All Parts are Equal or are They?

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When a person has back surgery or has had a limb amputated, it is standard for them to go through a rehabilitation process, including physical therapy or massage therapy to be prescribed. However, if a woman has breast surgery, rehabilitation (massage or physical therapy) is not automatically ordered and often not even suggested.
When a woman chooses to have her breasts removed, reconstructed, increased or reduced, it’s important that she understands not only the benefits of the procedures, but the risks as well. Chronic pain and postural problems can appear years later if rehabilitation is not completed following breast surgery.

Breasts are composed of mammary glands, connective tissue, blood vessels, nerves, and lymph vessels. Breast tissue can extend from the border of the breastbone near the center of the chest all the way to the armpit, and overlies the second to sixth ribs. The breast has an axillary tail, which is a tail of tissue that extends up into the armpit region. The breast lies on top of the pectoralis major muscle.
Breast tissue is part of the fascial web of connective tissue, which runs continuously throughout the body from head to foot and superficial to deep without interruption. Any alteration, even the slightest damage to the fascial network has major ramifications.
The body’s balance and symmetry can be significantly altered after a mastectomy, augmentation or reduction. This is something many women aren’t informed of or prepared for. Scar tissue is also a very important fact which women need to be aware of and prepared for. Unpredictable development of scar tissue is quite common after any surgery and can have long-term effects on the body.
Early intervention following breast surgery by a massage or physical therapist can play a pivotal roll in helping women heal and regain full function.
After mastectomy surgery a woman may experience tightness or pulling originating from her incision, which spreads across her body. This is caused by scar tissue, which is the body’s way of healing from surgery. The result can be very dense tissue under the incision, which is painful and which can restrict the arm’s range of motion (ROM). The restricted ROM puts women at risk for a painful condition known as frozen shoulder. Scars can range in size after a breast-conserving lumpectomy or a mastectomy procedure that removes the entire breast. Either way, most breast cancer patients are left with some sort of surgical scar as a by-product of their quest to heal.
In order to rebuild the breast, tissue is taken from another area of the body. It can be taken from several different locations. One host area is the Latissimus Dorsi. In the picture below you can see how much of the body is affected by this location.
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The TUG procedure uses skin and fat from the inner portion of the upper thigh; the incision scar will be hidden near the crease of the groin. The flap is named for the transverse upper gracilis muscle to which the skin and fat are connected. Muscle may be removed as part of the TUG flap.

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Radiation treatment for Breast Cancer has its own list of complications. This type of therapy not only changes tissue characteristics by making it more susceptible to breakdown, it continues to make tissues tighter for 2 to 5 years following treatment.

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It can also lead to:
Skin tightening;
Limited arm and shoulder mobility;
Chest expansion limitations;
Restrictions in and around the area of treatment.
Breast reduction surgery is still largely considered to be a cosmetic surgical procedure. However, it is most often performed to relieve significant physical and emotional problems resulting from overly large and/or heavy breasts. Surgeries are classified as “cosmetic” if it is an elective procedure that insurance does not cover. If it is a procedure that is restoring form or function, it’s referred to as “reconstructive”. Reconstructive procedures are often covered by insurance. The same procedure may be classified as cosmetic or reconstructive depending on how it impacts an individual. Public opinion still sees it as cosmetic but 9.5 times out of ten it is being performed to reduce pain or to alter the overall structure.

 

According to the American Society of Aesthetic Plastic Surgery, 112,964 breast reductions were performed in 2011. Breast reduction surgery leaves permanent scarring.

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The operation using the anchor technique leaves three scars:
One around the nipple (areola);
One from the nipple to the crease below the breast (this is the worst scar as it takes the most tension);
One from the breast bone to the armpit along the crease below the breast.

The severity of scarring largely depends on the individual. Most women are completely unaware of how the scar tissue is affecting them.

