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Due to the current nature of our national and international health care crisis, our physical therapy profession and businesses have been designated as “essential healthcare” for our communities. Therefore we need to have way to stay connected to our patients so they continue to have the highest quality of life.   

As evidenced to me today, we still need to be in a relationship with each other, even as you “shelter in place”. We know your healthcare challenges did not go away just because of this crisis. 

As a result of your needs we have trained our highly talented group of physical therapists to provide “Telehealth” to our community of patients. Our Physical Therapists can assist you with education to address your medical concerns with your musculoskeletal system, we can teach you self care modalities — such as how to use specific techniques to help ease your pain. 

We have free resources online, and can deliver exercises such as stretching and strengthening to you via our free app.  

We have the ability to progress your physical therapy program by using a HIPPA compliant medical portal where we will be able to video chat with you in real time, so you can ask questions and get answers, all within the safety and comfort of your home. 

We understand that having health issues during this time is stressful and it is easy to feel alone and unheard. 

We want our patients to know that we are here for them so that their fear and stress can be decreased and they can continue to thrive for their themselves, their families and this community. 

We can help through Telehealth! 

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Use the form below to schedule an Telehealth appointment.

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Author Bio:

Sheree DiBiase, PT, is the owner of Lake City Physical Therapy and she and her staff can help you with your telehealth physical therapy needs. Sheree has 35+ years of physical therapy experience — 30+ of those years spent in private practice. She owns and manages 4 clinics in the greater Spokane/CDA area. Schedule an appointment – https://lakecitypt.com/telehealth/

The Lymph system is a major system in our body that probably is the least understood and one of the systems that is barely talked about in health care today. However, really it is of vital importance on a daily basis for our health and overall well-being. The lymph systems primary function is to protect the body from infection and disease via the immune response system according to the National Lymphedema Network. It does this by the production, maintenance and distribution of lymphocytes. The lymphocytes are the “infection fighting cells.”

The spleen and thymus gland produce the lymphocytes. These cells then fight the unhealthy cells and they are transported by little watersheds and vessels to the bloodstream and ultimately flushed out of the body. The Lymph system could be called the body’s own “garbage disposal system,” it gets rid of all the junk.

The lymph system is made up of more than 700-800 lymph nodes throughout the body.

There are chains of nodes and then clusters of nodes in strategic areas. The clusters are located in a specific area to protect that area from invasion. For example, when you get a sore throat often you will often have enlarged lymph nodes on either side of your neck. These nodes collect and filter the waste, and regulate the protein levels, so we know we are “fighting off something” when they are enlarged.

The lymph system has lymph fluid that is clear and colorless. It is made up of protein, water, cellular debris and fatty acids. Now imagine the lymph vessels as a stream, which runs in one direction. They have a one-way value only and this pushes the lymph in that direction. All streams run back toward the heart. So the bloodstream needs to be able to handle the load each day of the lymph cleaning system. The lymph fluid can be mobilized by massage, compression; the “muscle pump” which is why exercising is so important, external pressure, breathing patterns, etc.

If the lymph fluid builds up in the tissue and is not flushed each day, as it should be it could harden the surrounding tissue. It also loves to bind to the fatty tissue and then it is especially hard to mobilize. The skin integrity is then compromised due to too much fluid and breakdown of the tissues can occur and then the efficiency of the muscle pump decreases. The lymph vessels will dilate and the one-way values cease to function and the area becomes swollen. This can happen anytime there is any accumulation of swelling, whether from an injury, a bruise, a localized tendonitis or post-surgically. You do not want fluid that is ever stagnant, because that is where infection can brew.

When the body is functioning efficiently the lymph system will activate itself no problem. However, if nodes have been damaged or destroyed as with radiation or surgical lines that interrupt the lymph streams flow pattern, then the lymph system cannot handle the load and will shut down. We see fluid get backed up behind C-sections scar lines, and even edema from a total joint.

If this happens to you do not be dismayed. There are things you can do to mobilize the flow of protein rich fluid. The first thing to do some very basic things like drinking more water, up to eight glasses a day. Decreasing your sodium intake to below 1,800mg a day (the average American consumes 3,500mmg a day). Stop smoking because this slows the lymph system down and decreases tissue healing.

