Nearly 50% of patients treated for head and neck cancer also develop some level of lymphedema

Lymphedema is an abnormal accumulation of protein rich fluid. It is generally due to the effects of treatment for cancer as a result of lymph node removal and scar tissue associated with surgery and radiation therapy.   Breast cancer patients make up the majority of people suffering from lymphedema, most commonly occurring in the arm. However, nearly 50% of patients treated for head and neck cancer also develop some level of lymphedema.

Addressing the “Bankers Waddle”

Such was the case for Matt, a 48-year-old engineer diagnosed with head and neck cancer in 2011. He did not have surgery and instead underwent two months of chemotherapy followed by two months of radiation therapy. During treatment, he lost 60 pounds and developed neck swelling during recovery, which he referred to as his “bankers waddle.”

On the suggestion of his oncologist dentist, Dr. Nelson Lowe, DDS, he was referred to Kim Marshall, PT, CLT a physical therapist and certified lymphedema therapist.

Decongestive therapy among several treatment programs 

“Matt was very typical of the type of patient I see for lymphedema following treatment for head and neck cancer,” said Marshall, a member of the National Lymphedema Network. “Over the course of two months we used complete decongestive therapy (CDT) techniques to reduce his swelling.”

This standard of care involves:

  • Manual Lymph Drainage
  • Compression Bandages
  • Skin and Nail Care to Prevent Infection
  • Therapeutic Exercises

In addition to lymphedema, head and neck cancer patients are also susceptible to neck weakness, postural changes and jaw tightness, commonly referred to as temporomandibular joint dysfunction (TMJ).

As part of his rehabilitation program, he was monitored for signs of TMJ, as these disorders can be especially troubling and are difficult to reverse.

Avoiding some of the long-term side effects of cancer treatment 

“As bad as the cancer was and knowing there are still some long-term residual effects that could develop, I feel extremely fortunate that I was able to skirt some of the nastiest visible side effects of this treatment,” Matt said. “Now I have a nice skinny neck. Everyone has their own path.

“I am grateful to Kim for really taking the time to work with me personally and develop an individualized program that was the best course of action for me,” he added.

A touch or neuropathy  

Along with the lymphedema, Matt noticed that a tingling sensation developed in his feet. Most likely this was the result of chemotherapy causing peripheral neuropathy. Identified as chemotherapy induced peripheral neuropathy (CIPN) this common side effect with certain chemotherapy agents can show up immediately after the start of chemotherapy or even after treatment has been concluded.

Kim is one of the first physical therapists in California to receive the STAR certification for oncology rehabilitation was able to address this issue during Matt’s treatment.

“We were able to reduce some of the tingling feeling Matt experienced with TENS (transcutaneous electrical nerve stimulation), and whirlpool treatments, but it did not fully resolve,” Marshall said. “Fortunately, his symptoms were not severe and were not affecting his balance; a typical side-effect, which can lead to additional problems that need to be addressed.”

Researches are working diligently to understand more about CIPN and develop drugs or delivery methods that can hopefully one day prevent this from happening. Until that time, physical therapist work with patients daily to help these patients improve their quality of life and educate them on exercises and strategies to manage day-to-day activities.

When tendonitis becomes a good thing 

Two years out from cancer treatment, Matt was back for more physical therapy. The good news is it was just a run-of-the-mill orthopedic issue, tendonitis in his elbow, An injury that was not related to his cancer diagnosis.

“My orthopedic surgeon gave me a few choices, surgery which he did not think I needed, a cortisone shot which he didn’t recommend, PRP, which I didn’t want to do, or physical therapy,” Matt said. “The choice was easy. My orthopedists has his own sports medicine practice, but I picked Kim for physical therapy. I feel very comfortable with her. She is extremely knowledgeable and very professional.

“She knows me so well and how to get me to do the things that I don’t necessarily want to do,” he added. “It is like a little family at Progressive Physical Therapy and Rehabilitation and everyone is very encouraging. I can’t image going anywhere else.”

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