This weekend was spent learning how to do Lymph Taping.   We were taught by Joyce Bosman, assisted by my one Vodder trainers, Jan Douglass.

Lymph Talking was developed in 1978 by Dr Kenzo Kase in Asia (Korea and Japan) and specific treatment methods for lymphoedema were not developed until 1995 by Ruth Copee from the USA.  The Summer Olympic Games in 2008 was the worldwide breakthrough on taping – it finally became known to the public.  There are many different names for the method – Kinesio-taping; Medical Taping Concept; Taping NeuroMuscular or NMT Methods, to name a few.

Lymph Taping uses an elastic cotton tape, we used Cure Tape all weekend.  Some of the benefits are:

  • increasing circulatory action and lymph flow
  • analgesic
  • maintenance and reduction of lymphoedema (primary and secondary) in limbs, face, breast, abdominal and genital areas
  • reduction of fibrosis
  • scar reduction
  • reduction in sinus or cold symptoms, jaw irritation, ear infections or swelling around the eyes
  • reduction in swelling post surgery or injury
  • reduction of hematomas and bruising

Lymph Taping for lymphoedema is most effective in Stages 0, 1 and early stage 2, before the fluid turns to fat or becomes fibrotic.

The tape is applied over stretched skin which causes it to lift, creating space underneath.  Wherever the tape is applied on the skin creates low pressure.  It is applied in strips which creates an area of low pressure (under the tape) and high pressure next to it.  Fluid naturally flows from high pressure to low pressure so the free fluid in the tissue under the skin will be “sucked up” by the tape.

Here are some photos of the day …

As you can see, the tape comes in a variety of colours and can be cut to different widths to fit in with whatever condition is being treated.  I haven’t included photos of treatment of breast oedema, abdominal and genital oedema for obvious reasons, but we covered all of those too.

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The Dr Vodder School has posted two exercise videos online especially for people with upper and lower extremity lymphoedema and lipoedema. Only with German commentary at the moment but they will be translated soon. Feel free to circulate.


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Did you know that there is an online event going on right now, called The Lipoedema Worldwide Summit 2016, organised by The Lipoedema Project & Lymphatic Research & Education Network (LE&RN).  It’s free to register and listen to all the talks and you have the opportunity to buy all of the talks at the end of the Summit if you would like continued access.  Well worth checking out for all the latest information and theories about Lipoedema.

 

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This was one of the many powerful presentations at the Conference, presented by Louise Koelmeyer of Macquarie University. What made it so powerful was that it was a case study of a patient who had undergone surgery and she and her husband were both there to discuss it with us first hand.  So many of the talks at the Conference are reports and statistics, so to be able to interact with an actual “case study” was invaluable.

The patient was 48, had six children and was then diagnosed with a gynaecological cancer, requiring surgery/chemo/radiation.  After her treatment she developed lymphoedema in her left leg.  She lived “out bush” so getting treatment was difficult but she did manage it fairly regularly but couldn’t attend often enough to control the swelling. She had to give up her work as a teacher as she couldn’t move easily but more importantly her leg was so large she couldn’t find clothes or shoes to fit so getting out was becoming increasingly difficult on numerous levels.

Her team of therapists spoke to her about surgical options being offered at Macquarie University and encouraged her to get in touch to see whether she was a good candidate for liposuction.  She went to the first assessment and struggled to get up the eight steps to the building, using her upper body strength to haul herself up.

She was found to be a suitable candidate for liposuction and from memory they removed 10 litres of fluid from her leg.  Directly after the surgery she was put in very heavy compression and she was sent for her recovery therapy to Mt Wilga Hospital in Hornsby.  The communication between her and Louise Koelmeyer was free flowing, they used Skype, texting and of course phone calls and when she developed an infection and communicated that to Louise she was quickly hauled back into hospital for treatment and monitoring.

Three months after her surgery, at a scheduled checkup, she was sitting with her good friend at the Opera Bar, looking up at the Harbour Bridge – she wondered what it would be like to climb it.  So, having had a glass of wine or two, she got on her phone and booked two tickets for the next day!  And three months after her surgery she climbed the 1332 steps on the bridge! Unbelievable!  At the six month mark she was running 10km.

Now I have to point out that one of the non-negotiables of this surgery is the wearing of compression 24/7.  If you cannot agree to this condition you will not be considered a suitable candidate.  This patient is 100% compliant with her compression.  She has two garments, the first is 30 mmHg and the second is 60 mmHg.  That’s some serious compression and getting it on requires her husband’s help.  Initially she was putting the 60 mmHg stocking on first but through trial and error has found it works better for her to put the 30 mmHg on first then the heavier compression glides on more easily.  It takes her about ten minutes daily to don her stockings.  She has on occasion fallen asleep after her shower at night, waiting for creams to dry (very important to look after the integrity of the skin) and woken up in the middle of the night and put her compression on straight away because it felt wrong to be without it.

