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August 12, 2002

Cancer Therapy Complications And Using The Computer
Francine Manuel, RPT, Alexandra Andrews, Ernest H. Rosenbaum, MD and Robert A. Wascher, MD, FACS

Introduction
Suggestions for Computer use with short and long term problems

Suggestions for Computer Chairs
Suggestions for the Computer Keyboards
Suggestions for the Computer Monitor
Suggestions for the Computer Mouse

Suggestions for Computer Number Pads
Cancer Therapy Complications And Using The Computer PDF Handouts


Introduction
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In our information-centric society, the ability to use a personal computer is essential in the professional and private lives of millions of people around the world. The functional impairment of using a computer comfortably with Post Breast Therapy Pain Syndrome (PBTPS), Lymphedema and Peripheral Neuropathy has received little attention.

PBTPS is a complex constellation of symptoms. The old term, Post-Mastectomy (after breast amputation) Syndrome, is not sufficiently descriptive with breast-preserving therapy. Newer treatments such as the Sentinel Lymph Node Biopsy (SLNB) may diminish the pain. PBTPS may result from poly-neuropathies caused by surgery, chemotherapy, radiation therapy, and hormonal therapy. Any surgery such as Mastectomy, Lumpectomy, Lymphectomy, breast implants, augmentation and reconstruction creates possible risk for PBTPS.

In post-surgery follow-up visits, patients are able to describe slight early post-operative pain, but often, PBTPS does not manifest as an ongoing chronic problem until 30-90 days or even many years later. Over 50% of patients diagnosed with PBTPS unexpectedly experience chronic pain and other serious sensory disturbances. They report increased pain with movement, leading to clinically significant arm and shoulder restriction of motion. PBTPS discomfort interferes with active daily living and sleep and impairs overall quality of life.

Upper-extremity Lymphedema, a potential complication of axillary dissection, may adversely affect an estimated 10-30% of breast cancer survivors in both short-term and long-term discomfort, chronic pain, debility, and loss of function in the affected limb. Lymphedema is not often discussed and remains an under-reported complication of cancer therapy.

Chemotherapy can affect the conveyance functions of the nerves inducing Peripheral Neuropathy. Some chemotherapy drugs may cause symptoms during or immediately after the first dose. Research to examine what proportion of patients have complete resolution of symptoms or how long it takes for symptoms to resolve is needed.

Patients who develop complications such as Lymphedema, Post Breast Therapy Pain Syndrome and Peripheral Neuropathy usually suffer throughout the duration of their entire lives. Clinical standard management advances are not well delineated, resulting in considerable confusion and frustration for patients. Anxiety and depression are two main repercussions from the challenges faced by patients within the workplace, social situations and at-home. These compromise quality of life. Considering these factors, it is important that all patients are carefully counseled.

Suggestions for Computer use with short and long term problems
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We offer the following brief suggestions for short and long term problems while recovering from surgery, swelling, pain, and other long term complications such as Lymphedema, PBTPS or Peripheral Neuropathy.

The problem of persistent swelling or pain in one or both arms after trauma of any kind can affect computer usage, especially for people who have to work on the computer for prolonged periods of time.
1. Reaching for the computer's mouse, keyboard or number pad may aggravate shoulder and arm pain because of the shoulder and upper arm muscles contracting. By reducing the angle between the arm and the body, the binding or pressure that the contracting muscles place on the shoulder and axillary nerve branches may reduce pain as well. Adjustable arm rests on chairs can help to relieve the arm muscles during key board and mouse use. Strategically placed pillows can be a useful solution.
2. You may need to purchase adaptive ergonomic equipment. There are various shapes and sizes of keyboards, computer mice (trackballs, touch pads, cordless/wireless etc.), and number pads to accommodate your needs. Visit a computer store to test them for comfort.
3. Rest your eyes. Exercises such as palming or scanning other objects in the room may be helpful.
4. Remember to take small breaks every hour or so.