Make sure you are sleeping at least eight hours a night to ensure the body’s healing mechanisms. Then increase your leafy greens veggies, fruits and decrease all processed foods to a minimum.

Next seek the assistance of your physical therapist, which has been specifically educated in the care of the lymph system. Remember, the lymph system can be trained how to move fluid around areas of scarring. We also teach the system how to transport edema around an area that there is restriction with four specific steps.

The four steps include specific muscle pump strategies, compression techniques or kinsiotex taping, manual lymph drainage massage and meticulous skin care. The therapists who are trained in edema reduction know and use these steps to assist the lymph system in re-booting itself whether it is from an orthopedic, cancer or immune system related problem. Please know your therapists can get your lymph system back on track.

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Sheree DiBiase is a licensed physical therapist and the owner of Lake City Orthopedic and Sports Physical Therapy in Coeur d’Alene and the Spokane Valley. She has been practicing outpatient physical therapy for more than 20 years and was an Adjunct Professor at Loma Linda University, School of Physical Therapy for seven years, she instructed in Applied Kinesiology, Biomechanics and Gait Analysis. Both of her offices provide care for cancer related fatigue, weakness and lymphedema. She can be reached at (208) 667-1988.

1) The initial lymphatics are endothelial vessels converging to form collecting lymphatics. The linings of the initial lymphatics have a high endothelial layer but no pericytes or smooth muscle media. They form a 3 dimensional plexus – like patterns within the connective tissue. The walls of these initial lymphatics have a one-way valve system. The valves prevent the reversal of the flow pattern. They are anchored by filaments to the connective tissues. The molecular structure of the vessels is similar to the anchoring filaments. The initial lymphatics collect interstitial fluid, proteins, lipids, colloids and cells. They feed into the contractile lymphatics, which has smooth muscle media. The unidirectional flow pattern happens here at this level. Since they have no smooth muscle media they depend on neighboring tissue structures for expansion and compression. This occurs by rhythmic deformation in 4 easy ways- skeletal muscle movements, arterial pulse and vasomotion, intestinal peristalsis and skin massage.

2) Collecting Lymphatics – The collectors have a sympathetic motor innervation. The values are bicuspid. The outer wall of the collectors is supplied by a rich network of blood vessels and myelinated nerve fibers. Collectors walls have 3 layers. Tunica intima, tunica media, tunica adventitia. In the tunica intima the endothelial cells have a cuboid/rhomboid shapes. There is a nuclear bulge in the lumen. In the cytoplasm there are vesicles, ribosomes and cytoplasmic filaments. Mitochondris Gogi app, centrioles and multivesicular bodies are in the cytocentrum. In the tunica media there are long smooth fusiform muscles cells that are essential to its function. Between the endothelium and the tunica media is an elastic membrane.

Open junctions are not present in the collectors. The adventitial layer has fibroblasts, collagen fibers and fiber bundles loosely arranged and parallel to the axis of the vessel. The outer wall of the collectors is supplied by a rich network of blood vessels and myelinated nerve fibers.

3) Lymphangions – In the collecting lympatics each vascular segment between 2 sets of valves represents the morphofunctional unit called a lymphangion. The contractions of smooth muscles of the lymphangion play a decisive role in lymph transport. It resembles small hearts.

4) Lymph nodes – They are peripheral and secondary lymph organs, along with the spleen, tonsils and lymphatic tissues of the mucous membranes. The nodes are present in groups or chains along the blood vessels. Their number size and form vary. The lymph node is encapsulated by an outer layer of collagen fibers. Blood vessels and efferent lymph vessels leave via the hilum. The internal framework is composed of trabeculae. Some trabeculae carry vessels from the capsule to the hilum. Between trabeculae there are reticular cells and reticular fibers. The space is filled with lymphatic tissue. The lymph traverses the nodes via the sinus system. The afferent collectors penetrate in the node through the capsule to peripheral sinus. Lymph runs from the peripheral sinus to the medullar sinus. At the hilum the medullar and peripheral sinuses combine to form a terminal sinus form the efferent lymph vessels originate.

