| How do you treat Lymphedema? The gold standard treatment is a form of medical massage that can be called: Manual Lymph Drainage (MLD) Lymph Drainage Therapy (LDT) Complete/Complex Decongestive Therapy (CDT) The goal of therap is to activate fluid circulation, to drain stagnant areas, stimulate the immune system, reduce pain, and keep muscle spasms to a minimum. To perform Lymphedema therapy, one must be certified and properly trained, look for your therapists credentials. Therapy feels like a massage only lighter. Your therapist will work on your body, usually head to toe. He/she will drain the nodes which again, feels like a massage. The main nodes are the waterwheel (behind earlobe), clavicle (near collarbone), axilla (under arms) and the iliac/inguinal nodes which are in the abdomen. A good deal of time is spent going back and forth to the main nodes to ensure good movement of fluids. Extra time will be spent on areas of swelling. Before you are worked on, the therapist will take your medical history and measure your areas of swelling. This is done so they can keep a record of how you progress to a smaller level. You will be taught to perform self bodywork, how to care for your skin, possibly skin brushing, do's and don'ts, special exercises to promote lymph flow, and how to wrap yourself. You usually are wrapped after each session. After you maintain the same size for a period of time, you will be ordered compression garments (sleeve, stockings) to wear instead of wraps. When NOT to go to or schedule therapy You should not schedule or go to an appointment if: You have active or acute infections You have a fever or inflammed red skin and possible infection Thrombosis (serious circulatory problems) Major heart problems (bodywork increases the cardiac load) Bleeding You are unable to urinate Also if you have any unexplained lumps or possible malignancies, you need to check in with your doctor and therapist. NEVER forget to tell your therapist about any problems you are having, and ALWAYS have your therapist update your health records to any new medications or problems. You should always have a current prescription for bodywork. Most therapist will not treat you without a referral. ALWAYS check your therapists credentials before you have bodywork done. DIURETICS - HOW EFFECTIVE ARE THEY? Reputable health authorities advise against using diuretics in the treatment of lymphedema pointing out that the therapy is generally not effective and can be damaging when used over a long period of time: The Canadian Medical Association Journal, Clinical practice guidelines for the care and treatment of breast cancer: 11. Lymphedema (CMAJ 2001;164(2):191-9) released in January of 2001 by Susan R. Harris, Maria R. Hugi, Ivo A. Olivotto, Mark Levine, for the Steering Committee for Clinical Practice Guidelines for the Care and Treatment of Breast Cancer notes: Diuretics, which have been recommended in the past, may temporarily mobilize water, but the increased interstitial oncotic pressure exerted by the high protein concentration of lymph fluid will cause rapid recurrence of edema. The diuretic effect in the rest of the body may cause adverse side effects, such as hypotension, dehydration and electrolyte imbalance. The National Cancer Institute (NCI) points out that, " Diuretics encourage vascular fluid depletion, but do nothing for excess protein deposits and could hasten connective tissue fibrosis. Therefore, diuretics should be used with caution and only for treatment of excess vascular fluid due to other causes (1998)". The 1995 consensus document of the International Society of Lymphology Executive Committee reports that although diuretics may be occasionally be useful during the initial phase of physiotherapy or in certain unique medical situations, their use on a long term basis is not generally effective. "Long-term administration of diuretics is discouraged as being of marginal benefit and potentially complicated by fluid and electolyte disturbances.". Managing your lymphedema takes time and practice. You're therapist will teach you how to properly bandage or wear compressions combined with self massage. Practice makes perfect so have patience. Although there is no cure and lymphedema is usually progressive, we can hope for research and studies to arise in the future to help those with the condition and also measure to prevent others from ever having it. Therapist Hygiene If you have open wounds or leaking fluid, your therapist may wear gloves. Gloves protect contact with fluids, substances, and chemicals. If working in the mouth to drain nodes, a therapist will wear gloves. Be sure if you have any known allergy to latex you inform your therapist BEFORE bodywork with gloves |
| We are called to be architects of the future, not its victims. ~ R. Buckminster Fuller |
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| LYMPHLAND |
| Managing Lymphedema
At a Glance Your doctor and nurse are more likely to take your symptoms seriously and be attentive to your progress if they regularly measure the circumference of your arm and compare it with your unaffected arm, documenting the measurements over time. You can usually control lymphedema by practicing good care and following basic guidelines. The health care professionals who specialize in the management of arm lymphedema are physical medicine doctors (physiatrists), physical therapists, and occupational therapists. But don't assume that anyone in these specialties is an expert in treating lymphedema. Ask about experience and references before you let anyone work on your edema problem. Most metropolitan areas have occupational or physical therapists with practices dedicated to managing the physical, psychological, and activity-related side effects of breast cancer treatment. If you can't find a therapist who specializes in breast cancer, look for a general occupational or physical therapist in a rehabilitation center or department who has experience taking care of women with breast cancer |
| Title: Early Intervention and Treatment Intervention for Lymphedema
Authors: Gergich N,1 Washington F,2 Pfalzer3 L, Soballe P1 and McGarvey C4 Affiliations: 1. Breast Care Center, National Naval Medical Center, Bethesda, MD. 2. University of Maryland School of Medicine, Baltimore, MD. 3. University of Michigan-Flint, Flint, MI. 4.National Institutes of Health, Bethesda, MD, Physical Therapy Dept., Abstract: DESIGN: This observational (case-control) outcome study investigated the frequency and severity of morbidities in a population of approximately 165 patients diagnosed with breast cancer before and after medical and surgical treatment. METHODS: A subset analysis of a cohort of women of women diagnosed with subclinical lymphedema (LE) was conducted. Pre-operative and follow-up arm volume measurements taken at 80% of limb length measured from ulnar styloid to tip of acromion at 1, 3, 6, 9, 12 and 18 months by optoelectronic volumeter (Perometer®) from 2001-2006. Quantitative girth measurements were collected over this period using an optoelectric limb volumeter. The device is an framed infrared scanning system (Perometer, Pero-system MeBgerate GmbH, Wuppertal, Germany). This instrument was designed specifically to measure girth (cm) and volume (ml) of the upper or lower extremities and has been validated for use in a clinical environment by Stanton1 and others. ANALYSIS: 2-way Repeated ANOVA with Time and Limb as factors and mean values calculated for Affected and Unaffected Arms. RESULTS: 43 women 34-82 years old (mean =55.3 + SD 12.1) reported symptoms of LE including heaviness or increased limb volume. Intervention was introduced if the volume change equated to approximately 100 ml or 3% volume change compared to preop measure. At intervention the volume increase in the affected arm was significant (83.0 ml + 118.8 [2.1 % + 5.2] p=0.001). Baseline to onset of lymphedema and intervention averaged 7.6 mos. Average time to follow up was 5.0 months, during which time the cohort demonstrated a significant (p=0.0000) mean volume decrease of 119.9 ml [8.6%] in their affected arm by using the sleeve. CONCLUSIONS: Pre-operative assessment, prospective surveillance and early intervention may have prevented the onset of irreversible LE in this small cohort. The garment significantly reduced affected limb volume to nearly that of the unaffected limb and therefore provides effective treatment when sub-clinical LE can be detected. Further research is warranted to confirm the long term effectiveness and cost effectiveness of this preventive model compared to a traditional impairment based model. 1. Stanton AW, Northfied JW, Holroyd B, Mortimer PS, and Levick, JR. Validation of an optoelectronic limb volumeter (Perometer). Lymphology. 1997 vol:30 (2): pp:77 -97 |
