by Kim Luebbers

I was 35 and working as a radiation therapist, giving treatments for cancer, when I was diagnosed with breast cancer. I had a husband and three children ages 7, 3, and 2. My breasts were very fibrocystic and I had a large area in my breast that had always troubled me but now appeared to be changing. I had aspirations and a biopsy before. The first biopsy in 1995 showed only fibrocystic disease. In September of 2001, I went to the doctor and a fine needle aspiration showed atypical cells, suspicious for malignancy.

Two weeks later an open biopsy was performed which showed ductal carcinoma insitu and a 5mm tubular carcinoma. After talking to my surgeon, medical oncologist and radiation oncologist, I decided to have a double mastectomy. To some, this treatment choice may have seemed too aggressive but I knew that breast cancer in younger women tends to act more aggressively, and I had lots of other lumps in my breasts. My tumor had not shown up on mammogram and I didn’t want to have to worry about what kind of cells were in those lumps.
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I also consulted with a plastic surgeon to discuss options for reconstruction. I opted for immediate reconstruction and my surgeon and plastic surgeon performed the operation together. My tumor was small, I had no positive lymph nodes and I had very little breast tissue left after surgery. For all these reasons the doctors agreed I did not need any radiation or chemotherapy. The reconstruction was very helpful to me in dealing with the loss of my breasts.

All my efforts were focused on getting well physically, trying to eat and sleep well and not let the pain get to me. I was dealing with the physical part of my cancer, not doing too badly, handling things well, or so I (and everyone) thought.

You might think that this would be the end of my journey; however, this is when the toughest part began. When I finally began to deal with the emotional part of having a cancer diagnosis and losing my breasts, it became extremely difficult for me to give radiation treatments to my patients. I knew we were facing the same monster. Everyone’s story was different, yet similar, different diagnosis and tests, yet similar emotions. I found it difficult to be grateful for my prognosis.

I was physically tired having all these emotions of anger, sadness and despair while also trying to keep up with working full-time, the housework, being a wife, and being a mother to three small children. It put a strain on my relationship with my husband. I felt indifferent about a lot of things and felt joy in nothing.

At a yearly appointment with my gynecologist, I finally broke down sobbing. She asked me if I thought I needed an antidepressant and I said, "No." Why couldn’t I be as strong emotionally as I was physically? I felt like a failure.
Because I was so depressed I agreed to take the medicine prescribed. Slowly my mood began to improve and I was able to get beyond the depression and start to find joy again. My work was not as hard for me emotionally. I was able to empathize with my patients, understand how they were feeling and encourage them.

It is difficult to deal with a cancer diagnosis, to have check-ups and worry about the possibility of the cancer coming back or spreading, For me, it was scary to have to deal with my own mortality at my age. Some of the most difficult days for someone with cancer may be after the treatments are finished, just when everyone thinks you’re fine.
Within a week of celebrating my third year of being cancer free, I had a scare. I had to have one of my implants removed due to an infection. This doesn’t happen very often, but leave it to me to have a low risk complication. After three months of healing I was able to begin the reconstruction over again. After two more surgeries and about six more months, I will be back to my "new" normal self.

I am grateful no cancer was found when my implant was removed. I am completely satisfied with the decision my doctors and I have made so far. I would not change anything except for having cancer in the first place.
It is important to have a support system during and after cancer treatment. I personally believe that the emotional side of cancer is the most difficult to deal with. I encourage people to reach out to others for support; people in our churches, co-workers, friends and family. Most often people are willing to help. As survivors, we need to let others know when we need the help. In asking for help we display our strength.

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by Cheryl Badura, OTR/L CLT and Jill Gaulke Harlan, OTR/L CLT

Lymphedema is a chronic condition that involves the swelling of a body part (arm(s), leg(s), trunk, face) due to trauma of the lymphatic system. When lymph channels become blocked and lymph fluid cannot drain properly, protein-rich fluid tends to accumulate in the affected body part. Primary lymphedema can be present at birth or develop from unknown causes later in life. Secondary lymphedema develops because of lymph node removal or damage. Damage or removal of the lymph vessels can occur as a result of surgery (i.e. mastectomy, lumpectomy), radiation, infection or other trauma.
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Secondary lymphedema is a risk for a lifetime for anyone who has undergone surgery or radiation for breast cancer. In fact, the average onset of lymphedema for someone who has had breast cancer is 1½ years after surgery. Most often lymphedema will develop in the arm of the affected side, but will also occur in the trunk or breast. I t is important to be aware of signs and symptoms of lymphedema so treatment can be started right away. Lymphedema will not go away on its own; it will worsen over time if not properly treated.

Signs and symptoms of lymphedema include the following:

• Increase in limb size
• Feeling of heat in limb
• Puffiness
• Pitting of skin if pressed
• Aching limb
• Inability to pick up fold of kin on a finger
• Decreased sensation of a limb or "pins and needles"
• Redness (although this could also indicate infection)

It is important to see a physician right away if any of these signs or symptoms appears.

A certified lymphedema therapist will provide treatment that includes a specialized massage technique called manual lymph therapy (MLT) or manual lymph drainage (MLD). The gentle massaging action stimulates the lymphatic system and promotes drainage of lymph fluid, toxins, proteins and debris out of the affected areas. The lymph fluid is absorbed back into the system, and the remaining components are exerted from the body through urination or sweating.
A second key component of treatment involves application of low stretch compression bandages (never ace wraps) which allow a pumping effect when muscles contract, stimulating lymphedema reduction.

Another component to treatment and a key to lymphedema prevention and management is meticulous skin care. Some examples are a daily skin check, including examining your limb for cuts, burns or bites as these are
potential sources for infection. Treat any skin opening with antibiotic cream and protect hangnails or cracked, torn cuticles. Also note the signs of infection (redness, warmth, tenderness, red streaks, or swelling) and contact your doctor if any are present. It is also important to protect your skin from the sun and overheating. Wear sunscreen and avoid saunas or hot tubs.

​Avoid skin constriction by wearing loose fitting clothing and jewelry. Finally, insist that your affected arm(s) NEVER be used for injections, blood tests or blood pressure measurements.


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