1 00:00:01,840 --> 00:00:04,520 Speaker 1: Welcome to Wellness sun Mass. I'm doctor Nichol Saffire and 2 00:00:04,640 --> 00:00:06,920 Speaker 1: Breast Cancer Awareness Month continues. 3 00:00:07,000 --> 00:00:07,480 Speaker 2: That's right. 4 00:00:07,920 --> 00:00:10,040 Speaker 1: It may be October and you look around. You're seeing 5 00:00:10,039 --> 00:00:14,079 Speaker 1: a lot of pumpkins and pumpkins, spice lattes and apple doughnuts. 6 00:00:13,680 --> 00:00:15,920 Speaker 2: And all of those other beautiful fall things. 7 00:00:16,400 --> 00:00:19,040 Speaker 1: You're probably also seeing a lot of pink, especially if 8 00:00:19,040 --> 00:00:22,639 Speaker 1: you follow my social media. Why is that? Well, I 9 00:00:22,640 --> 00:00:24,640 Speaker 1: think we all know at this point one in eight 10 00:00:24,680 --> 00:00:27,200 Speaker 1: women will develop breast cancer in their lifetime. 11 00:00:28,240 --> 00:00:29,720 Speaker 2: That number is only increasing. 12 00:00:29,840 --> 00:00:33,840 Speaker 1: We're seeing rising incidences of breast cancer, especially in younger women. 13 00:00:34,040 --> 00:00:37,040 Speaker 1: So October is the time where we push our message 14 00:00:37,040 --> 00:00:41,239 Speaker 1: of early detection matters. The earlier you find cancer, the 15 00:00:41,280 --> 00:00:44,720 Speaker 1: easier it is for us to treat and to improves survivability. 16 00:00:45,159 --> 00:00:48,600 Speaker 1: So get your mammogram, make sure you're doing your breast checks, 17 00:00:48,680 --> 00:00:51,600 Speaker 1: all of that stuff. That's what October is all about 18 00:00:51,640 --> 00:00:55,920 Speaker 1: for the breast imaging world. But while yes, we may 19 00:00:56,240 --> 00:00:59,600 Speaker 1: diagnose over three hundred thousand new cases of breast cancer 20 00:00:59,720 --> 00:01:03,600 Speaker 1: in the United States this year alone, today's episode is 21 00:01:03,640 --> 00:01:07,920 Speaker 1: talking about something else. Let's talk about the four million 22 00:01:07,959 --> 00:01:11,880 Speaker 1: Americans women and men who are living with the history 23 00:01:11,880 --> 00:01:14,680 Speaker 1: of breast cancer, meaning they were just diagnosed and their 24 00:01:14,760 --> 00:01:18,880 Speaker 1: undergoing treatment right now, or they've completed their treatment and 25 00:01:18,959 --> 00:01:23,240 Speaker 1: they have been declared cancer free, or they've completed their treatment, 26 00:01:23,360 --> 00:01:27,280 Speaker 1: or they're still undergoing treatment because their disease has progressed. Now, 27 00:01:27,280 --> 00:01:30,080 Speaker 1: that's a lot of people, and these are survivors who 28 00:01:30,160 --> 00:01:33,360 Speaker 1: carry both the triumphs but also the challenges of this 29 00:01:33,520 --> 00:01:36,000 Speaker 1: disease forward. And that's what we're going to focus on 30 00:01:36,000 --> 00:01:40,319 Speaker 1: on today's episode, because survivorship doesn't always mean the end 31 00:01:40,360 --> 00:01:43,800 Speaker 1: of the story. And one of the most underrecognized and 32 00:01:44,000 --> 00:01:49,280 Speaker 1: under talked about but life altering complications of treatment from 33 00:01:49,320 --> 00:01:53,520 Speaker 1: breast cancer is lymphedema, which is a swelling often in 34 00:01:53,560 --> 00:01:58,080 Speaker 1: the arm, the breast, the chest, the neck, triggered by 35 00:01:58,120 --> 00:02:02,760 Speaker 1: treatments that disrupt the attic system. Estimates very broadly, but 36 00:02:03,040 --> 00:02:06,680 Speaker 1: up to twenty percent of breast cancer survivors may have 37 00:02:06,920 --> 00:02:11,200 Speaker 1: some level of persistent lymphidema, and it may climb even 38 00:02:11,280 --> 00:02:16,880 Speaker 1: higher as post treatment time passes. Is a debilitating condition. 39 00:02:17,680 --> 00:02:19,840 Speaker 1: You see women walking around, they may be having a 40 00:02:19,880 --> 00:02:23,600 Speaker 1: sleeve on their arm, a compression sleeve, but even after 41 00:02:23,600 --> 00:02:26,960 Speaker 1: the cancer is gone, they live with this constant pain 42 00:02:27,120 --> 00:02:29,959 Speaker 1: and reminder of what they have been through. So today 43 00:02:30,080 --> 00:02:33,120 Speaker 1: I'm honored to have doctor Dione joining us to unmask 44 00:02:33,200 --> 00:02:37,720 Speaker 1: the realities of lymphidema and talk about some exciting advancements 45 00:02:37,800 --> 00:02:40,800 Speaker 1: in the field because what was once felt as an 46 00:02:40,880 --> 00:02:45,320 Speaker 1: untreatable condition, now they're actually providing some options and some 47 00:02:45,960 --> 00:02:48,440 Speaker 1: relief to these women who are trying to continue on 48 00:02:48,480 --> 00:02:51,720 Speaker 1: with their life after their breast cancer diagnosis. Let's dive in. 49 00:02:52,040 --> 00:02:54,839 Speaker 3: Well, thank you so much, Nicole for really shedding light 50 00:02:54,919 --> 00:02:59,760 Speaker 3: onto this disabling and permanent disease that's usually lost in 51 00:02:59,800 --> 00:03:06,320 Speaker 3: the shadows of cancer. Lymphidema is a currently incurable chronic 52 00:03:06,360 --> 00:03:11,160 Speaker 3: disease marked by swelling of the arm, but sometimes the chest, 53 00:03:11,280 --> 00:03:15,520 Speaker 3: the breast, and even the neck after removal of lymph 54 00:03:15,600 --> 00:03:20,760 Speaker 3: nodes and radiation most commonly. Basically, the lymphatic system is 55 00:03:20,760 --> 00:03:23,600 Speaker 3: the sewage system of the body. It clears out fluid 56 00:03:23,600 --> 00:03:27,320 Speaker 3: waste from your arm, from your breast, purifies it through 57 00:03:27,320 --> 00:03:29,440 Speaker 3: the lymph nodes, and then puts it back in the blood. 58 00:03:30,040 --> 00:03:33,880 Speaker 3: When lymph nodes are removed, however, or radiated, there can 59 00:03:33,919 --> 00:03:36,600 Speaker 3: be a blockage of that flow of lymph going into 60 00:03:36,680 --> 00:03:39,040 Speaker 3: those lymph nodes, and that fluid waste can back up 61 00:03:39,080 --> 00:03:41,840 Speaker 3: into the arm or the breast or the chest and 62 00:03:42,680 --> 00:03:47,000 Speaker 3: wreak havoc. That's just episode one. Episode two is the 63 00:03:47,040 --> 00:03:50,160 Speaker 3: reaction of your immune system, because the lymphatic system is 64 00:03:50,240 --> 00:03:53,760 Speaker 3: part of the immune system to that injury. And what 65 00:03:53,800 --> 00:03:57,840 Speaker 3: that means is the immune system reacts by causing a 66 00:03:57,840 --> 00:04:01,720 Speaker 3: lot of inflammation that causes further scaring throughout the arm. 67 00:04:03,160 --> 00:04:07,520 Speaker 3: Predisposes you to infection, sometimes life threatening infections that can 68 00:04:07,640 --> 00:04:13,280 Speaker 3: enter the bloodstream and this requires lifelong compression, massage, and 69 00:04:13,360 --> 00:04:17,000 Speaker 3: therapy and can lead to pain and disability at a 70 00:04:17,080 --> 00:04:17,839 Speaker 3: very high level. 71 00:04:18,160 --> 00:04:20,320 Speaker 1: You say that this happens when you remove the lymph 72 00:04:20,320 --> 00:04:23,320 Speaker 1: nodes from the axila, the armpit, or you have to 73 00:04:23,360 --> 00:04:26,240 Speaker 1: irradiate them, but that is still standard of care because 74 00:04:26,279 --> 00:04:29,279 Speaker 1: our data tells us if we're not removing these lymph nodes, 75 00:04:29,360 --> 00:04:33,240 Speaker 1: especially if there's micro or macromatastasies, that increases their risk 76 00:04:33,440 --> 00:04:37,600 Speaker 1: of advanced cancer later on in their life. So what 77 00:04:37,600 --> 00:04:39,680 Speaker 1: can is there anything that can be done to kind 78 00:04:39,720 --> 00:04:42,440 Speaker 1: of decrease the risk of lymphidema or prevent it altogether. 79 00:04:42,680 --> 00:04:45,479 Speaker 3: Well, this is a this is an exciting area because 80 00:04:45,640 --> 00:04:48,680 Speaker 3: it's much preferable to avoid lymphidema then try to treat it. 81 00:04:49,080 --> 00:04:51,640 Speaker 3: And so at the time of the removal of the 82 00:04:51,680 --> 00:04:54,440 Speaker 3: lymph nodes, the standard of care for many years was 83 00:04:54,560 --> 00:04:57,120 Speaker 3: just to close up and hope for the best, and 84 00:04:57,279 --> 00:04:59,479 Speaker 3: about one out of three women would go on to 85 00:04:59,520 --> 00:05:04,000 Speaker 3: develop them. However, just like just like we would reconstruct 86 00:05:04,040 --> 00:05:06,440 Speaker 3: a breast, or at least offer the option for breast 87 00:05:06,440 --> 00:05:11,839 Speaker 3: reconstruction after nystectomy, patients in an ideal setting should be 88 00:05:11,880 --> 00:05:15,880 Speaker 3: given the option of reconstructing the lymphatic system that's taken 89 00:05:15,880 --> 00:05:19,720 Speaker 3: apart during surgery. And what that involves is taking those 90 00:05:19,800 --> 00:05:22,640 Speaker 3: little tiny tubes that we're going into the lymph nodes 91 00:05:23,040 --> 00:05:26,039 Speaker 3: that are being removed, and instead of just clipping them 92 00:05:26,120 --> 00:05:28,680 Speaker 3: like a dead end, plugging them into a vein to 93 00:05:28,800 --> 00:05:31,599 Speaker 3: give the fluid an exit out of the arm. And 94 00:05:31,680 --> 00:05:37,160 Speaker 3: this is called immediate lymphatic reconstruction, a type of lymphovenous 95 00:05:37,200 --> 00:05:42,840 Speaker 3: bypass that can reduce the risk of causing lymphedema. That's 96 00:05:42,920 --> 00:05:46,000 Speaker 3: working on the site of the site of the surgical 97 00:05:46,040 --> 00:05:48,720 Speaker 3: injury itself, but also there are things that you can 98 00:05:48,760 --> 00:05:53,640 Speaker 3: reduce your overall level of risk. For example, increase body weight, 99 00:05:53,880 --> 00:05:58,280 Speaker 3: higher BMI over thirty or even over twenty five can 100 00:05:58,320 --> 00:06:01,040 Speaker 3: increase your risk of developing lymphedema. 