Lymph node function: The lymph nodes are biological filtering stations. The phagocytic action of the macrophages cleanses the system of bacteria, cell debris, antigens and corpuscular elements. The lymph nodes produce lymphocytes. The lymph nodes regulate the protein content of the lymph, so that is the same as the intercellular fluid. The most significant changes in the lymph fluid occur there. They are like fluid exchange chambers where the protein concentration is established so there is equilibrium as Starlings law suggests.

Lymphatic pathways of UE-Lower arm to elbow – 4 primary-anterio-lateral and anterio-medial, posterio-lateral and posterior-medial.

4 secondary-bicepital, anterio-medial basilic, anterio-lateral cephalic and posterior triceptial Caplans pathway.

The cephalic pathway has 3 routes – to cephalic vein to nodes in axilla, across clavicle to C/S transverse nodes, to the clavicopecotoral group of the cephalic lymph nodes.

Lymphatic pathways of the LE – The superficial bundle: The ventromedial bundle – greater saphenous vein, the dorso-meidal bundle lesser saphenous vein.

The deep bundles: the anterior tibialis bundle, the posterior tibialis bundle.

(Lymph nodes of the LE. There are Superfical nodes there are upper and lower groups and Deep inguinal nodes that follow the femoral vein.)

Lymphedema is a collection of protein rich fluid caused by reduced transport capacity with insufficient tissue proteolytic activity in the face of a normal lymphatic load as defined by Foldi. It is an accumulation of water, proteins and in increase in cellular and ground matrix.

Unilateral Chronic Lymphedema clinical findings:

1) Pain is not constant

2) Positive stemmer sign

3) Fibrosis – development of fatty tissue

4) Papillomatosis

Lipedema: Edema that is caused by abnormal adipose deposits in the subcutaneous regions. It is usually bilateral in nature and affects mostly women. There is often a family history. There is no pitting signs, often associated with obesity and “orange peel ” at visual inspection and painful with pressure. Usually located between the pelvis and the ankle with sparing of the feet. Often it occurs 1-2 years after puberty.

Research for MLD-Leduc Method: The research method included using a Lymphoscintigraphy and a nanocolliod with TC 99 and a gamma camera to record activity. The call up maneuver enhanced the flow when applied proximally to the lymphedema. The reabsorption maneuver increased significantly the colloidial protein reabsorption. The call up maneuver will not enhance the flow if lymph nodes are in between the lymphatic site and the treated area. In 8/13 people a new pathway was established with MLD who underwent a min of 19 MLD RX’s. The study showed there is no contraindications in using MLD in people with heart failure or lower limb edema. It was shown that with the use of lymphoflouroscopy an increase in lymph flow was seen with the MLD and superficial mapping of the pathway could be seen as a result also. It is evident that MLD is a significant intervention for those with lymphedema and can be used alone as a source of treatment with good results.

Research for MCB-Leduc Method: They researched whether MCB with muscular contractions would effectively decrease lymphedema. They used a pressure transducer at the skin/bandage region to record the results and a hand held manometer to do the repeated contractions with. Then they were able to track the labeled colloids at the axilla and it was statistically significant. An increase in activity occurred at 6 min and 40 secs aft her the beginning of the exercise and this increased remained after the exercise was done. It was noted that when muscle contractions were done in the limb with the MCB in place an increase in colloid reabsorption and transport occurred. In those who only did a muscular contraction with no MCB in place no noted increase in transport occurred. It is recommended to limit the use of MCB with those suffering from lower limb lymphedema.

A study was also done on the types of bandages to use. The pressure was measured at he interface between the bandage and the limb. When the MLB was used the increase was significant at rhe interface and increased tension in the limb. In the elastic bandages it increased pressure at the interface and then plateaued.

Contraindications to MLB:

1) DLA, erysipelas

2) Cardiac condition

3) DVT

4) Arterial perfusions impairment

Contraindications to Pneumatic Pump:

1) DLA, erysipelas

2) Cardiac condition

3) DVT

4) Arterial perfusions impairment

Sheree DiBiase, PT, and her staff can be reached at (208) 667-1988 and they can help you with your physical health challenges. Never give up on your health. It’s your prized possession. Lake City Physical Therapy.

Lymphedema affects approximately two million people in the United States. Its incidence is on the rise because each year approximately 500,000 Americans will be treated for some type of cancer that will be treated for some removal or the destruction of their lymph nodes. One out of every five of those people will then develop lymphedema.

