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Rehabilitation

REHABILITATION PACKAGES

Removal of involved axillar lymph nodes in patients with breast cancer increases the risk of lymphedema of the limb (lymphostasis/lymphedema) and significantly affects the quality of life and boosts the risk of infection.

Lymphostasis (lymphedema) is a born or acquired syndrome caused  by lymph circulation disorder - the outflow of lymph from the lymphatic capillaries and peripheral vessels.

Risk factors are:

• axillary lymph node dissection (removal of lymph nodes under the armpits);
• radiation therapy to the area of the lymph nodes and lymphatic drainage pathways;
• development of infections and lymphocysts in the axillary zone in the early postoperative period;
• progression of the primary disease in the axillary zone;
• age and weight of the patient

Lymphostasis can be early (6 months to a year) and late (a year and higher), has 3 clinical stages and manifests in the form of:

• Edema (full or partial) of the trunk or limb
• Sensation of heaviness in the limb on the side where lymph nodes were removed
• Bursting or nagging pain
• Deterioration of mobility and sensation of tension in the shoulder and elbow joints
• Changes in tissues (keratosis - roughening of the skin; the Stemmer symptom - inability to pinch the skin;cellulite and lymphorrhea)

Lymphostasis can progress slowly and therefore requires constant monitoring. Unfortunately, stage I is easy to miss , while treatment of stages II, III require daily visits to the hospital for physical therapy. LISOD has developed a coordinated and standardized approach to edema prevention, diagnosis, and treatment. Our certified physical therapists have extensive experience of providing comprehensive decongestant physical therapy.

To prevent or treat lymphedema, LISOD has prepared rehabilitation packages and support of certified physiotherapists. Experts give recommendations on how to reduce the risk of lymphedema, and if lymphostasis occurs, a complex conservative treatment is given (no surgery).

PACKAGE “PREVENTION OF LYMPHOSTASIS”

Includes 4 follow-up visits during the year to the certified physical therapists for monitoring and adjustment of recommendations that improve quality of life and prevent complications. Consultations are 1, 3, 6 and 12 months post surgery.

The price also includes a high-quality compression sleeve.

To assure quality treatment and avoid contraindications, offered in addition may be consultations of a surgeon, psychologist and nutritionist

For those patients that cannot come to  hospital a full online consultation will be provided.

The package can be prolonged for the following year.

PACKAGE “TREATMENT OF LYMPHOSTASIS”

The earlier signs of lymphostasis are detected, the better chances of successful treatment and improvement of woman’s quality of life are.

The gold standard for non-surgical treatment of lymphostasis is a complex decongestive therapy (CDT).

Note, that treatment for lymphedema must be a comprehensive plan: each component may have advantages and disadvantages, but the right combination thereof allows achieving highly effective treatment.

Treatment methods of CDT:

• MLD massage. Manual drainage. This is a massage that dose not affect the flow of blood , its goal is to activate the entire lymphatic system
• therapeutic and breathing exercises. The specialist will design the intensity and range of movements and the best number of repetitions and sets to reduce swelling and pain
• patient training. Placing the swollen limb while sleep or rest; care
• compression therapy. The compression hosiery is chosen individually according to the manufacturer’s sizing chart and purpose 
• bandaging. Multilayer bandaging technique. Enables optimal pressure upon the lymphatic system to reduce swelling
• taping. The most common and safe method facilitating lymph drainage and reducing pain
• weight control. Excess weight elevates the risk of swelling and aggravates its treatment. Patients may opt to consult with a nutritionist and receive recommendations on a balanced diet

NUTRITIONIST’s RECOMMENDATIONS

Cancer treatment at LISOD is procured by a variety of specialists under a strict control at every stage. Physical rehabilitation and psychological support contribute to achieving the best treatment results and a good quality of life for patients, and swift recovery after therapy. Proper nutrition plays a fundamental role here.

Things to consider

The nutrition of a cancer patient must be complete and balanced, the daily calorie content should not be less than 2000 kcal. Recommended is protein rich nutrition - meat, fish, dairy. Consumption of easily digestible carbs needs to be reduced by limiting sugar, jam, and sweets. Keeeping to a diet must be for a long while.

Food should be taken in small portions, fractionally and frequently: 5–6 times a day, warm, but not hot, up to 40C eaten slowly,  thoroughly chewing.

Note! Good functioning of gastrointestinal tract , apart from nutrition, is a function of a calm and rational lifestyle with long stays in the fresh air and moderate physical activity.

Follow a simple rule: three main meals and two or three supplementary ones. You can increase the frequency of meals while reducing the portions. E.g, lunch can be split into three meals: first course; second course and salad; third meal is the dessert.