101 00:06:01,760 --> 00:06:02,760 Speaker 2: And there why is that? 102 00:06:02,839 --> 00:06:05,520 Speaker 1: Why does I mean we talk about excess wasys being 103 00:06:06,120 --> 00:06:07,680 Speaker 1: a risk factor for a lot of illness. 104 00:06:07,680 --> 00:06:09,760 Speaker 2: How does that increase lymphidema risk? 105 00:06:09,920 --> 00:06:12,760 Speaker 3: Two ways that we know. One is it increases the 106 00:06:12,839 --> 00:06:16,520 Speaker 3: load of fluid waste produced, so it increases the stress 107 00:06:16,760 --> 00:06:19,880 Speaker 3: and demand of the lymphatic system. And two is that 108 00:06:19,960 --> 00:06:24,880 Speaker 3: we see an increase in inflammation along the specific lymphatic vessels, 109 00:06:24,880 --> 00:06:30,839 Speaker 3: those tubes transporting lymph and that inflammation impairs the ability 110 00:06:31,360 --> 00:06:34,280 Speaker 3: of lymph to flow out of the arm and also 111 00:06:34,360 --> 00:06:35,240 Speaker 3: causes scarring. 112 00:06:35,480 --> 00:06:37,640 Speaker 2: But is this lymphatic bypass? 113 00:06:37,720 --> 00:06:40,000 Speaker 1: I mean, this sounds incredible, I mean and it actually 114 00:06:40,000 --> 00:06:42,200 Speaker 1: makes a lot of sense, but I don't actually hear 115 00:06:42,240 --> 00:06:45,000 Speaker 1: about it in day to day practice. So is this 116 00:06:45,040 --> 00:06:48,000 Speaker 1: something that is you know, potentially on the horizon of 117 00:06:48,000 --> 00:06:51,479 Speaker 1: being standard of care or know how how women even 118 00:06:51,520 --> 00:06:52,240 Speaker 1: have access to this? 119 00:06:52,839 --> 00:06:56,359 Speaker 3: Fortunately, there are more and more people getting involved and 120 00:06:56,480 --> 00:07:01,320 Speaker 3: interested in learning these techniques. Typically it's done by plastic 121 00:07:01,400 --> 00:07:05,840 Speaker 3: surgeon or microsurgical trained a surgeon that can connect very 122 00:07:05,839 --> 00:07:11,160 Speaker 3: tiny tubes together. So it's it's not widely available, but 123 00:07:11,520 --> 00:07:16,480 Speaker 3: it's becoming more common in majors in major centers, and 124 00:07:16,520 --> 00:07:18,400 Speaker 3: we perform this regularly. 125 00:07:19,040 --> 00:07:22,400 Speaker 1: Now, is this something obviously being done at the time 126 00:07:22,400 --> 00:07:22,960 Speaker 1: of surgery? 127 00:07:23,040 --> 00:07:26,040 Speaker 2: Is ideal? Is it something that is potentially being. 128 00:07:25,960 --> 00:07:30,080 Speaker 1: Used for treatment for those who are already suffering from lymphidema. 129 00:07:30,240 --> 00:07:32,679 Speaker 3: Yes, ideally this is done at the time of surgery 130 00:07:32,680 --> 00:07:35,200 Speaker 3: and you avoid the problem to begin with. But if 131 00:07:35,240 --> 00:07:38,480 Speaker 3: a patient should develop lymphidema, there are a variety of 132 00:07:38,480 --> 00:07:42,280 Speaker 3: different surgeries that can be done. One is lymphovenus bypass, 133 00:07:42,320 --> 00:07:46,040 Speaker 3: which is taking that blocked lymphatic vessel, cutting it and 134 00:07:46,080 --> 00:07:48,640 Speaker 3: plugging it into a vein so that there's fluid that 135 00:07:48,720 --> 00:07:51,400 Speaker 3: can that can drain out of the arm. And there 136 00:07:51,400 --> 00:07:54,280 Speaker 3: are a number of other procedures like lymph node transplant 137 00:07:54,600 --> 00:07:57,760 Speaker 3: basically replacing the lymphodes that were removed at the time 138 00:07:57,800 --> 00:08:00,680 Speaker 3: of surgery, kind of like planting seeds that grow new 139 00:08:00,760 --> 00:08:05,160 Speaker 3: lymphatic vessels at a variety of other techniques. 140 00:08:06,120 --> 00:08:08,960 Speaker 1: So for anyone out there listening to this who may 141 00:08:09,000 --> 00:08:12,840 Speaker 1: be suffering from some lymphidema, obviously the bypass is the 142 00:08:12,880 --> 00:08:16,000 Speaker 1: most aggressive. Putting anybody through surgery comes with. 143 00:08:15,960 --> 00:08:16,560 Speaker 2: Its own risk. 144 00:08:16,640 --> 00:08:19,520 Speaker 1: But what are some non invasive things that they can 145 00:08:19,560 --> 00:08:21,480 Speaker 1: be doing to try and help with some of the 146 00:08:21,520 --> 00:08:22,360 Speaker 1: discomfort that they have. 147 00:08:22,480 --> 00:08:26,760 Speaker 3: Well, lymphabena is bypass actually minimally invasive. It doesn't generally 148 00:08:26,880 --> 00:08:30,280 Speaker 3: hurt because these things are so tiny live no