 

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Kelly Bowers, a massage therapist from Washington, DC states:
“I had breast reduction surgery in 1992. By 2012 I rarely thought of it and certainly didn’t think the scars were an issue any more. They were barely visible! Then I had scar release work. I was stunned at how far I felt the effects of the work. I felt it from my shoulder to my hip! I’m delighted I had a chance to experience this work and finally take care of these scars as they deserved to be taken care of.”
The American Society for Aesthetic Plastic Surgery also reported that breast augmentation is the most popular surgical cosmetic procedure for women, with more than 316,000 procedures performed in 2011. Yes, augmentation is an elective cosmetic surgery, but it is still a surgery that alters the body. Rehabilitative therapy is necessary after any surgery.

Women who have breast augmentation frequently experience:
Limited upper extremity mobility (range of motion);
Arm weakness and swelling;
Fatigue;
Shoulder dysfunction;
Back pain;
Chest pain.

 
Scar tissue can occur at any time after the augmentation has been performed, not just within the first few months. Capsular contracture is the term used to describe scar tissue that can form around breast implants which may cause the breasts to harden, look or feel different, and may cause some discomfort from the tightening of the capsule. Capsular contracture is an unpredictable complication, but it is also the most common complication following breast augmentation.

 
Scars left by breast augmentation surgery are usually hidden in the crease beneath the breast (inframammary fold incision), around the nipple (peri-areolar incision) or in the armpit (transaxillary incision). Rehabilitation/therapy and physical activity are integral to recovery and to reduce post-breast surgery side effects such as:
Scar tissue/soft tissue immobility;
Flexibility limitations;
Limited range of motion;
Decreased strength.

 
Even if a woman does not actually develop pain or limited function directly after the procedure, at some point pain and disability will become present if scar tissue is not addressed in a timely and proper fashion.

Words can cut like a knife – leaving deep wounds and scars….

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At this past weekend’s Scar Tissue Release, class we were fortunate to have a Registered Nurse volunteer as the demonstration client. She was incredibly generous with her feedback on what she was experiencing during the treatment and answered questions for the students. Two of her scars were from 18 & 20 year old C-sections, respectively. As she told us the stories of the surgeries, the conversation turned to the trauma, both physical and emotional that the events caused.

Apparently, as the surgeons were preparing to cut her open, they were busy discussing their golf game. The surgerical nurse stopped the banter and gave them a what for. Just think how you would feel at that moment, laying on a cold operating table, about to have your abdomen sliced open in order to bring your child into the world, being denied the experience of natural birth. As she told her story, you could see that even after 18 years, she was still very emotional about it.

Since she is a cardiac recovery nurse, I took the opportunity to emphasize a few points I had made during the class lecture. Specifically how “donor” sites, areas where skin or veins are removed in order to repair another injured area of the body, are ignored once they have healed. When I asked her opinion on this matter, she agreed whole heartedly that no further thought is given to these areas; however, she referred to these areas as the “harvest” site.

Everyone in the room took a breath. I knew what they were all thinking as I looked at each of them. The Nurse looked around puzzled, and I explained to her that I refer to the area as a “donor” site. She thought about it for a minute and shook her head. “I never even thought of that, but you are totally right…how horrible.”

How we–doctors, therapists, trainers, family and friends–refer to someone, something, or situation sets the intent. This, in turn, dictates how we regard, and therefore treat or not treat. Most often when we think of harvesting an organ, we think of cadavers. So of course an area that was used for “harvest” does not need further care or concern.

The next day, one of my current clients was among the volunteers for the student practice session. He had burns over 2/3rds of his body from a car fire. He is one of the most balanced and centered people I know. He shared two very important points with the group. First, that he never even considered that there was any kind of restriction, much less a need for therapy, on the areas where they took skin for grafts and that he was blown away by the resulting treatment’s effects all of the areas, grafted and donor. Second, while still recovering in the hospital, a representative of a burn group came by to help him understand and deal with how his life was about to change. “How everyone was going to stare at him and treat him differently…” You can imagine the rest of the conversation. He could not believe this person was there to help him and fortunately he choose not to listen to her doom-and-gloom speech.

I had another client, a massage therapist, who, while filling out her intake form, said to me in regard to the question asking her to list all surgeries, “Well, I did have a C-Section, but I do not really consider that a surgery.” Unbelievably, she was not the first woman to make this statement to me either.