Breakfast and lunch should must be rich in calories, while dinner somewhat lighter. Most rich in calories is the lunch.

Food processing

The most useful is lightly processed food with no or minimal heat treatment. Such as, muesli, fresh vegetables and fruits, fresh fruit and vegetable juices, yoghurts, kefir, yogurt, fresh milk, fresh natural cottage cheese, soft cheeses, still alkaline mineral water, dried fruits and berries.

Moderately processed food: dishes cooked by thermal treatment (heating): wholemeal bread, wholemeal confectionery, cereals or cereal products, boiled or stewed vegetables and fruits, baked or steamed vegs and fruits , natural honey, low-fat meat or fish boiled, stewed/steamed, fruit or berry teas.

Not advisable is highly processed food: sugar, food oversaturated with starch, canned foods, sweet carbonated drinks, instant drinks, alcoholic beverages, offal dishes, frozen ready-made meals, highly heated fats.

Consumption of water must be 2–2.5 liters a day, inbetween the meals, preferably: herbal or fruit or berry tea, green tea, black tea with milk, still mineral water.

Food that causes undesirable reactions must be eliminated.

Food and dishes that are not recommended

• Fatty meats and fish and dishes made from them, creams, puddings, pies, fatty cookies, too sweet dishes
• Vegetables that cause bloating: peas, beans, lentils, soybeans – aaccording to tolerance; coarse varieties of cabbage – raw white and red cabbage - according to tolerance; raw garlic, onion, red chilli pepper - as tolerated
• Food that causes fermentation: black, rye bread, beer, kvass, sugar
• Fresh bread made from premium flour and pastries made from butter dough
• Spicy, pickled, salted, smoked dishes and canned food
• Alcohol, carbonated drinks with added preservatives, canned juices, sour teas, coffee from over-roasted beans

Recommended food and dishes

• Soups, borsch or puree soups with a light vegetable, meat or fish broth
• Lean, not sinewy meat or poultry boiled, stewed, baked or steamed. Lean meat: veal, rabbit, turkey, chicken. Low-fat fish: pike perch, pike, pollock, cod, hake, pollock, hake. You can cook cutlets stewed in a frying pan with no crust; meatballs, meatballs, quenelles, fricassee, beef stroganoff
• • Boiled eggs: one a day; omelette with milk, vegetables, cheese
• Porridge from various cereals – semolina, buckwheat, oatmeal, pearl barley, rice; pasta from durum wheat
• Baked veg and fruits: apples, pumpkin, celery root, carrots, beets, sweet pepper, zucchini, eggplants - in any combination and proportions, salt free
• Sautéed vegs: cauliflower, broccoli, carrots, zucchini, eggplant, peeled tomatoes, peeled sweet pepper. Simmer with min amount of sunflower oil, salt free
• Fruit and vegetable casseroles and puddings with cottage cheese: apple + carrots + pumpkin + cottage cheese.
• Fruit and veg juice: from apples, grapes, carrots, celery, dill, parsley, cucumbers, tomatoes and bell pepper (in small amounts). In any combination of comfort and proportion diluted with boiled water  1:1
• Fruits: baked apples , no sugar. Fruit &cheese puddings and casseroles with no crust: apples + raisins + apricot + cottage cheese, sugar free
• Rosehip drink – pour 1 glass of rosehip with two liters of water in a thermos overnight; drink warm in the morning
• Soft unsalted cheeses: Adyghe, mozzarella, feta, lightly salted feta cheese
• Fermented dairy: medium-fat cottage cheese, low-fat kefir, yoghurts, cottage cheese casserole with fruits, cheesecakes, Halusky with  min amount of flour
• Oatmeal jelly with fruits or berries. Oatmeal jelly can also be added as a supplementary meal to an afternoon snack or lunch, assuming breakfast was hearty
• Fruit and berry smoothies with cereals and yogurt. It is worthy to note that smoothy is a very nourishing meal therefore must no be eaten before your main meal

Sample menu  (2000 kcal)

8:00-8:30  Oatmeal, buckwheat or any cereal porridge with fruits (150 g/50 g). Or an omelet with vegs (20 g) and soft cheese (20 g). Black tea with milk (100–150 ml) or natural coffee with milk. 

11:00-11:30  Medium fat cottage cheese (70 g) with fruits: dried apricots, raisins, banana, figs (30 g);  chopped nuts (1 tsp) at one’s choice may be added+ fruit tea (150 ml)

14:00-14:30 Vegetable,  meat or  fish light broth soup (200-250 ml) with a piece of boiled white meat or fish (30-50 g). Mashed potatoes (150 g ready-made) and beef stroganoff (70 g). Gray or black bread, freshly baked (30 g). Vegetable salt free salad  (100 g) seasoned with olive oil (1/2 tsp). Green tea , no sugar (100–150 ml).