transplants 149 00:08:30,280 --> 00:08:33,360 Speaker 3: a bigger surgery, but there are non surgical things that 150 00:08:33,440 --> 00:08:36,559 Speaker 3: can be done and this is a new and exciting 151 00:08:36,679 --> 00:08:41,760 Speaker 3: part of frontiers of lymphidema treatment. So one is the 152 00:08:41,880 --> 00:08:46,520 Speaker 3: role of GLP one receptor agnis drugs like ozepic and 153 00:08:47,080 --> 00:08:50,880 Speaker 3: Manjaro commonly used to treat weight loss, diabetes, and now 154 00:08:50,920 --> 00:08:55,120 Speaker 3: sleep apnia. We've seen so many secondary benefits like reduction 155 00:08:55,520 --> 00:08:59,880 Speaker 3: in heart attack, strobe, dementia, but on the lymphidema front 156 00:09:00,280 --> 00:09:03,520 Speaker 3: we were first to publish the use of these drugs 157 00:09:03,520 --> 00:09:07,360 Speaker 3: and treating lymphidema and also looked at patients who underwent 158 00:09:07,480 --> 00:09:10,960 Speaker 3: removal of their lymph nodes, comparing those who were taking 159 00:09:10,960 --> 00:09:14,480 Speaker 3: a GLP one versus those not on a GLP one 160 00:09:14,840 --> 00:09:18,800 Speaker 3: and found that the group taking GLP ones were at 161 00:09:18,920 --> 00:09:21,640 Speaker 3: much lower risk of developing lymphedema. 162 00:09:22,400 --> 00:09:24,840 Speaker 1: Now do you think that is because you're lowering their bmi? 163 00:09:25,040 --> 00:09:27,640 Speaker 1: As you said, you know someone who has excess weight 164 00:09:27,720 --> 00:09:29,840 Speaker 1: there at increased risk or do you actually think that 165 00:09:29,840 --> 00:09:33,840 Speaker 1: there's something maybe hormonally happening from the GLP one in 166 00:09:33,840 --> 00:09:37,000 Speaker 1: addition to removing the excess weight that's also contributing to 167 00:09:37,559 --> 00:09:39,240 Speaker 1: decreasing the risk of limphidema. 168 00:09:39,320 --> 00:09:43,760 Speaker 3: That's a great question, and I think it's both. There 169 00:09:43,840 --> 00:09:50,120 Speaker 3: is doctor PhD. Doctor Jorge Castarina out at Tulane had 170 00:09:50,200 --> 00:09:57,679 Speaker 3: recently presented they've identified a GLP one receptor on lymphatic 171 00:09:57,760 --> 00:10:03,800 Speaker 3: vessel itself, so we think that the actual drug is 172 00:10:04,000 --> 00:10:08,160 Speaker 3: directly affecting the lymphatic system. There are also pathways where 173 00:10:08,520 --> 00:10:13,960 Speaker 3: GLP one receptor agnes can reduce inflammation and that's a 174 00:10:13,960 --> 00:10:17,600 Speaker 3: big cause of lymphedema as well as reducing the weight, 175 00:10:17,640 --> 00:10:22,320 Speaker 3: which is associated with increased lymphedema and worsening function. So 176 00:10:22,400 --> 00:10:24,320 Speaker 3: I think they're direct and indirect effects. 177 00:10:24,640 --> 00:10:27,240 Speaker 1: You're listening to Wellness and Mass, we'll be right back 178 00:10:27,240 --> 00:10:33,240 Speaker 1: with more. So if you're publishing on this and we 179 00:10:33,320 --> 00:10:36,760 Speaker 1: have so many women out there suffering with lymphidema, I mean, 180 00:10:36,800 --> 00:10:39,400 Speaker 1: do you see in the foreseeable future that GLP ones 181 00:10:39,520 --> 00:10:42,040 Speaker 1: could be prescribed for women with limpidema? 182 00:10:42,200 --> 00:10:45,040 Speaker 3: I do believe. So we've launched the first of its 183 00:10:45,160 --> 00:10:49,120 Speaker 3: kind prospective study, so a high level study to determine 184 00:10:49,160 --> 00:10:53,679 Speaker 3: if GLP ones do in fact reduce lymphedema, because we've 185 00:10:53,720 --> 00:10:59,280 Speaker 3: had so much anecdotal evidence. So we've been treating patients 186 00:10:59,360 --> 00:11:03,439 Speaker 3: offully with GLP ones who weren't interested in surgery or 187 00:11:03,480 --> 00:11:07,280 Speaker 3: were having surgery but weren't exactly optimized, and we want 188 00:11:07,280 --> 00:11:10,240 Speaker 3: them to get the best result, and so their numbers 189 00:11:10,280 --> 00:11:13,600 Speaker 3: have been down their limb size, most of them, not all, 190 00:11:13,640 --> 00:11:16,920 Speaker 3: but most of them have seen a benefit their limpiedema. 