxiety and post-traumatic stress disorder. It is essential to treat these conditions in order to achieve better pain control.