Lymphedema: A Breast Cancer Patient's Guide to Prevention and Healing.

Lymphedema: A Breast Cancer Patient's Guide to Prevention and Healing Burt J, White G. Alameda, CA 94501, Hunter House Inc, 1999, paperback, 224 pp, illus, ISBN: 0-89793-264-1, $12.95.

This book is organized to present very thorough and practical information on the full scope of lymphedema management. The authors are Jeannie Burt, who used to have lymphedema, and Gwen White, a physical therapist with 25 years of clinical experience who now specializes in the management of lymphedema. Their accomplishment is that they have written a book focused on patient education and empowerment while compiling a wide range of information and expertise that offers an excellent resource to clinicians.

The text is divided into 4 parts: (1) "Lymphedema: What It Is and How to Prevent It," (2) "Treating Lymphedema," (3) "Beyond Conventional Treatments," and (4) "Finding Resources." Personal stories of experiences with lymphedema located throughout the book reinforce the content.

The chapters in part 1 describe (including photos and diagrams) lymphedema and its types, illuminate the relationship of comprehensive breast cancer management to lymphedema, and provide a brief and thorough review of anatomy and a functional review of the lymphatic system. Details of signs and incidence of the condition and the history of lymphedema management lead into a comprehensive listing of tips for prevention with a thorough rationale supporting each tip. These tips indicate that life-long adherence is required, and the authors encourage readers "to live even if you do have lymphedema."

Part 2 discusses the general principles of treatment, focusing on massage, bandaging, exercise, and skin care. The procedure of manual lymph drainage (MLD) is described, and the precautions and contraindications are explicitly identified. Massage is suggested as a continuation of the physical therapy program, and descriptions and diagrams for self-massage and partner massage are provided. Scar tissue massage techniques are included as part of holistic management. Part 2 also includes chapters on the rationale and technique of compressive bandaging, the use of compression with special garments, and the use of vasopneumatic pumps. The exercise portion of part 2 begins with breathing and postural activities, followed by a "how-to" chapter that identifies exercises to treat lymphedema, such as lymph drainage exercises, stretching and flexibility exercises, strengthening exercises, and aerobic exercise. Adherence to the exercise regime is supported by the rationale and goals for each exercise component, and the contraindications for exercise are discussed. Readers are advised to seek medical advice prior to initiating exercise and if they experience any problems.

Part 3 broadly discusses emotions and the powers of the mind and spirit, and it briefly presents information on nutritional supplements. Part 4 includes finding resources and where to get help, suggestions on questions to ask while seeking treatment, and a comprehensive glossary.

This book includes current trends in comprehensive lymphedema management. It appears to offer its audience an abundance of information--the significance, care, prevention, and understanding of this complication--in a single source. It is designed to complement medical management, including physical therapy and occupational therapy. One of its greatest values is that it offers many options to women by educating them in a holistic manner.

Barbara Reddien Wagner, PT, MHA University of Scranton Scranton, Pa

Ms Wagner is Academic Coordinator of Clinical Education in the Department of Physical Therapy. Her teaching interests include women's health, oncology, and psychosocial aspects of disabilities.