191 00:11:17,000 --> 00:11:19,840 Speaker 3: Therapists tell us, the patients themselves tell us, and of 192 00:11:19,880 --> 00:11:22,360 Speaker 3: course we measure this, but we really have to see 193 00:11:22,360 --> 00:11:25,920 Speaker 3: what the high level study shows a long term but 194 00:11:26,080 --> 00:11:28,880 Speaker 3: I'm very optimistic looking at our preliminary data. 195 00:11:29,640 --> 00:11:32,480 Speaker 1: Well, we certainly need high level studies to get insurance 196 00:11:32,559 --> 00:11:35,679 Speaker 1: companies to cover certain things, as we all know, and 197 00:11:35,679 --> 00:11:37,360 Speaker 1: then it still even takes a long time. 198 00:11:38,240 --> 00:11:38,480 Speaker 2: You know. 199 00:11:38,679 --> 00:11:42,040 Speaker 1: The thing for me with GLP ones is I feel 200 00:11:42,040 --> 00:11:46,440 Speaker 1: like they're being overused and overused when maybe unnecessary, and 201 00:11:46,640 --> 00:11:50,080 Speaker 1: underused when there could be potential benefit. And you know, 202 00:11:50,120 --> 00:11:53,400 Speaker 1: people automatically get turned off when the conversation of GLP 203 00:11:53,480 --> 00:11:55,600 Speaker 1: ones happen because they're like, oh, I'm not going to 204 00:11:55,640 --> 00:11:56,359 Speaker 1: take ozembic. 205 00:11:56,400 --> 00:11:56,959 Speaker 2: I'm not going to. 206 00:11:56,920 --> 00:12:00,560 Speaker 1: Take these And while I to criticize them, think maybe 207 00:12:00,600 --> 00:12:03,400 Speaker 1: people are reaching for these medications for weight loss well 208 00:12:03,440 --> 00:12:06,880 Speaker 1: before they probably should, and when we're being introduced to 209 00:12:06,920 --> 00:12:10,520 Speaker 1: another medication that's essentially a lifelong prescription for something because 210 00:12:10,559 --> 00:12:12,920 Speaker 1: the minute you take you stop taking it, your weight 211 00:12:12,960 --> 00:12:14,600 Speaker 1: comes back and then. 212 00:12:14,520 --> 00:12:15,560 Speaker 2: Some for a lot of people. 213 00:12:16,200 --> 00:12:19,360 Speaker 1: But unfortunately it's getting a bad rap because I too. 214 00:12:19,720 --> 00:12:21,200 Speaker 2: If you read the data, there. 215 00:12:21,080 --> 00:12:25,200 Speaker 1: Are some well documented benefits when it comes to GLP 216 00:12:25,280 --> 00:12:27,720 Speaker 1: ones and I'm not just talking about, you know, wearing 217 00:12:28,200 --> 00:12:31,800 Speaker 1: a smaller waste size. I'm talking about I'm talking about 218 00:12:31,840 --> 00:12:36,760 Speaker 1: the decreased strokes, cardiovascular potentially dementia, and the fact that 219 00:12:36,800 --> 00:12:40,160 Speaker 1: they could potentially help patients with lymphidema, to me is 220 00:12:40,360 --> 00:12:43,320 Speaker 1: just incredible and I would much rather see the money 221 00:12:43,360 --> 00:12:47,280 Speaker 1: going for these people for their GLP ones, even with 222 00:12:47,400 --> 00:12:50,920 Speaker 1: just anecdotal evidence. So I'm glad to hear it's being 223 00:12:51,000 --> 00:12:53,360 Speaker 1: used off label, but it's very expensive and not everyone 224 00:12:53,360 --> 00:12:54,920 Speaker 1: can afford these medications. 225 00:12:56,000 --> 00:12:58,679 Speaker 3: I agree, and I'm with you. I think when it 226 00:12:58,720 --> 00:13:05,160 Speaker 3: comes to any of these discuss trends, politics and culture 227 00:13:05,280 --> 00:13:07,520 Speaker 3: all come into this. When we should really look at 228 00:13:07,520 --> 00:13:11,000 Speaker 3: the data and the science. If the data shows for 229 00:13:11,080 --> 00:13:14,720 Speaker 3: a patient with lymphidema that is diagnosed with a permanent, 230 00:13:14,800 --> 00:13:18,920 Speaker 3: incurable condition, that there is a potential benefit to reverse 231 00:13:19,880 --> 00:13:21,920 Speaker 3: what they have, and they're doing they're spending hours a 232 00:13:22,000 --> 00:13:25,600 Speaker 3: day treating this. That's a wonderful thing. And I also 233 00:13:25,640 --> 00:13:30,679 Speaker 3: think most people aren't aware that for hormone receptor breast cancer, 234 00:13:30,800 --> 00:13:34,200 Speaker 3: which is most breast cancers not triple negative hormone receptor, 235 00:13:34,800 --> 00:13:39,640 Speaker 3: these patients are put on a hormone suppress suppression which 236 00:13:39,760 --> 00:13:44,600 Speaker 3: changes their metabolism, and about forty percent of them will 237 00:13:44,640 --> 00:13:47,040 Speaker 3: gain significant weight. So they're doing. 238 00:13:46,960 --> 00:13:51,920 Speaker 1: Essentially putting someone into menopause overnight. So perimenopausal menopausal women 239 00:13:52,040 --> 00:13:55,319 Speaker 1: like myself, if you realize how it's harder to lose 240 00:13:55,360 --> 00:13:57,800 Speaker 1: weight as you get to a certain age, well, as 241 00:13:57,840 --> 00:14:00,400 Speaker 1: he's saying, these medications just kind of thrust into this 242 00:14:00,440 --> 00:14:01,360 Speaker 1: menopause overnight. 