Lymphedema occurs when the normal drainage of fluid in our body is disrupted. As the fluid accumulates, the area will become red, hot, swollen and painful. Often the arm or leg will double in size. In a normal lymph system, the body utilizes a network of nodes and ducts. Those nodes and ducts maintain the balance of the body’s fluid, they filter our waste products and fight bacteria.

However, when lymph nodes have been removed or destroyed by radiation this lymphatic system loses its ability to maintain this delicate fluid balance. As a result, there is an accumulation of protein-rich fluid that becomes a breeding ground for bacteria. If this swelling in the tissue is left untreated, it can lead to permanent tissue damage, scarring and long-term disability.

Presently, it is seen most often in women who have had breast cancer surgery where lymph nodes have been removed and radiation therapy has been done. This swelling in their arms can occur weeks, months or even years later after surgery.

That is exactly what happened for Sarah Micheals. She had decided to take an airplane trip to New York City to visit her daughter. Five years earlier she had breast cancer surgery and had been doing just fine since then. However, the next morning after she woke up at her daughter’s home, something just didn’t seem right. She felt like she was getting the flu. Her body ached and her right arm had a strange red streak on it. Throughout the day the pain in her arm became worse and her arm started to swell. She got so swollen she could barely hold her coffee cup and she had to remove her rings. Finally her daughter took her to the ER, where it was discovered she was suffering from an infection in that arm resulting from lymphedema. She was given antibiotics, which cured the infection, however, the swelling in her arm remained. She then was referred to physical therapy for treatment of the swelling.

Physical therapy care for lymphedema consists of Manual Lymph Drainage Massage (MLDM), Medical Compressions Bandaging (MCB), special exercises that milk the lymph system and supplement the massage, skin care and treatment of any infections.

The physical therapy care will help decongest the swollen body part, eliminate fiber tissue and improve the immune system function. Once the body part has reduced in size a protective garment needs to be worn on that extremity to avoid re-accumulation of that lymph fluid. This protective garment helps to maintain the natural fluid balance of the affected body part.

If you are a cancer patient who has had any lymph nodes removed or radiated here are some guidelines you should follow in order to prevent this chronic, progressive disease.

• Wear a protective garment for flying of when doing any new actives you are not accustomed to.

• Wear gloves during household chores or gardening to avoid minor cuts, animal scratches, bug bites and puncture wounds. Use antibacterial ointment right away if you do get a wound and consult your physician immediately.

• Avoid injections and blood pressure monitoring on the body part.

• Exercise at a moderate pace and keep “muscle pump” active. (Swimming in 75 to 85 degree F water is one of the best forms of exercise due to the natural pressure gradient in the water).

• Avoid hot baths such as Jacuzzi tubs, whirlpools, heat from hair dryer and sun exposure.

• Avoid any deep tissue massage.

• Wear clothing that is not restrictive to allow appropriate lymph flow. Wear your rings and watch on other extremity.

• Eat a diet low in sodium and saturated fats. Discontinue use of alcohol and nicotine.

• Keep skin clean and well moisturized. Use electric razors only.

If you have further questions regarding Lymphedema or you are wondering whether you have this disease, you can go online to the National Lymphedema Network at www.lymphnet.org or call them at (800) 541-3259.

Sheree DiBiase, PT, is a licensed physical therapist and the owner of Lake City Physical Therapy in Coeur d’Alene and the Spokane Valley. She has been practicing outpatient physical therapy for more than 20 years and was an Adjunct Professor at Loma Linda University, School of Physical Therapy for seven years, she instructed in Applied Kinesiology, Biomechanics and Gait Analysis. Both of her offices provide care for cancer related fatigue, weakness and lymphedema. She can be reached at (208) 667-1988.

October is Breast Cancer Month. Breast cancer continues to affect too many of our friends and family members and the women we are doing life with everyday. The whole reason we take this month is to prevent and eradicate breast cancer. It is so we can tell all the women we know and love that we need to be proactive in preventive measures and to be there for each other if we do get breast cancer.

I just had a lovely woman who would tell you that you being too busy for a breast exam should not be an excuse. She learned to not put off her mammogram because it can give the vital information we need quickly and accurately. In her case, they caught a very small tumor that was very aggressive during a routine mammogram and as a result she will have great outcomes.

