Manishi Khatter thought she was through the worst of it. After being diagnosed with breast cancer, she had a lumpectomy and radiation, finishing her treatment just before Christmas in 2023.\u00a0<\/p>\n
Then, in January, she noticed her left breast and chest wall felt swollen. It could have been slow healing, but Khatter \u2014 a family doctor who works in women\u2019s health \u2014 suspected something worse.<\/p>\n
By March the upper part of her left arm was swollen too, and she knew \u2014 it was lymphedema, a chronic and debilitating condition that affects 1.25 million Canadians<\/a>, most of them cancer survivors.\u00a0<\/p>\n \u201cMy first reaction was, \u2018There must be a solution, this isn\u2019t going to be my life forever.\u2019 Then I started to realize, \u2018OK, maybe it is, because this is long term,\u2019\u201d Khatter recalls.<\/p>\n \u201cWhen you have cancer you\u2019re just trying to survive, but lymphedema is one of the things that doesn\u2019t go away.\u201d<\/p>\n Khatter had already signed up for the Alberta Cancer Exercise<\/a> program run by Margaret McNeely<\/a>, University of Alberta professor of rehabilitation medicine<\/a>, adjunct in oncology<\/a> and director of the U of A\u2019s Cancer Rehabilitation Clinic<\/a>. McNeely also leads a nationwide project to update Canada\u2019s lymphedema treatment guidelines<\/a>.\u00a0<\/p>\n Now McNeely is heading up the new Lymphedema Research and Training Program, part of the recently established Dianne and Irving Kipnes Health Research Institute<\/a>. It will focus on early detection and intervention, filling a desperately needed gap in research and clinical treatment options for people like Khatter.\u00a0<\/p>\n \u201cWe can\u2019t prevent lymphedema, but we can monitor it closely \u2014 especially for high-risk people who\u2019ve had more surgery or more advanced breast cancer \u2014 and at the first signs of swelling we can start treatment,\u201d McNeely says. \u201cOur aim is to reduce the swelling and support the lymphatic system to get back on track.\u201d<\/p>\n Numbers on the rise<\/p>\n A healthy lymphatic system delivers nutrients and white blood cells throughout the body and carries away debris and harmful substances by filtering them through the lymph nodes. When lymph flow is blocked, fluid builds up, causing painful swelling (edema) that can lead to increased risk of infection.\u00a0<\/p>\n It can happen anywhere in the body, depending on where the damage is. Secondary lymphedema can occur following treatment for breast, gynecological, and head and neck cancers, as well as melanoma<\/a>. Primary lymphedema is when a person is born with a damaged lymph system.\u00a0<\/p>\n Khatter did not have high-risk factors like obesity, diabetes or a sedentary lifestyle. But she did have surgery on a tumour and some lymph nodes under her arm, as well as radiation.<\/p>\n Less-damaging surgical methods are available, but with improved cancer detection and more people surviving, lymphedema case numbers are on the rise, according to the Canadian Lymphedema Framework<\/a>.\u00a0<\/p>\n Despite this, there\u2019s a lack of research into the best ways to treat lymphedema, says McNeely.<\/p>\n \u00a0<\/p>\n Mental and physical exhaustion<\/p>\n McNeely\u2019s best advice \u2014 and Khatter\u2019s own instinct \u2014 was to see a physiotherapist right away.\u00a0<\/p>\n Khatter was willing to try almost anything to control the swelling. She did daily prescribed stretches and kept up with her gym routine. The physiotherapist told her where to find specially fitted compression garments like a bra and sleeve, which help to keep fluid from building up. They are uncomfortable but must be worn eight to 12 hours each day.<\/p>\n She found a massage therapist who could do manual lymph drainage, a technique designed to push fluid out of the affected area and improve function of the entire lymph system. She went weekly at first, paying out of pocket, and learned how to do some of the fluid-clearing techniques at home.<\/p>\n Khatter found this daily lymphedema care routine \u2014 and daily reminder of her breast cancer diagnosis \u2014 exhausting physically and mentally.\u00a0<\/p>\n It took months before she would wear the compression sleeve without covering it with other clothing because she felt self-conscious and didn\u2019t want to answer questions about her diagnosis.\u00a0<\/p>\n \u201cIt was all still feeling so raw and so fresh, and a part of me wanted to just hide it,\u201d she says.<\/p>\n After a while, she realized that most people didn\u2019t even notice the sleeve, or chose not to ask. Now she wears funky sleeves with paisley and flower patterns on them that look like tattoos.\u00a0<\/p>\n She\u2019s embraced her new look \u2014 and her new routine \u2014 because it\u2019s working.\u00a0<\/p>\n \u201cI do believe \u2014 although there is no way to verify this \u2014 that my early intervention with physiotherapy, education, manual lymphatic drainage and compression are why my lymphedema did not progress and in fact has improved since diagnosis,\u201d Khatter states. \u201cThe only way to really know is to stop doing it all and have it get worse, and I\u2019m not willing to do that.