243 00:14:01,480 --> 00:14:04,240 Speaker 3: And then so exactly, and you have many young women, 244 00:14:04,360 --> 00:14:07,920 Speaker 3: many of our patients are in their thirties. They're very active, 245 00:14:08,880 --> 00:14:11,520 Speaker 3: they're doing and eating the same way they have been, 246 00:14:11,600 --> 00:14:13,800 Speaker 3: but all of a sudden, they've put on twenty five 247 00:14:14,760 --> 00:14:20,840 Speaker 3: or thirty pounds despite being active despite a diet and exercise, 248 00:14:20,920 --> 00:14:25,120 Speaker 3: so it can be very very difficult. Your body metabolism 249 00:14:25,200 --> 00:14:29,640 Speaker 3: just changes, so I think everybody is different. It has 250 00:14:29,720 --> 00:14:32,320 Speaker 3: to be looked at case to case. We don't directly 251 00:14:32,360 --> 00:14:34,520 Speaker 3: go to GLP one for everything. We want to do 252 00:14:34,560 --> 00:14:38,520 Speaker 3: everything all natural. But the reality is is that many 253 00:14:38,640 --> 00:14:42,360 Speaker 3: patients are exhausting everything. We see patients that spend hours 254 00:14:42,360 --> 00:14:45,160 Speaker 3: a day and they're getting nowhere with their limb and 255 00:14:45,760 --> 00:14:48,880 Speaker 3: the GLP one helps them. I personally am on GLP 256 00:14:48,960 --> 00:14:51,960 Speaker 3: one for diabetes, so this is not a drug. Is 257 00:14:51,960 --> 00:14:55,560 Speaker 3: a drug I have personal experience with All drugs have 258 00:14:55,640 --> 00:14:59,400 Speaker 3: potential side effects and adverse effects, and you should speak 259 00:14:59,440 --> 00:15:02,560 Speaker 3: to your doc her when getting on anything new, as 260 00:15:02,600 --> 00:15:03,800 Speaker 3: well as your oncological team. 261 00:15:04,680 --> 00:15:07,280 Speaker 1: I diagnosed one of my best friends with breast cancer 262 00:15:07,280 --> 00:15:10,960 Speaker 1: a couple of years ago and she said bilateral mustectomy. 263 00:15:10,960 --> 00:15:13,440 Speaker 1: Ever since, but she is dealing with the same thing. 264 00:15:13,480 --> 00:15:17,800 Speaker 1: It's hormone positive. Losing weight is just a major struggle 265 00:15:17,840 --> 00:15:21,080 Speaker 1: for her, and she works out more than anyone I know. 266 00:15:21,600 --> 00:15:25,120 Speaker 1: She eats incredibly. I have encouraged the GLP ones for 267 00:15:25,160 --> 00:15:27,960 Speaker 1: her and she's just not quite there yet, which I 268 00:15:28,320 --> 00:15:31,400 Speaker 1: you know, I applaud her for not wanting to take 269 00:15:31,480 --> 00:15:34,040 Speaker 1: quote unquote the easy way out, but it's not necessarily 270 00:15:34,040 --> 00:15:36,640 Speaker 1: the easy way out. When your body is working against you. 271 00:15:37,600 --> 00:15:39,840 Speaker 1: The medications that you're taking to try and decrease your 272 00:15:39,880 --> 00:15:42,360 Speaker 1: risk of your cancer to come back, it's really working 273 00:15:42,400 --> 00:15:45,440 Speaker 1: against you trying to have a healthy weight. So there 274 00:15:45,840 --> 00:15:49,760 Speaker 1: are benefits of GLP ones. So for women out there 275 00:15:49,800 --> 00:15:52,720 Speaker 1: who maybe who are having some maybe just mild lymphidema, 276 00:15:52,800 --> 00:15:54,120 Speaker 1: I want to go back to that for a second, 277 00:15:54,160 --> 00:15:57,560 Speaker 1: because I just think lymphidema's not talked about enough. They're 278 00:15:57,600 --> 00:16:01,560 Speaker 1: having mild lymphiedema, maybe they're not quite ready for medication 279 00:16:01,800 --> 00:16:04,200 Speaker 1: for surgery. What are just some things that women can 280 00:16:04,240 --> 00:16:07,680 Speaker 1: be doing at home to try and decrease their lymphedema 281 00:16:07,760 --> 00:16:10,720 Speaker 1: from progressing. 282 00:16:12,160 --> 00:16:15,560 Speaker 3: Right, Well, I'm glad you brought up my o lymphidema 283 00:16:15,680 --> 00:16:19,320 Speaker 3: as a general note. Lymphidema, like any disease, process starts 284 00:16:19,360 --> 00:16:23,640 Speaker 3: before you see the swelling, just like breast cancer before mammography. 285 00:16:24,240 --> 00:16:26,320 Speaker 3: The only way you diagnosed it is either by seeing 286 00:16:26,400 --> 00:16:28,960 Speaker 3: an alternative mass or feeling a large lump in the 287 00:16:28,960 --> 00:16:32,960 Speaker 3: breast or the axilla. Lymphidema started long before you actually 288 00:16:32,960 --> 00:16:35,040 Speaker 3: see the swelling, and this is kind of lost on 289 00:16:35,080 --> 00:16:37,680 Speaker 3: a lot of medicine that really doesn't move to do 290 00:16:37,760 --> 00:16:41,000 Speaker 3: anything until you see the big swollen arm. But the 291 00:16:41,080 --> 00:16:45,680 Speaker 3: things that you can do are actually lymphatic massage helps. 292 00:16:46,200 --> 00:16:49,280 Speaker 3: So when any patient comes to our office, we'll image 293 00:16:49,320 --> 00:16:52,880 Speaker 3: their lymphatic systems. We actually inject a tiny amount of 294 00:16:52,920 --> 00:16:56,440 Speaker 3: die and the patient can see their lymphatic system. That's 295 00:16:56,480 --> 00:16:59,400 Speaker 3: important because you can see if you have lymphatics that 296 00:16:59,440 --> 00:17:03,440 Speaker 3: are only partly blocked, or if the whole arm is blocked. 