As Physical Therapists we play a role in caring for breast cancer patients. We usually see our patients about 12-14 days after surgery or once their drains are removed. We focus on getting their arms moving again and on restoring their overall strength with everyday activities. We educate our patients on skin care and scar mobility so edema doesn’t build-up in that area. Then we screen all patients for possible lymphedema issues from a long-term perspective so that they can be active in understanding symptoms such as pressure and “feelings of fullness” around the breast, chest or arm.

The two main reasons that you would get Lymphedema following breast cancer is:

If you had Lymph nodes removed, whether sentinel node, three nodes or all nodes removed, and radiation.

Often our patients have never heard of lymphedema or the possibility of lymphedema. Prevention now is the key. The more you know about the likelihood of it the more you can prevent it. If they do have lymphedema issues then there are easy steps that can be followed to ensure the proper care of this problem.

Lymphedema can be taken care of with Four Simple Steps:

1) Massage every day – Learn how to re-direct the lymph fluid to a new area around the area where the nodes were removed. Keep the scar lines mobile so that no fluid gets backed up behind the scar region.

2) Exercise on a daily basis – Learn special exercises that pump the lymph system and keep it moving where it should go.

3) Good Skin care – Keeping the skin in the area of where the lymphedema is located soft and pliable.

4) Use of compression sleeves – Use of garments especially during high risk activities such as flying, going over the pass and repetitive workloads.

Sheree DiBiase, PT, is a breast cancer specialist and she is the owner of Lake City Physical Therapy

. She and her staff treat breast cancer patients everyday. Please call or come in if you have questions or you are just not sure what to do, we can help. On Oct. 17 we will have a free educational class for anyone with Breast Cancer at 6 p.m. in our Coeur d’Alene office. Please call (208) 667-1988 to attend.

Who doesn’t love a good story! Especially one with adventure, a hero and heroine and all that stuff. Well growing up in my big Italian family we would often sit around the dinner table after church and talk the afternoon away. We heard all the adventures of our family’s life. My aunts, uncles and family friends would share funny and often amazing tales of their life. As kids, we would hang on their every word, even if the story seemed to get embellished as the years went on.

Now that I am a physical therapist I hear peoples stories everyday. And just for the record, they always amaze me. This window into a person’s life shows me so many things. I see their character, and drive to live life fully. The most amazing stories I am told often happen when my patients are under great adversity. Like when one of my patients was on vacation here from Guatemala and she had some pain in her chest and went to Urgent Care. It wasn’t what she thought they would find, but it was a tumor 5 cms in size. She had gone to the doctor in her hometown numerous times about this pain, but they told her it was nothing to worry about. She is so thankful she came to the states for a visit.

Or another one of my patients who was at the courthouse taking care of some business when a woman she didn’t even know, who had recently had breast cancer said to her “How long it had been since you have had a mammogram? You should have one right away, don’t wait.” And sure enough this woman went and had a mammo and she had early stage breast cancer. I mean who would think that a woman you don’t even know could save your life.

So here I am asking you the same thing. This is Breast Cancer Awareness Month and it is the time to tell all these stories so that we can help save people’s lives. Do not become too busy for your health. A few weeks ago I met a woman who has family who has a history of breast cancer and she got so busy in her life she hadn’t had a mammo in three years. When she finally got around to it, they found a tumor the size of a walnut deep in her chest wall. She had never even noticed it.

The National Cancer Society recommends the following when it comes to Breast Cancer Awareness:

1) Know your risks – is there a family history?

2) Get screenings – mammograms and breast exams, talk with your doctor about any abnormalities.

3) Know your body – you will notice tissue changes or lumps in your breast.

4) Make healthy lifestyle choices – what you eat, drink and how much sleep and exercise you get everyday makes a difference.

A story in past generations was how we learned valuable lessons. A story today could help save other women’s lives. Please keep telling your stories. We would like to be able to eradicate breast cancer and you are part of that story.

Sheree DiBiase, PT, can be reached at Lake City Physical Therapy

, (208) 667-1988. She and her staff are breast cancer specialists and having been caring for cancer patients in Coeur d’Alene and the Spokane Valley for more than 15 years.