As health care providers we must take care of how we phrase our words, and just as or more importantly, we need pay attention to and assist in altering how our clients refer to themselves. The first step on the road to healing is understanding and awareness.

Do’s & Don’ts of Healing Scar Tissue-Tip #2

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Scars often occur do to improper treating/handling of cuts, scraps and open wounds. Here are few tips to help avoid any unnecessary scarring and infections while caring for the wound.

DO:

images (22)Colloidal Silver- has been around for almost a hundred years since it was first used by physicians and medical experts as a form of antibiotic, capable of fighting a great number of bacteria that thrive in the human body. It was proven potent for killing such infectious organisms, safe without the unfavorable side effects associated with other types of antibiotics.

Colloidal silver is not only a powerful bacteria-fighting agent. Several studies have revealed that colloidal silver is also a great antiseptic that works to heal cuts, abrasions, and wounds. It helps the skin develop its healthiest form without destroying tissue cells. Colloidal silver has wonderful healing properties and helps damaged tissue to regenerate. Major hospital burn units use colloidal silver bandages and ointments.

How it works:
Studies have shown that colloidal silver works to treat scars and stretch marks by simply immobilizing the enzyme that the fungi, bacteria, and viruses use for them to survive. The silver interacts and blends with the blood once applied to the scars and stretch marks and then enter the cells to look for the infectious organisms that need to be destroyed. It destroys the bacteria quickly by suffocating them in less than six minutes. The suffocation takes place right after the initial contact of the silver with the organisms. If the task is successfully done, the colloidal silver is not just capable of restoring the scars and stretch marks, but it also helps to make the immune system more active and strong.

How to apply:
Apply a few drops of the solution placed directly into the affected skin. You can use a cotton bud for the application, and you can also use a band-aid for disinfection purposes.

Precautions:
It is important to note that the colloidal silver should not be overly used for an over dosage of this solution can cause certain complications. You might feel something itchy or sluggish after a few days of application, but this is simply typical for colloidal silver. You can eliminate these symptoms by taking enough amount of water.

Another problem individuals must deal with involves mixing colloidal silver with other drugs you may take on a daily basis. This could be anything from something as small as something to relieve head and body aches to more potent pharmaceuticals that help with osteoporosis and various other disorders and diseases.
colloidal silver blue skin
The most talked side effect is Colloidal argyria. This occurs when you have taken excessive amounts ofcolloidal silver and it begins to look as though it is staining the skin. If you overdo it you take the risk of turning your skin blue.

History:

images (1)Silver has been known for its medicinal and antimicrobial properties for thousands of years. Hippocrates,“Father of Medicine,” used silver for tissue repair & wound healing. The ancient civilizations of Greece and Rome used silver to control bodily infection & prevent food spoilage. The King of Persia used silver containers to carry water to prevent contamination. Throughout the ages, the ‘Metal of the Moon’ as it was known to some of the ancients has been used effectively for numerous medicinal purposes.

Prior to the 1938 colloidal silver was the principle antibiotic treatment in the United States, prescribed by thousands of medical doctors. At that time colloidal silver was considered to be very high-tech. In the last several decades, major colloidal silver technology advancements have been made enhancing safety and efficacy

Don’t:

images (2)Hydrogen peroxide has been touted as the miracle chemical of the century. Its uses include water purification, bleaching of commercial products, and use as a cleaning agent. However, when it comes to its medicinal uses, it has a long history of being abused and misused.

When you pour hydrogen peroxide onto wounded tissue, the wound immediately starts to bubble, a process imagesthat is followed by an intense pain. People used to think that this meant the antiseptic properties of hydrogen peroxide were kicking in. Scientists now know that this is actually an indication that healthy tissue is dying. This slows down the healing process and gives scars a greater chance of forming. Multiple randomized, controlled trials show that hydrogen peroxide does not prevent or treat infections in wounds.