\u201d<\/p>\n Even though the swelling is now under control, she continues to wear compression garments every time she works out, and for a period of time most days, especially when her arm feels heavy. She goes for manual lymphatic drainage once a month for maintenance. She swims regularly, an exercise known to improve lymphedema.<\/p>\n \u201cI was very fearful at the beginning that my whole arm and my hand were going to swell up, and that never did happen,\u201d she says. \u201cNow lymphedema is in the background instead of front and centre in my life.\u201d<\/p>\n Building evidence for better care<\/p>\n McNeely says Khatter did everything right.\u00a0<\/p>\n \u201cI know this as a clinician, but we don\u2019t have the research evidence to support it in practice,\u201d says McNeely, a member of both the Women and Children\u2019s Health Research Institute<\/a> and the Cancer Research Institute of Northern Alberta<\/a>.\u00a0<\/p>\n Her new research program aims to gather that missing evidence and improve quality of life for people living with lymphedema \u2014 a personal cause for donor Dianne Kipnes<\/a>, who developed lymphedema in her legs after undergoing surgery for cervical cancer.\u00a0<\/p>\n New tools like MRI are now available so McNeely and her team can analyze what\u2019s happening within the muscle, fat and other tissue of a swollen limb, instead of just using a measuring tape to monitor overall size.\u00a0<\/p>\n Their latest randomized controlled trial examined the effect of combined compression therapy and progressive resistance exercise. While the data are still being analyzed for publication, McNeely says study participants felt an improvement in their symptoms. The MRI data will help the team understand which patients benefited most, allowing them to tailor future treatment recommendations.<\/p>\n \u201cA lot of women stop doing much with the arm because when they use it, they feel like it gets more swollen,\u201d McNeely explains. \u201cWe tested the participants\u2019 muscle strength prior to starting the exercise program and then challenged them. We would modify the exercise program if their swelling increased, but the intensity of the resistance exercise was slowly increased and the arm would adapt nicely.\u201d<\/p>\n That study was led by doctoral student Mona Al Onazi<\/a>, a CRINA scholarship winner<\/a>, and was funded by the Alberta Cancer Foundation<\/a>.\u00a0<\/p>\n McNeely is also updating the training for health-care professionals who work with cancer patients. Simultaneously, U of A oncology researcher Spencer Gibson<\/a>, the Dianne and Irving Kipnes Chair in Lymphatic Disorders<\/a>, is working to understand other causes at a molecular level, including oxidative stress<\/a> and lipid toxicity associated with fatty acids<\/a>.<\/p>\n \u201cI think the Kipnes Institute has the potential to bring people together from basic science, medicine, radiology, nutrition, occupational therapy, exercise science, even psychosocial oncology,\u201d she says. \u201cThis network of people who are all linked with a common goal to improve care is my vision.\u201d\u00a0<\/p>\n Khatter says she\u2019s eagerly awaiting McNeely\u2019s research results.<\/p>\n \u201cWe need to do better at early detection and management, and get the knowledge and education to the people who need it. I am truly an example of what that can accomplish.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"Manishi Khatter thought she was through the worst of it. After being diagnosed with breast cancer, she had…\n","protected":false},"author":2,"featured_media":332019,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[10],"tags":[49,48,7714,146214,146215,42791,146213,146210,34919,146208,84,146211,146209,146207,146212,146206,146218,32675,109017,34016,146217,146216],"class_list":["post-332018","post","type-post","status-publish","format-standard","has-post-thumbnail","category-health","tag-ca","tag-canada","tag-cancer","tag-cancer-rehabilitation-research-clinic","tag-cancer-research-institute-of-northern-alberta","tag-cancer-survivors","tag-compression","tag-dianne-and-irving-kipnes-health-research-institute","tag-early-detection","tag-faculty-of-rehabilitation-medicine","tag-health","tag-lymphedema","tag-lymphedema-research-and-training-program","tag-manishi-khatter","tag-manual-lymph-drainage","tag-margaret-mcneely","tag-mona-al-onazi","tag-oncology","tag-physiotherapy","tag-prevention","tag-spencer-gibson","tag-women-and-childrens-health-research-institute"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/332018","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=332018"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/332018\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/332019"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=332018"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=332018"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=332018"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}