Now here’s the result – so far (she is still being followed up and measured regularly and each time has a continued loss of fluid/circumference) – she and her husband have been on a round-the-world trip because … she can fit into normal clothes and shoes so can go to different climates with ease.  She is back working three days a week.  Energy levels are back.  She looks absolutely normal.  She’s costing her husband and absolute fortune in shoes!

There is hope with liposuction, but it takes work and commitment – daily.  If you feel you can commit to this, then please, talk to your therapist about your options.

Thursday 23rd June 2016 – a follow up … here’s a link to an article in the Sydney Morning Herald about the same patient, with photos of before and after.

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I wish I had taken some notes is all I can say, but I was so mesmerised by Dr Ramin Shayan of the University of Melbourne, Australia that I just sat and listened.  So I’ll have to rely on what impacted me most to pass onto you.

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Dr Ramin Shayan

First of all I have to mention Dr Shayan’s humility – he addressed the Plenary Session of the Conference on the last day and started out by saying how much more we all knew than him and he was in awe of being in a room of so many therapists with so much knowledge. Well, you could hear a pin drop – we’re used to being ignored in the medical world so having a surgeon commend us was a big thing.  He added that he’s usually stuck as the last speaker at medical conferences after many delegates had already left and those who were still there were almost asleep. Turns out that lymphoedema/lipoedema is ignored no matter what level of medical training you have.  Isn’t that a really sad indication of our healthcare system?

Dr Shayan talked about the surgery he is doing with lymphoedema and lipoedema, in particular lympho-venous stenosis – attaching a lymphatic capillary to a vein to bypass the damaged area.  They are having excellent success with this procedure.

He also specialises in liposuction and debulking for lymphoedema and lipoedema so if you are considering surgical treatment, I can full recommend him as a caring, knowledgeable surgeon who understands the lymphatic system to a microscopic detail.

Dr Shayan was also present at the second Lipoedema Conference held last weekend  in Melbourne and was interviewed by The Project for their package on lipoedema which aired this week on Channel 10.  Watch it here.

 

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I’ve just returned from the 11th Australasian Lymphology Association Conference, held in Darwin from 26-28 May, 2016.  These conferences are filled with information on the latest research which is always interesting and a bit mind-boggling at times.  I was very excited that this year there was a real focus on Lipoedema, a condition I am passionate about.  I’ll try and set out as much useable information as I can from two speakers in particular – Dr Ramin Shayan from the University of Melbourne, Australia and Associate Professor Karen Herbst from the University of Arizona, USA.  In this post I’ll focus on Dr Herbst.

Firstly, according to Dr Herbst, a few of the symptoms of lipoedema (for more information click here):

  • fatty enlargement of limbs (firstly legs, arms can develop later)
  • pain
  • predominantly women affected, if men then they have low testosterone or liver disease
  • bilateral and symmetric
  • sluggish lymph
  • can have pitting oedema
  • vascular fragility and bruising
  • varicose veins
  • persistent enlargement of limb even after elevation
  • calorie restriction doesn’t affect size of limbs
  • swelling increases with heat
  • disproportion between upper and lower body
  • feet not involved in early stages
  • hyper mobility
  • low tissue resistance
  • hypothermia of skin

There are different stages:

  • Stage 1 – skin still smooth but texture feels different
  • Stage 2 – skin is lumpy and nodular
  • Stage 3 – lymphoedema is also present

Nodules can be felt in all stages and the good news is that not everyone progresses through all stages.

There are different types:

  • Type 1 – buttocks and hips
  • Type 2 – waist to knees
  • Type 3 – waist to ankles
  • Type 4 – arms only
  • Type 5 – lower extremity only

The abdomen is involved as well as the area above the pubic area.

OK.  So here’s the helpful information, now that you have an idea of what’s involved symptom wise.

  • healthy, anti-inflammatory diet (high fat, high protein and low processed carbohydrates)
  • movement (whatever doesn’t cause a flare up of symptoms, water based activities seem to work best)
  • manual lymphatic drainage (find a practitioner here)
  • bandaging (if lymphoedema or fibrosis is also present)
  • compression (20-30 mmHg)
  • pumps (if you react well to manual lymphatic drainage generally, make sure there is an abdominal piece)
  • medications – work with your GP

Dr Herbst has found that amphetamines are helpful (these are more available in the US, basically diet pills).  You would need to consult with your doctor to find out more.

She also recommends Butcher’s Broom as it helps to increase lymphatic pumping and helps prevent venous insufficiency.