17:00 Oatmeal jelly with fruit, or fruit jelly, or cocoa (200 ml). Cottage cheese casserole with fruit (100 g), or a piece of carrot cake (70 g), or rice-curd pudding (70 g)

19:00-20:00  Sautéd vegs or vegetable stew without meat (250 g) and a piece of boiled, baked or steamed low-fat fish (100 g). In case of no pronounced feeling of hunger, a glass of smoothie with cereals (200 ml) instead  (optionally)

21:00 One medium-sized sweet baked apple  with sugar-free cottage cheese or a glass of low-sour kefir or medium-fat yogurt

PROFESSIONAL REHABILITATION

For patients of LISOD medical support is ongoing throughout the length of treatment and follow-up period after discharge from hospital. A physician and a physical rehabilitation professional are staying by by the patients.

Depending on the case physician gives recommendations as to supportive treatment of cardiovascular, respiratory or gastroenterological diseases. He also gives nutritional recommendations for a variety of disorders: diabetes, cardiac diseases, gastrointestinal diseases, etc. Therapeutic rehabilitation plan is developed amid treatment of cancer disease.

A physical rehabilitation specialist is focusing on training LISOD patients. The goal of training is to bring back the ability of a patient diagnosed with cancer to live a normal life.

Health and rehab programs most commonly include non-drug techniques that help boosting the reserves of human health and regaining capacity to work.

Specialist’s efforts are targeted at the patients after operation and those who due to complications of the main disease are limited in physical activity or mobility.

To make sure rehabilitation is effective, the following are the principles to comply with:

• early start of rehabilitation measures (though, late start is better than never);
• continuity;
• integrity;
• individual approach

In postoperative period, rehabilitation measures contribute to:

• early functional rehabilitation of the operated area, prevention of its functional disorders due to surgical trauma
• proper mobilization of patients with limited movement
• prevention of complications such as pneumonia, thrombophlebitis, lymphostasis
• improvement of blood circulation and reduction of pain in the operated area or one affected by diseases

Generally, rehabilitation plan can be coupled with the treatment of cancer or as stand-alone effort

LISOD has a team of experienced rehabilitation specialists practicing up-to-date, effective rehabilitation methods, such as:

Comprehensive fascial decongestant therapy, namely:

• manual lymphatic drainage (training in self-massage);
• skin care of the sore limb;
• compression therapy;
• special therapeutic exercises;
• breathing exercises
• lymphatic drainage taping of the upper and lower extremities;
• compression bandaging;
• physiotherapy

The rehabilitation professional stands by the patient throughout the treatment, and whenever required will adjust a personalized physical rehabilitation plan. They also provide consultations on the use of compression garments

 What is it about?

World experience proven rehabilitation to be critical for the psychological state of patient. Expanding their physical capabilities raises spirits, cheers them up, inspires confidence. The recovery of the body is coming sooner. Classes with a rehabilitation therapist at LISOD are both individual and a group ones. The professional develops a plan to fit the characteristics and nature of the disease. Training load is not excessive.

Note, it is never too late to contact a rehabilitation professional. LISOD professionals have resources and eagerness to give hand!

PSYCHOLOGICAL SUPPORT

Cancer treatment may turn to be complex and lengthy. This is the time when patients need the support of loved ones and also help of a professional psychologist. Often seeking help are relatives of patients , it is important they stay restraint, calm, aware, able to evaluate the situation correctly, interact with doctors. For many of them emotional stress does not subside after discharge - they are worried about a possible relapse of the disease, social problems, family and work relationships. In this period patients need  therapeutic support, psychological assistance not less than during their treatment . And we are always happy to be there for them to help. Our goal is not just a salvage at any cost, but a salvage together with a high quality of life.

Things our patients need to know

• psychological help at LISOD is free and is a fundamental part of comprehensive treatment
• professional psychologist conducts individual consultations and sessions with patients
• psychologists consult relatives of patients on regular bases. They help cope with anxiety and build relationships correctly to support a loved one
• psychologist’s aim is to do best they can for the recovery of our patients, to fill their lives with warmth, understanding, meaning and confidence

Some background information

Studies in old European countries and the USA proven that cancer patients that received psychological support during and after the treatment not only better  cope with the disease, but also less suffer from relapses.

It may seem incredible, but the truth is that interaction with a psychologist may dramatically change the situation -  your well-being will improve, you will get new motivation and new strength to battle the disease.

To receive information about psychologists, make an appointmentp for a consultation or sign up to a psychological support group contact your administrator