Women are unique! Because of that uniqueness women need a different type of health care. Women need health care that is specifically designed for them.

Lake City Physical Therapy sees you as not just another patient, but as someone special and amazing. Our staff knows what it is like for women to get what they need throughout all the stages of their life. Because we are women and we have struggles with all the same health issues you have. We’ve had athletic injuries, back pain while pregnant, weight gain after our babies that never went away, leaky bladders when we cough and laugh.

We know what it’s like to have a body that aches everyday, migraine headaches, perimenopuase and menopause issues that last for years, tummy muscles that never seem the same after a c-section, and a neck ache from carrying a five year old all over town. We often look in the mirror and wonder whose body is that anyway.

Our Lake City staff helps women through all the stages of their life, so you can achieve the level of health you desire. Our goal is to not only help you improve physically but for you to develop the confidence to know that your body can do what you need it to everyday. Because we know that you have people who need you and our depending on you. We want women who are beautiful in all aspects of their life.

Physical Therapy and Women’s Health Issues:

Headaches

Muscular Fatigue

Pre-natal and Postpartum issues

Pelvic Pain

Urinary Incontinence

Osteoporosis

Lymphedema

Breast cancer reconstruction

Back and neck pain from postural positions

Sheree DiBiase, PT, is the owner of Lake City Physical Therapy and she and her staff can be reached for a therapeutic massage at (208) 667-1988. We accept cash and insurance as indicated. Also, please join us at 6 p.m. Nov. 14 for a hour massage therapy class. You will learn massage techniques so you can take care of yourself and your family.

Thanksgiving is here and it is one of my favorite holidays. I love this time of year because I get to focus on what’s really important to me, my family and friends and this year is special because my oldest son will come home from college (and I miss him like crazy). It doesn’t matter if the turkey is perfect or the mashed potatoes are fluffy or if the gravy is too thick. It just matters that we are all together hanging around our big old table with everyone laughing, talking and teasing each other. It’s a time to let things of the past year roll under the table and be forgotten. I ask myself this same question every year right around Thanksgiving, will you become a bitter lady or a better lady this year?

Traditions and times change and sometimes that is hard for our family. This year we will celebrate Thanksgiving without my beloved mother-in-law and we will do it a little differently than we usually do. We are having a big breakfast that my sister-in-law is hosting with everyone and then we will all go our separate ways. It is a break from tradition, but one thing my mother-in-law shared with me before she passed away was that she hoped for peace for all of her children and their families. Peace to live and be without so much baggage from our past hanging around. She felt we wasted so much time and energy with all these past mind sets and it destroyed our opportunity for today and the future. She wanted us to live and be free to be what we were called to be. She was a good woman and I miss her so much. Anyway, this Thanksgiving, we will make new traditions, and we will be thankful for all the times we had together with her, and I will be forever grateful to her for the gift of her son to me.

As a physical therapist I see people everyday with physical challenges and disabilities, with terminal illnesses and loss of loved ones as a result. They truly have experienced a break from tradition and often their lives are never the same. It can be daunting to family to have loved ones sick and in pain everyday and it affects the whole family system. Family’s can often become torn apart from illness and devastating injuries. Divorce rates escalate and relationships are destroyed. The physical trauma from injuries can quickly turn the mind body connection upside down. What do we do?

Physical health issues happen everyday. Someone you love just gets diagnosed with juvenile diabetes, fibromyalgia, a mini stroke, breast cancer or heart disease and suddenly your life, as you know it is over. Do we give in to the despair or do we vow to take this challenge and let it makes us better? Such choices. Such a fight. What a battle. You must stand up and take charge and not let the physical challenges destroy who you are.

Come to physical therapy where we can help you integrate this physical challenge into your life. Education and your whole family understanding this physical change is the first step in wellness. Don’t ever give up on your physical health. As physical therapists we get it, we have been there. We know what to do. Will you be bitter or better? Only you can decide.

Sheree DiBiase, PT, and her staff can be reached at Lake City Physical Therapy (208) 667-1988, where we hope to grow better and not bitter from life’s challenges. Please join us from 5:30-8 p.m. Dec. 12 for our Christmas Health and Wellness Bazaar.