Here are the BIG yet surprisingly simple things you can do for yourself:

  • intermittent fasting. This helps get natural amphetamines into the body. She recommends a 20 hour fast – water and herbal teas during the day and normal dinner.  For more information she recommended the regimen by Dr Jason Fung.  There is a book available but I can only find the Kindle edition at the moment
  • selenium – it inhibits inflammation and decreases oedema. Her recommendation is to get that from eating three Brazil nuts a day! You couldn’t get much easier than that.  She suggests starting with one nut and increasing to three
  • lemon – half a lemon squeezed into water daily
  • avoid MSG

Dr Herbst recommended the book Lymphedema and Lipedema Nutrition Guide – I could only find a Kindle edition on Amazon but you may find it in your bookstore.

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I can’t tell you how impressed, excited and amazed I am with the wonderful ladies of the Lipoedema Australia Support Society (LASS).  They have once again crossed boundaries and have been featured on The Project on Channel 10.  The Project went to the second LASS conference last weekend and filmed there as well but didn’t feature that footage in the package, but they did interview Dr Ramin Shayan of the University of Melbourne, Australia.  He is the group leader of the Lymphatic and Regenerative Surgery Group at the O’Brien Institute and his focus is surgery for lymphatic conditions, including Lipoedema.

I will be working on a post about Lipoedema news at the Asia Pacific Conference I attended a week and a half ago, including information from Dr Shayan’s presentations and will hopefully have that ready later today.

Here’s the link.  Have tissues handy!

 

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I’m just back from a week in Darwin in the Northern Territory of Australia having attended the 2016 Asia Pacific Lymphology Conference.  I’ve made a very short video giving a few highlights for you to view  here.  I’ll be working on a few blog posts over the coming weeks to talk about what I learnt at the Conference.  I’m still processing all the information – my brain hurts!

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Chris came to me at the beginning of January, having had a squamous cell carcinoma removed and a total axillary clearance with four weeks of radiation last October.  The swelling in her breast started almost straight away after the surgery and she had been for a number of treatments with a physiotherapist who diagnosed her with lympoedema.  She also has a small amount of cording which doesn’t seem to impact her too much.  At the time of her first visit her L-dex was at 19 (it had got as high as 32, so that was a major improvement).

She is a fit, active 71 year old who delivers pamphlets and who goes to the beach every day.  She has made a lifestyle choice to be a sun-worshipper and doesn’t use sunscreen because she feels it’s filled with chemicals.  Otherwise, she’s really healthy, takes heaps of vitamins and generally lives a very social life.

But the lymphoedema was really bothering her.  After her first treatment I sent her to get a compression sleeve and unfortunately she was given one that was not strong enough.  I also made her a “swell spot” from Mobiderm bandaging to use in her bra to break down some of the fibrosis in her breast.

At the second treatment she said she was really pleased with the “swell spot”, she felt the swelling was down and she was more comfortable.  We added some laser to the treatment and added a homeopathic remedy called Lymphomyosot which she bought from the homeopath next door.

I didn’t see her for about ten days as she was seeing the physiotherapist in that time.  Her elbow had swollen up before she saw the physio, so luckily she was given some bandaging at that visit which helped, but there was still significant swelling.  She came into the treatment with bandaging just around her elbow which she had done herself, having cut the bandages to size.  I explained that bandaging had to start from the fingers and continue all the way up.  We discussed getting her a ready-made Mobiderm sleeve to wear at home at night to see if that helped.  In the meanwhile I cut a small piece of Mobiderm bandaging to place at her elbow until the sleeve arrived.

At the next visit the following week she tried on her new sleeve and loved it so much she decided then and there to wear it all the time. It was much more comfortable than her usual compression.  I suggested she bandage her hand at night just to make sure fluid didn’t make its way down (there had been some the previous week) and gave her a DVD to watch to help her learn how to do it herself.

The following week she had a follow up with her physio who said L-dex had gone down from 22 to 15, great work!

But the best news is, less pain, less swelling and discomfort.  All in one week.  What more could you ask for?

She also had a consultation with Dr Helen Mackie at Mt Wilga who suggested she think about having one week’s intensive bandaging.  She’s seriously considering that when she gets back holiday.

Here she is sporting her Mobiderm garment – out and proud!

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A couple months ago I wrote a post about Mobiderm bandaging and mentioned that I was going to measure my client for a custom made garment with a zip.  The garment arrived a couple weeks ago and last week she came in wearing it so that I could see how it fit.

Her impression so far is that it is easy to get on (though she does have to have a rest half way through putting it on) and comfortable to wear.  It is a bit hot but bearable.  She has never been able to tolerate compression before so hearing that she is willing to be compliant is great news.  She’s not sure how much change she’s seen so far but it has only been a week.

Here are a couple photos …

Do you notice something very exciting?  She can wear her normal shoes over the garment!

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