When hydrogen peroxide is applied to the wound, it combines with a natural chemical in human tissue. This combination generates oxygen and water. The concentrated amount of oxygen that is generated can kill off any bacteria that may be contaminating the wound, but it also kills healthy tissue in the body at the same time. The type of killing that is done by the concentrated oxygen is toxic to the human body. It kills anything alive indiscriminately, whether it’s bacteria or healthy human cells. When the body is trying to repair the wound by sending in a microscopic repair crew, these cells can fall victim to the random killing by hydrogen peroxide.

To prevent wound infection, there are many more precise ways to kill the bacteria without hurting the healthy tissues in the body.

History:
Along with its role in infection prevention, hydrogen peroxide has historically been used to get rid of dead tissue in a bad open wound. This has also been proven ineffective, and the majority of medical professionals have halted this practice.
Instead of using hydrogen peroxide, most doctors use a sterile salt water to clean the wound. This salt water is often drawn into a syringe and squirted into the wound to clean out any debris trapped inside the wound.

In a pinch:

Minor accidents, abrasions and bruises will occur at the most inconvenient of times. It may be useful to know how you can help prevent infection if you don’t have a medical disinfectant like rubbing alcohol handy. Here’s a simple solution you can assemble from household ingredients if you’re in a pinch.
Ingredients:
• Bottled water
• 1 tablespoon salt
• 1 teaspoon vinegar (alternatively, fresh lemon juice)

Steps
• Add bottled water into a glass cup until it is a little more than three-quarters full, making sure that the glass was clean beforehand
• Add salt into water. Salt can be iodized. The salt used for regular cooking will be ideal. Salt is known to contain many bactericidal properties.3
• Mix well until all the salt dissolves in water.
• Add vinegar and mix well. Any kind of vinegar (processed or natural), will do the trick. Vinegar contains a mild acetic acid, which can cleanse and disinfect wounds. If vinegar is unavailable, fresh lemon juice will also suffice.
• Soak into cotton wool and apply to fresh cuts and abrasions on skin. It’s preferable to open a sealed pack of cotton wool.
• After use, dispose of this liquid. It’s not suitable for storage either at room temperature or by refrigeration. Make a fresh preparation each time this procedure needs to be repeated.

Other Natural remedies

download (3)Cayenne pepper: For internal bleeding take one tablespoon of cayenne in a cup of water to stop the bleeding. Cayenne can also be placed directly on an external cut to stop bleeding. You may completely pack the wound if you have enough pepper. Black pepper may be used instead if cayenne is not available. This remedy does not sting like you might imagine and is very important for emergencies.
Plastic Wrap Applying plastic wrap to the skin for three to seven minutes will help clotting and won’t take off the scab when it is removed.

download (2)Sugar: Sugar is an excellent disinfectant. For open wounds or skin ulcerations, sprinkle on granulated sugar to help kill bacteria and speed healing. Smear a ring of petroleum jelly around the edges of the wound to hold the sugar in place, then put a little sugar directly on the wound. Cover the wound with a bandage; change the bandage once or twice a day.

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Tea: Apply a moistened tea bag to the cut to soothe and stop the bleeding.

images (3)Tea tree oil: Derived from the leaves of the native Australian Melaleuca alternifolia tree, tea tree oil contains antiseptic compounds that make it a powerful disinfectant. Use a 10% solution (about 1½ tablespoons to a cup of warm water) to rinse and cleanse wounds.
No matter how you choose to treat an open wound. Always err on the side of caution and if it is a very deep wound or shows any signs of infection contact your doctor immediately.

The children are our future…So how about we pay attention now!

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I received a call the other day from a fellow Massage Therapist. He was
referring one of his clients, a 15 year old male athlete ( lacrosse
goalie and football linebacker) with severe pain in his right knee. The boy’s coach told his mother he needed an MRI and that he most likely tore
something. My friend did not agree and wanted to see what I
thought and if Integrated Therapeutic Stretching would help. He had tryouts in two days and they were concerned about injury.

According to the client he only felt the pain when he was crouching in goalie position. I had him do it for me. He had all of his wait on the outside of his feet which were not wide enough apart to support his weight properly.

