Deborah Howell (Host): Lymphedema is most commonly diagnosed after cancer treatments. So, what is it, and what can you do about it? I'm Deborah Howell. And today, we'll increase our awareness about lymphedema and lymphedema SOZO treatment with Stephanie Retter, a physical therapist assistant at High Point Therapy at the Women's Hospital. Hi, Stephanie. Welcome.

Stephanie Retter: Hi, Deborah. I'm happy to be here.

Host: We are happy to have you, and I'm getting ready to learn right now. So, what exactly is lymphedema?

Stephanie Retter: Well, it is an accumulation of protein-rich fluid in the tissues below the skin, and it happens when something blocks or damages the lymphatic system. Most often, it is caused by the removal of lymph nodes or damage to the lymph nodes caused by cancer treatments such as radiation. And then, depending on the area that was affected, the lymphedema can occur in such areas as the breast, chest, shoulder, arm, abdomen, leg, or in the head and neck. The thing with lymphedema is once it occurs, it cannot be cured, but it can be managed.

Host: What about being prevented? Can lymphedema actually be prevented?

Stephanie Retter: Well, that's some exciting news. Because until very recently, we did not have any tools to actually prevent lymphedema. Education on risk factors and providing that information to our patients, it was really the only thing we had, though that is a good tool, and it remains one of the really important components of treating someone who is at risk for lymphedema. But now, we have the SOZO Bioimpedance to use as a tool in prevention of lymphedema.

Host: So, you know, I have to ask you, what is SOZO Bioimpedance?

Stephanie Retter: Well, the first little bit might sound little scary, but hopefully I can explain it in basic terms. But it is a bioimpedance spectroscopy. It is FDA approved, it's simple and quick, and it is a device which measures fluid tissue status and changes by using electrical impulses. Now, don't let that scare anyone away, because you don't feel a thing and it is absolutely safe. It's as simple as stepping onto a scale. You just remove your socks and shoes, step onto the SOZO machine, placing your hands and feet onto the plates. It only takes about 30 seconds to have your results.

By using this device prior to a patient's surgery, and then seeing the patient for followup visits at three to six-month intervals, the results show us if the patient is starting to have an increase in fluid in the affected area before it can even be detected at a subclinical level. Now, what I mean by subclinical level just means before maybe the patient was noticing any changes or before me as a therapist can see any changes in measurements of that affected area. I do have an example that I can give you of one of our patients that might help better explain that.

Host: Sure. I'd love that.

Stephanie Retter: Well, we had a patient, her SOZO measurements had increased even though she was not showing any signs of swelling in her arm as she had had breast cancer. So, we had the patient begin wearing a compression sleeve on that arm at the appropriate times, and then we had her start using a home compression pump, and she also had an exercise routine that she did regularly. When she returned after three months, her SOZO measurements were down to nearly her baseline, so where she started before she ever had surgery. We were all so excited. So at that point, we had actually prevented her from having lymphedema in her arm.

Host: That's amazing.

Stephanie Retter: It really is exciting for us as therapists that have been treating lymphedema for years, because we didn't have that and we have that now. So now, what changes is she doesn't have to wear that compression garment all the time or use the home compression devices often. So, she'll just be more following risks, you know, precautions, things like that. And it really is a game changer for her life.

Host: Well, for you as a therapist, first of all, the SOZO machine and 30 seconds of pain-free diagnostics, that's got to be a miracle. And then to be able to actually prevent lymphedema, that's just amazing.

Stephanie Retter: It is. I mean, it is truly wonderful for our patients because, you know, once you have lymphedema, it cannot be cured. It is there and you have to learn to manage it. You know, it's one of those things as cancer survivors want to be able to just move forward with their life. But if they develop this chronic condition, it's kind of a constant reminder and something they have to manage and deal with. So, it is important.

Host: Yes. And once you have lymphedema, how is it treated?

Stephanie Retter: So, treatment can include varying combinations of about seven different things that I can go over with you here. Education to me is absolutely number one. Helping a patient understand what lymphedema is and how it can effectively be managed, but also being able to educate, being able to see a patient prior to them having lymphedema so that we can educate them on prevention and the risk. It's so important in reducing lymphedema from actually happening in the first place. So, I think education is always like the first thing that I like to prioritize.