Suggestions for Computer Chairs
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Adjustable chairs are essential for comfortable computer usage.
1.The height should be adjusted so that your feet are on the floor, knees are bent at 90 degrees.
2.The seat of the chair should come out to about 2-4 inches from the back of your knees. You should not feel a lot of pressure under your thighs.
3.The arm rests should be wide and adjustable in height.
4.The back of the chair should allow for some tilt forward and back.

Suggestions for Computer Keyboards
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1.There are flexible keyboards, some split in the center, smaller keyboards without a keypad, optical keyboards. Size does matter. A too large keyboard can aggravate pain and stress the muscles by causing your hands and arms to overstretch. Find a keyboard that is comfortable for you. The higher you can place your arms in relation to the keyboard, the more advantageous.
2.Put pillows under your arms and place the keyboard on your lap.
3.Elevate the keyboard with telephone books and put pillows on your desk as arm rests.
4.If you have PBTPS or Lymphedema in one arm only, consider using the keyboard on a slant by lifting one side (your lymphedema side) with books, pillows or foam.
5.Use bean bags of varying sizes for the underarms and as a forearm rest.
6.Cut a piece of foam at any angle that is comfortable for your particular problem. Electric knives are the easiest way to cut foam into shapes.

Suggestions for Computer Monitors
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1.Raise your monitor to eye level. You can do this simply by placing telephone books, wood blocks, or risers under the monitor. There are special devices for laptops. You do not want to be looking down.
2.You may want to invest in special computer glasses.
3.Sit up straight.
4.Do not lean on one arm to read the monitor.
5.Tuck little pillows or cotton socks filled with soft material in your armpits to help relieve pressure.
6.Check for glare.

Suggestions for the Computer Mouse
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Mouse size and shape does matter.
1.Don't clutch the mouse like a life preserver. Your hand should be relaxed.
2. Keep your mouse close to the keyboard. Do not make wide circles with your arm or wrist.
2.Your wrist should lie flat or be supported by a bean bag, foam, or stuffed sock.
3.Some choose to put a pillow under their arm if they are using a mouse. Beware that an unsupported hanging elbow will create added pressure on your shoulder and may cause pain.
4.To achieve a comfortable height there are mouse platforms available, even some that fit over the number pad of a keyboard.
5.Look for a mouse that fits your hand. If you have a small hand, consider buying a mouse made for travel or children.
6.Switch the mouse from hand to hand. When using the mouse switch from using your dominant hand to your other hand. This frees your dominant hand to type on the keyboard without switching back and forth between mouse and keyboard.
7.Use keyboard shortcuts - don't use the mouse exclusively.
8.Take sporadic mouse and wrist breaks.
9.Beware of the USB (Universal Serial Bus) hump. The typical USB mouse has a higher hump in the middle of the mouse than the older PS2 mice. This hump can make hands adopt awkward positions. This may create painful hands, wrists, forearms and shoulders.
10.There are mice of all types and sizes including external touch pads, track balls, optical, foot , and head mice. A cordless gyroscopic mouse allows you to manipulate the mouse in mid-air (i.e. without having to roll it along a surface). It takes a bit of getting used to, but this aid may be particularly helpful.

Suggestions for Computer Number Pads
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1.Your hand should be relaxed, supported and at a comfortable height.
2.Check to see if the number pad in your keyboard is comfortable.
3.You may want to buy an external number pad.
4.Some choose to put a pillow under their arm if they are using a number pad. Beware the unsupported hanging elbow which will create added pressure on your shoulder and may cause pain.
5.Take hand and wrist rest breaks.

Cancer Therapy Complications And Using The Computer Handouts
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Cancer Therapy Complications And Using The Computer Handout
http://www.cancersupportivecare.com/computerpage1.pdf
Suggestions for Using The Computer with Cancer Therapy Complications Handout
http://www.cancersupportivecare.com/computerpage2.pdf


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