Cedar Rapids therapist strives to alleviate lymphedema woes

Dr. Sandy Sublett is convinced a new testing method can prevent months of debilitating pain for a large segment of her Cedar Rapids clientele. And she’d like the larger medical community to follow her lead. Ms. Sublett, owner of Advanced Therapy Specialists, a physical therapy practice in northeast Cedar Rapids, is part of a nationwide group of therapists seeking to draw more attention to the proactive detection and prevention of lymphedema, a condition characterized by the buildup of lymphatic fluid in various locations in the body, most often in the arms and legs. Under normal conditions, the lymphatic system drains excess moisture from the body’s tissues. However, lymphedema generally occurs as the result of a traumatic injury that leads to a blockage of the body’s lymphatic system, or by the removal of lymph nodes as the result of surgical procedures. In early stages, the impaired drainage of lymphatic fluid can lead to uncomfortable swelling; as the condition advances, fibrotic tissue begins to develop and the affected areas become excessively swollen and misshapen. And it’s more than an issue of discomfort – in extreme cases, it can result in a lack of mobility and be a source of serious infection. More than 200,000 lymphedema cases are reported in the U.S. each year. 58% of all cancer patients are at risk of developing lymphedema, and certain cancer patients can be particularly vulnerable to the condition, especially those diagnosed with melanoma, pelvic area cancers and breast cancer, which carries a lymphedema risk as high as 80%. Ms. Sublett’s clinic specializes in lymphedema treatment at all stages, but she said it’s important to detect the condition in its early stages to provide the most effective treatment. “I'm part of a group worldwide that's trying to create a paradigm shift on swelling management, both for non-lymphedema and lymphedema,” she said. “All lymphedema therapists want everybody who has lymphedema to get in (for treatment) sooner.” Left untreated, lymphedema patients can experience leakage of lymphatic fluid through a wound in the skin. “They start weeping this fluid, and the fluid starts eating off the other skin and causes these big wounds,” she said. “It’s a wreck. And they'll try to get these wounds fixed, but you can't fix the wounds until you get the swelling out.” Left untreated, lymphedema can require chronic treatments and infections, becoming a lifelong condition for some patients. Treatments for severe cases can include physiotherapy, pneumatic pumps, hospitalization and corrective surgery.

New technology providing early detection

In many cases, testing methods can detect the potential for lymphedema before it develops, or address the condition in its early stages and head off further development.

That’s where a new technology comes in. It’s called the SOZO digital health platform, new to Advanced Therapy Specialists in recent months. The device, similar in physical appearance to a doctor’s office scale, uses bioimpedance to scan the body’s tissues through a microcurrent transmitted through the body as the patient touches metal pads with their hands and feet. The test, which can be conducted in approximately 30 seconds, generates an “L-dex” score, proprietary to SOZO and manufacturer Impedimed, which measures the ratio of fluid accumulation in a limb at risk for lymphedema and compares it to a healthy limb. The score is determined through a technology known as bioimpedance spectroscopy (BIS), which can detect fluid retention changes as small as 2.4 tablespoons in the limbs – much more accurate and precise than traditional lymphedema detection methods, which often relied on simple physical measurement of limb dimensions. Lymphedema detection at such an early stage maximizes the success of effective and proactive treatments, including options such as compression devices, breathing techniques, exercises and manual massage provided by certified lymphedema specialists. Ideally, Ms. Sublett said, patients diagnosed with breast, pelvic and skin cancers would be screened shortly after diagnosis to set a baseline for bodily fluid distribution, then continue screenings at prescribed intervals to detect fluid changes early in the treatment process.

Local clinic is first in Iowa with SOZO

Advanced Therapy Specialists is among a small group of clinics nationwide, and the first in Iowa, piloting the new SOZO technology on a three-year lease. Impedimed said SOZO is backed by more than 20 years of research involving the study of 17,500 patients, and Ms. Sublett said she hopes she can develop a catalog of successful cases to convince more medical providers to refer their patients for the screening. “At this point, it’s not the standard of care everywhere,” she said. “Our hope is when someone is diagnosed with cancer, they get scanned right away. Eventually, there should be other clinics – oncology groups, cardiologists and such – using this kind of device. It's just such new cutting-edge stuff.” Ms. Sublett said she wants to begin touting the benefits of SOZO with her peers. “I’m actually hoping to get together with all the other certified lymphedema therapists in the area to make sure they know we have this,” she said. “I don't have the capacity to take all of their patients. But they can send them here and use the information from the Impedimed in their treatment. It's easy to shoot it out, and it’s easy for them to give their patients the care they need. We can support other therapy clinics at this point.” From there, she’d like the larger medical community to take note of the technology. “I've been talking to the (local) hospitals, and I know that at least one of them is looking into it,” she said. “But hospitals are big organizations, and it takes a while to get things to happen.” In fact, many medical professionals aren’t well-informed on the causes and proper treatment of lymphedema, Ms. Sublett said. “Some doctors have said, ‘oh, you're swelling, here's a diuretic,’” she said. “Or patients can get fat shamed. But you can’t get rid of lymphedema by dieting. Some of our patients have legs that are just horrendous, and doctors didn't know what was wrong with them and didn't know where to send them. It's heartbreaking. And we're hoping that we can start to make a change … I'm not in this just as a business person. I'm just in it because I'm a therapist that wants to do therapy the right way.”