297 00:17:04,160 --> 00:17:08,480 Speaker 3: If everything's blocked, you can squeeze that arm, but it's 298 00:17:08,520 --> 00:17:11,480 Speaker 3: like squeezing a toothpaste with the cap still on, and 299 00:17:12,080 --> 00:17:14,520 Speaker 3: you really then the role of surgery is to provide 300 00:17:14,560 --> 00:17:19,040 Speaker 3: an exit so that therapy actually does move something out 301 00:17:19,040 --> 00:17:22,080 Speaker 3: of your arm. In patients who have a partial obstruction, 302 00:17:22,680 --> 00:17:25,280 Speaker 3: actually massage from the fingers all the way up to 303 00:17:25,440 --> 00:17:29,000 Speaker 3: the axilla, to the armpit and to the neck. There's 304 00:17:29,040 --> 00:17:33,119 Speaker 3: a special type of lymphatic massage called manuallymphatic drainage that 305 00:17:33,200 --> 00:17:37,359 Speaker 3: olymphi emotherapist does is definitely beneficial. We see this on 306 00:17:37,440 --> 00:17:40,320 Speaker 3: the imaging of the actual lymph moving. It's a beautiful, 307 00:17:40,840 --> 00:17:47,280 Speaker 3: very beautiful organ system that exercise muscle. When muscles contract, 308 00:17:47,400 --> 00:17:51,880 Speaker 3: they're actually squeezing your lymphatics, and that facilitates the movement 309 00:17:51,920 --> 00:17:57,280 Speaker 3: of fluid out of the actual limb. There's also breathing exercises. 310 00:17:57,280 --> 00:18:01,600 Speaker 3: Your diaphragm is a big negative pressure pump, so your 311 00:18:01,680 --> 00:18:05,280 Speaker 3: lymphatic system includes your entire body, all your organs from 312 00:18:05,320 --> 00:18:08,760 Speaker 3: your legs, your arms, your head and neck. But there 313 00:18:08,760 --> 00:18:12,760 Speaker 3: are breathing exercises that can facilitate lymphatic transport in the 314 00:18:12,840 --> 00:18:18,960 Speaker 3: larger vessels up the main lymphatic duct into your bloodstream. 315 00:18:19,520 --> 00:18:26,200 Speaker 3: And of course, in patients where weight is elevated, weight 316 00:18:26,240 --> 00:18:30,560 Speaker 3: reduction will will improve and reduce inflammation and improve emphatic flow. 317 00:18:31,280 --> 00:18:34,880 Speaker 1: I actually love that you show patients with the lymphatic 318 00:18:34,960 --> 00:18:38,960 Speaker 1: dye because when people can visualize what's actually happening and 319 00:18:38,960 --> 00:18:43,040 Speaker 1: they have a better understanding, I truly think that their 320 00:18:43,160 --> 00:18:46,080 Speaker 1: outcomes are better because of that, because if they have 321 00:18:46,119 --> 00:18:48,480 Speaker 1: an understanding of it, then they understand why to do 322 00:18:48,520 --> 00:18:52,000 Speaker 1: the massage, why they might potentially need that bypass surgery, 323 00:18:52,000 --> 00:18:54,560 Speaker 1: as you're mentioning, I think that's that's great, and it 324 00:18:54,600 --> 00:18:58,120 Speaker 1: takes away that whole paternalistic aspect of medicine, which we're 325 00:18:58,119 --> 00:19:00,960 Speaker 1: so notorious for of just saying this is what's wrong, 326 00:19:01,000 --> 00:19:03,040 Speaker 1: this is what needs to be done, and you're taking 327 00:19:03,040 --> 00:19:05,440 Speaker 1: it so that they're a part of that conversation by 328 00:19:05,520 --> 00:19:08,760 Speaker 1: understanding it, and as they can pick that active role 329 00:19:08,880 --> 00:19:10,440 Speaker 1: in their healthcare, it's great. 330 00:19:11,040 --> 00:19:17,120 Speaker 3: Well, the imaging has been a huge transformation in lymphatic reconstruction, 331 00:19:17,320 --> 00:19:20,040 Speaker 3: So in surgery you need to see it. If you 332 00:19:20,040 --> 00:19:21,960 Speaker 3: can see it, you can operate it on it, you 333 00:19:22,000 --> 00:19:25,760 Speaker 3: can understand it, and the treatment can match the actual 334 00:19:25,840 --> 00:19:28,840 Speaker 3: problem that you're looking at. If you're just looking at 335 00:19:28,840 --> 00:19:30,960 Speaker 3: the size of the limb and you're not looking under 336 00:19:30,960 --> 00:19:35,040 Speaker 3: the skin, you really don't know what you're dealing with. 337 00:19:35,119 --> 00:19:38,880 Speaker 3: So imaging is transformed things. The other thing that patients 338 00:19:38,920 --> 00:19:42,240 Speaker 3: can do because going to a lymphidemo therapist is not 339 00:19:42,560 --> 00:19:45,360 Speaker 3: always it's not always available. As a surgeon, it would 340 00:19:45,400 --> 00:19:48,120 Speaker 3: be very difficult for me every day or every other 341 00:19:48,200 --> 00:19:50,760 Speaker 3: day to go. But to have pneumatic there are pneumatic 342 00:19:50,760 --> 00:19:55,280 Speaker 3: compression devices where it's sort of an at home system 343 00:19:55,520 --> 00:19:58,440 Speaker 3: where you slide your arm and your chest into while 344 00:19:58,440 --> 00:20:02,280 Speaker 3: you're watching or just say around. This thing actually does 345 00:20:02,320 --> 00:20:06,120 Speaker 3: the massage for you and pumps things. So another that's 346 00:20:06,119 --> 00:20:08,199 Speaker 3: another option many patients aren't aware of. 347 00:20:09,359 --> 00:20:12,240 Speaker 1: So doctor Diane, thank you so much for being here today. 