I ran him through some quick range of motion & muscle tests as he lay on the table with no resulting pain but revealed very limited ROM throughout the boy’s lower body. As we started to stretch it was quickly discovered that his left glutes were locked up. Hip rotators on both sides were in as bad a shape. IT Band and hamstrings were at 60% ROM and his quadriceps were down to 45%. This is 15 years old folks!

It is terrifying to see the physical shape of children today. Either they are overweight and under exercised or they are over worked, participating in multiple sports where proper strength and flexibility training is nonexistent.

Sports injuries are on the rise in children and teenagers. Each year more than 3.5 million sports-related injuries requiring medical treatment occur in children under age 15. Today, as more and more children and adolescents participate in the same sport year-round, many young athletes are developing overuse injuries. In fact, overuse is responsible for about half of the sports injuries that happen to middle and high school aged students.

We worked together through each stretch, showing him how his body is supposed to move utilizing body proper form and mechanics. He was very eager to learn as was his mother. I assisted and guided him through the stretches focusing especially the ones which really opened his restrictions. Both he and his mother were surprised at how tight he was in the beginning and at speed with which he loosened up.

Now as we were working I observed a deep scar about 1inch in length on his left knee which he claimed was “no big deal” and said it was over a year old. His mother chimed in “the bad one was on his foot”. Three years prior he flayed his right foot open on a fence. There was a huge c shaped scar on the sole of his foot which upon palpation showed to have spread and attached into the arch.

I asked if he wanted to see something cool and then I proceeded to release the scar on his knee. When I asked him to bend his knee his eyes opened wide and said “That’s Sick!”. His knee flexion had increased by 20% . Next with his mother’s permission I went to work on his foot. When I was done I had him stand up. He laughed out loud and said “No Way! Thats Totally Sick! I can feel the bottom of my foot”. His mother , shocked at his reaction said ” I didn’t know you couldn’t feel your foot?!” “Neither did I” was his reply.

We followed this up with gait re-education and proper mechanics required for his respective sports positions (i.e. crouching and squatting). While he still had some minor pain he could see how adjusting his stance took the pressure off his knee. After having him go through the stretches once more I recommend to the mother that if the pain comes back or increases then she should indeed seek their doctor’s advice.

The mother was shocked at how much the scars were affecting her son. I explained to her that scars and adhesions are generally overlooked by health professionals because the extent of physiological affects they can have on the body have never really been acknowledged. The slightest restriction from falling off his bike at 4 could alter how he grows and have major repercussions from one end of his body to the other.

Four days later the duo returned, the tryouts went great and when asked about his knee he said “it still hurts every now and then but whenever I felt it start I shifted around until I felt right and the pain stopped.” I asked if had been stretching and he say before and after the games. (In the four days since I had seen him he had two lacrosse matches and two days of football tryouts). He was also very excited for more scar therapy “It was so weird but I could feel my foot moving better as I played!” His mother than asked if I had any extra time to look at her two scars that have been driving her crazy for years.

During the course of my career I’ve treated many patients whose problems could be traced back to a scar they had forgotten they even had. While not every scar presents a problem, very often they do. Doctors, along with basically everyone else, tend to ignore scar tissue from surgery and accidents especially in children.

Today children are playing more and more sports driven by the need of scholarships and future fame. It is time we start to pay attention to the adverse affects of training and playing so hard so young. We need to make sure that the fall off the bike or the cut from climbing over the fence does not lead to issues later on.

Do’s & Don’ts of Healing Scar Tissue-Tip #1.

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Whether it’s acne pock marks, or the legacy of a burn, wound or surgery, few of us like scars on our skin. And there’s no shortage of remedies that claim to make scars smaller, thinner, less noticeable and heal faster. In this series of blogs I will attempt to shed some light about natural and medical scar treatments.

Do:

download (5)Use Lavender essential oil to treat scars especially burns. Lavender is one of the best all-round essential oil, according to Shirley Price in her book “Aromatherapy for Women.” Lavender oil is gentle, inexpensive and effective. Lavender essential oil can be used to treat acne, scars and most skin conditions; it can be applied direct to the skin, in small quantities.