Now when we actually come to actually treating the lymphedema, you want to involve exercises that promote general contraction of the muscles, because that helps to move the excess fluid out of the affected area.

Another component would be what is called manual lymphatic drainage, and I know that can be confusing. But what it is, is just a specialized type of massage, very light massage that's performed typically by someone who is a certified lymphedema specialist, and that is to remove the extra fluid to other parts of the body that can effectively handle the fluid because they haven't been damaged by treatment or surgery or things. So, that's what the manual lymphatic drainage does. And it's a very relaxing, easy, soft massage.

The next one, always an important component, is good skin care. It helps to reduce our risk of skin openings or infections, which can make the edema worsen. So if you already had lymphedema you want to take good care of your skin. You want to keep it moisturized. You want to protect it. Let's say gardening, those type of things, you would use gloves, wear long sleeves, just to protect from splinters and such. But if those things happen, it doesn't mean it's going to make things worse, or that it's just a matter of if it happens, you remove or clean any openings, you want to keep them clean, and those type of things. But just good overall skin management and skin care is important.

The next part is special compression bandaging. And basically, that's using bandages that they look like ACE wraps but they are not, they have different property that help to move the fluid out of that extremity. And we wrap either the arm or the leg with that and do that over a course of a period of time to help reduce the swelling. And once we do that is when we would use like the manual lymphatic drainage and the compression bandages to get to the next step, which are compression garments. Now that, we would measure you for the garment, and then we would make sure that it fits properly, that it can be put on and off independently. And that it is effectively managing that edema. So, we'd have some follow-up visits, making sure that the garment fits well, works properly. Those garments are form-fitting. They can be on your hand, on your arm depending on where your swelling is, your leg. So, that is a really important part of helping to manage and keep that edema down. Once we've got it down, that compression garment helps to keep that edema under control.

Host: Got it.

Stephanie Retter: And then, the final thing that I'll talk to you about is just as far as a component of treatment. It's called an intermittent compression pump, and it is a form of treatment used to simulate the manual lymphatic drainage massage that we do. We work with insurance and the doctors to try to get these for home, for our patients so they have them at home. What it does is it fills with air, like you would put it on your arm or put it on your leg. It's like a little suit, and it fills with air and then deflates and it repeats that. And it's moving the fluid out of that affected area. You know, we recommend that you would be receiving that from someone who has been certified as a specialist in lymphedema care because there's a lot of details and intricacies with it. And then to start a treatment, you know, it needs to be prescribed by your doctor and then provided by the certified lymphedema specialist. Myself and the three PTs that I work with here at High Point, we have all gone through extra educational courses and are certified lymphedema therapists.

Host: Good to know. I have a final question for you, because we are running out of time. What are some of the common misconceptions about lymphedema?

Stephanie Retter: One of them is that the lymphedema can happen right away after surgery or that it does happen right away after treatment. But more commonly if it occurs, it's months or years later. Once someone is at risk, it is a lifetime risk, but it doesn't mean that it'll necessarily happen. Another misconception is that lymphedema can be cured once it occurs. It can be managed, but it can't be cured, which is an important reason why prevention and the use of the SOZO are so important.

Host: So important, yes. Well, Stephanie, thank you so much for all this great information. Such a pleasure having you on the podcast. We also thank you for all the good work you do.

Stephanie Retter: Well, thank you. I appreciate your time and I'm very passionate about this as a cancer survivor myself. And we have another one here at High Point, another therapist who is also a survivor and just real passionate about being there and helping people who have been diagnosed so that, as I say, the treatments save your life and therapy provides you with the tools to live that life to the fullest.

Host: Well, your passion is shining through, Stephanie.

Stephanie Retter: Thank you.

Host: That does wrap up this episode of the podcast series from Deaconess the Women's Hospital, a place for all your life. For more information about High Point Therapy, visit deaconess.com/thewomenshospital/services/highpointtherapy.

Please remember to subscribe, rate, and review this podcast and all the other Deaconess Women's Hospital podcasts. And for more health tips and updates, follow us on your social channels. I'm Deborah Howell. Thanks for listening and have yourself a great day.