348 00:20:12,280 --> 00:20:14,360 Speaker 1: I think I've actually learned a lot. And I thought 349 00:20:14,400 --> 00:20:16,880 Speaker 1: I know a lot of limpandema, but I have an 350 00:20:16,880 --> 00:20:21,920 Speaker 1: even better understanding now. And I don't even know bypass 351 00:20:21,560 --> 00:20:25,200 Speaker 1: was an option, and now that's making me feel very 352 00:20:25,200 --> 00:20:28,520 Speaker 1: ignorant in kind of my own field. But I think 353 00:20:28,560 --> 00:20:31,159 Speaker 1: it's just very hopeful for people who are suffering from this, 354 00:20:31,200 --> 00:20:33,679 Speaker 1: because I do see them every single day coming in 355 00:20:33,920 --> 00:20:37,879 Speaker 1: wearing their lymphatic sleeves, talking about the massage, but still 356 00:20:38,000 --> 00:20:39,200 Speaker 1: just an excruciating pain. 357 00:20:39,440 --> 00:20:43,320 Speaker 3: I think also that lymphatic surgery is something we do 358 00:20:43,400 --> 00:20:47,959 Speaker 3: every week. There are minimally invasive options usually available to 359 00:20:48,000 --> 00:20:50,720 Speaker 3: most people. If you have a big problem, it's probably 360 00:20:50,800 --> 00:20:53,919 Speaker 3: going to involve more. But I think it's something that 361 00:20:54,119 --> 00:20:57,560 Speaker 3: at least patients should be aware of that exists, just 362 00:20:57,720 --> 00:21:00,360 Speaker 3: like patients undergoing to stectomy should be aware their breast 363 00:21:00,440 --> 00:21:05,240 Speaker 3: reconstructions and option. And it's really a pleasure to see 364 00:21:05,280 --> 00:21:09,800 Speaker 3: you as a colleague. Memorials Encountering is near and dear 365 00:21:09,800 --> 00:21:13,080 Speaker 3: to my heart. I spent a decade there and I 366 00:21:13,160 --> 00:21:16,760 Speaker 3: really bless you for all the great work you do 367 00:21:16,840 --> 00:21:19,480 Speaker 3: and it's great to have excellent colleagues. Thank you so 368 00:21:19,600 --> 00:21:20,360 Speaker 3: much well. 369 00:21:20,400 --> 00:21:22,760 Speaker 1: As we have heard, the story of breast cancer is 370 00:21:22,800 --> 00:21:25,919 Speaker 1: not only about diagnosis and treatment. It's also about the 371 00:21:25,960 --> 00:21:30,280 Speaker 1: long journey many survivors are walking afterwards. And as I mentioned, 372 00:21:30,280 --> 00:21:33,040 Speaker 1: with more than four million people living with the history 373 00:21:33,040 --> 00:21:36,359 Speaker 1: of breast cancer in the United States, a large percent 374 00:21:36,440 --> 00:21:39,880 Speaker 1: of them are suffering from lymphedema, meaning hundreds of thousands 375 00:21:39,920 --> 00:21:44,320 Speaker 1: of people are coping with this often invisible, chronic complication. 376 00:21:45,080 --> 00:21:48,680 Speaker 1: There is hope, as we have heard, through awareness, early detection, 377 00:21:49,040 --> 00:21:53,760 Speaker 1: preventative strategies, and comprehensive care, many of these cases can 378 00:21:53,840 --> 00:21:57,080 Speaker 1: be managed, and some may be preventable altogether. As we 379 00:21:57,200 --> 00:22:01,800 Speaker 1: just heard, doctor Dion's insight helped Castle on how clinicians 380 00:22:01,800 --> 00:22:06,040 Speaker 1: and surgeons and patients alike can better unmask and maybe 381 00:22:06,040 --> 00:22:10,239 Speaker 1: address lymphedema before it becomes debilitating. So if you are 382 00:22:10,240 --> 00:22:13,440 Speaker 1: someone you love is navigating life post breast cancer care, 383 00:22:13,960 --> 00:22:17,880 Speaker 1: continue this conversation with them, because there are clearly things 384 00:22:17,880 --> 00:22:21,200 Speaker 1: that can be done about lymphatic health. Ask about monitoring, 385 00:22:21,240 --> 00:22:23,719 Speaker 1: as we heard, you want to make sure you are 386 00:22:23,720 --> 00:22:25,879 Speaker 1: getting in front of it instead of behind it because 387 00:22:25,920 --> 00:22:29,000 Speaker 1: it's easier to treat it earlier on than when it's 388 00:22:29,000 --> 00:22:31,959 Speaker 1: gotten out of control. Thank you so much for listening. 389 00:22:32,000 --> 00:22:35,120 Speaker 1: I'm doctor Nicole Sapphire. This is wellness Unmasks. Make sure 390 00:22:35,160 --> 00:22:38,200 Speaker 1: you listen to all of our episodes on iHeartRadio or 391 00:22:38,200 --> 00:22:40,800 Speaker 1: wherever you get your podcasts, and we'll see you next time.