Lavender essential oil is a very effective antiseptic, antibacterial and antimicrobial that reduces pain, itching and promotes rapid healing. In addition, lavender reduces scarring. When lavender oil is applied to a burn from the onset, the burn may heal with no scarring at all. (For larger burns, put lavender oil onto a gauze or cloth and apply to the burn every few hours.)

How to use it?
• Apply several drops (2-4) on location several times a day
• Directly inhale, diffuse, or
• May be used as a dietary supplement

Safety Considerations With Lavender Essential Oil

Lavender essential oil can sting a little when a wound is still fresh, but once it’s scabbed over and has started healing, lavender essential oil, applied topically, can help minimize scarring while it heals.

Lavender has a relaxation property, often used to fragrance products for bedtime, like lotions and satchels for bedrooms. WebMD warns that lavender essential oil can depress the central nervous system and cause drowsiness and sleepiness (especially good when used properly to treat insomnia and induce relaxation but dangerous when used for other properties and healing in which sleepiness is not a desired effect). You shouldn’t drive or do other dangerous things until you know how lavender will work for you.

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History fact: A French scientist, René Gattefossé, was severely burned in a laboratory accident and immersed his hand in a vat of Lavender for two weeks. Gattefossé found that Lavender oil promoted tissue regeneration quickly and healed the wound with no scarring!

Don’t:

One of the most popular treatments for scarring is vitamin E.
But will vitamin E really help to improve your scar?

can_vitamin_e_h_photoVitamin E, or tocopherol, is a fat-soluble antioxidant. It’s found in capsule or liquid form at drugstores, grocery stores, health food stores, and online. The so called effective remedy consists of opening vitamin E capsules and applying the content on the scar. But this topical use of vitamin E does not result in scar healing. Vitamin E has been shown to penetrate layers of the skin and reduce the formation of free radicals which can interfere with healing. Vitamin E also influences the production of collagen, a structural protein partially responsible for the strength and elasticity of skin. Although many people apply vitamin E oil to their skin to minimize scars and it’s sometimes recommended by physicians after skin surgery, there’s very little evidence that shows it helps.

Vitamin E Research :
Current research does not support vitamin E oil to reduce scar formation.

A study on the effects of topical vitamin E on the cosmetic appearance of scars at the University of Miami that there is no benefit to the cosmetic outcome of scars by applying vitamin E after skin surgery and that the application of topical vitamin E may actually be detrimental to the cosmetic appearance of a scar. In 90% of the cases in this study, topical vitamin E either had no effect on, or actually worsened, the cosmetic appearance of scars. Of the patients studied, 33% developed a contact dermatitis to the vitamin E. Therefore it was concluded that use of topical vitamin E on surgical wounds should be discouraged.

Research by K.C. Wan and J.H. Evans at the Hong Kong Polytechnic University, published in 1999 issue of “Free Radical Biology & Medicine,” found higher amounts of free radicals in hypertrophic scars, which become thicker, redder and more elevated than regular scars. Another study by T.L. Khoo at the Hospital Universiti Sains Malaysia, published in a 2010 issue of the “Journal of Plastic, Reconstructive & Aesthetic Surgery,” concluded that tocotrienols, a vitamin E subfamily, made no significant improvement in scar parameters. Also, a study conducted by Morganroth, Wilmot and Miller in Philadelphia for a 2009 issue of the “Journal of the American Academy of Dermatology” determined that scar products containing vitamin E oil did not support usage for the reduction of postoperative scar formation.

Be on the lookout:
For specific ingredients found in commercial wound ointments and dressings.
Listed below are just a few ingredients present in store bought wound products. Most of these products produce skin irritation, sensitization, and are linked to allergies, cancer and/or immune suppression. Here they are:
• Petrolatum
• Mineral Oil
• Propylene Glycol
• Butylated Hydroxytoluene (BHT)images (19)
• Benzalkonium Chloride
• Yellow #5; FD&C Blue #1
• DMDM Hydantoin

Even many of the natural ointments contain some of these ingredients. Make sure to read the labels and please, test the area for allergic reactions before applying anything to your skin!