Archives for posts with tag: bandaging

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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.

http://ntpages.com.au/lisahiggins

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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http://lisahiggins.ntpages.com.au

A couple weeks ago I had some training on how to use the Mobiderm bandaging system and I ordered a set for me to use in the clinic as well as some stock on consignment.  I don’t do a lot of bandaging but I was so impressed with how much thought had gone into this system that I decided I’d get a set to use on my existing clients to see if it improved the treatment.

One of my clients has been very indulgent of me and allowed me to film her while I applied the bandaging on her arm – watch the video below:

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Another of my regular clients has given me permission to share her experience with the bandaging.  She has lipo/lymphoedema and has areas of fibrosis, particularly on her left leg.  She comes weekly for 1.5 hour treatments but we haven’t been able to get her into compression.  She had tried conventional compression a few years before but found it very difficult to get on because of her size.

I took some measurements as soon as she came in then applied bandages to her left leg.  I then did MLD to her upper body and right leg before removing the bandaging (she probably had the bandages on for about 35-40 minutes)  and clearing her left leg with MLD as normal.  I then remeasured her at the end of the treatment.

I need to point out here that I have used a modified measuring system for this purpose – I took readings at 10 cm intervals above the ankle and 4cm below the ankle.

.                     before    after

70cm              85          83
60cm              75          74
50cm              65.6       65
40cm              53          52.5
30cm              54          54
20cm              43.5       43
10cm              35          33
ankle               37.5      35
-4cm               28         28
-8cm               26         26

As you can see, there was a reduction in most of the measurements (except the feet which stayed exactly the same).

She said at the end of the treatment that her leg felt a little tender and that continued for a couple days but she was impressed enough that we are going to organise a custom made garment for her that has zippers to make it easier for her to put on.

The Mobiderm bandaging is much lighter than conventional bandages and is very easy to apply.  Have a look at the youtube video above to see just how easy it is.  For more information on Mobiderm please click here.

Here’s a photo of what the custom-made zipper garment will look like:

IMG_1661

http://www.lisahiggins.ntpages.com.au

This post was orginally going to be written by my very tolerant friend, A.  She’s been my test dummy since I originally started my massage study back in 2004 – she had a lumpectomy a few years before and had developed lymphoedema as a result.  She’d get on my table and let me practice all my lymphatic techniques on her (and her husband donated his body to my remedial massage practice – man they were great friends).

A. has been coming to see me over the years to help her keep her lymphoedema under control.  Sometimes regularly, sometimes not.  Life has this habit of jumping in the way of best intentions.  She was going to write this post, but again, life has jumped in and the time has slipped away, so I offered to write it from her feedback.

When I got my laser a few months ago, A. was one of the first on my table as guinea pig.  We were amazed at how well she responded, there was significant softening of the fibrosis at the top of her forarm and her skin felt soft for the first time in ages.

After the third week of my Vodder course I persuaded A. to let me again use her body in the pursuit of my studies and she duly rocked up on a Sunday afternoon and let me run wild with her.

I explained that the most significant difference in the treatment protocol was the treatment of fibrosis.  I would normally go in a bit firmer with her fibrosis but really kept in mind the idea that lymphatic drainage should always be gentle.  But with Vodder, “aggressive” is the word they use in relation to fibrosis.  Can you believe it?  I still have bruises on my leg from where the lecturer demonstrated the fibrosis treatment on me – on someone without an issue it’s really painful, for someone with an issue, it feels normal.  Ouch.

So, I watched with anticipation as I started giving her the “aggressive” treatment.  Her eyes widened and her jaw dropped.  Luckily she trusts me.  At the end of the session she had a feel of her forarm and couldn’t believe how much it had reduced and how great it felt.

Then, because she is so lovely, she let me bandage her.  She’s never had bandaging done before, nor does she want it again, so she’s going to be very regular with her treatments from now on to avoid the possibility of ever having to undergo it.   Here’s her beautiful arm …

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A’s beautifully bandaged arm

I spoke with A. on the following Wednesday.  She said that she actually felt sort of bruised on Monday and Tuesday but that on Wednesday it felt normal again, but that the arm was still soft and feeling great.  Normally she says that she’s ready to rip her compression sleeve off by about 8pm, but she was able to leave it on until bedtime.  And normally within a couple days she starts to feel congested again, but not this time.

She came in for a follow up after ten days.  Progress report – her eczema on her hand was playing up, she had a paper cut (man do those hurt!) and a torn “quick” on one of her nails, all on the affected side.  Normally that would mean big swelling and heaviness.  While the arm wasn’t as good as the week before, it really wasn’t that bad, considering all the things that had gone on during the week.

We did another treatment and towards the end my comment to her was “your arm’s squidgy”.  She looked at me like I was a little deranged.  Maybe I am?  She sat up at the end of the treatment and investigated her arm … “you’re right, it is squidgy, and I have wrinkles”.  Her sleeve just slid on.  She had the cheesiest grin on her face – love it.

UPDATE 28/8/13

So, had third treatment today and at the end she was so amazed she said we should have taken a video of the treatment.  Well, too late for that, but we could take a video of her enjoying her soft arm – her favourite spot is the indent that she now has in her elbow, she hasn’t seen that for a long, long time.  The video’s a bit dark, but that reflects the subdued ambience of my treatment room – it’s all about comfort!

This is new territory for me  – I’ve just created my first youtube video!  Here’s the very supple movement of her arm …

http://youtu.be/u3so183HeMs

I’ve been following Helen’s blog (http://lymphnodetransplant.wordpress.com) since before she had her amazing surgery back in March.  Before then, I had no idea that it was even possible to transplant lymph nodes and so I was very interested (and to be honest, excited) to see how she went.  Helen has been very open with sharing the ups and downs of her surgery and has continued to bring information on lymphoedema, manual lymphatic drainage, exercise, self massage, bandaging, compression – all the important things when dealing with lymphoedema.  I’m sure her blog has brought answers to many out in the real world who are looking at options to manage their lymphoedema, as there’s not much available written from a patient’s perspective, the info that is out there is all in doctor speak.

I received an email from Helen after my first week of Vodder training – she had calculated when I’d be back in the clinic after my training and wanted to come in to have some Vodder lymph drainage with me and to try my laser (http://www.riancorp.com/FAQ/frequently-asked-questions-ltu-904-laser-for-lymphoedema.html) to see if it helped with her scar.  So we scheduled an hour and a half appointment so we could discuss her case history and have enough time to do some laser as well.

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Riancorp Laser -http://www.riancorp.com/FAQ/frequently-asked-questions-ltu-904-laser-for-lymphoedema.html

Yesterday was the day.  I was very excited to meet her finally.  It’s always interesting to meet someone after only communicating in writing, you get to hear accents.  Helen is originally English and I’m originally from Trinidad.  There was so much to say.

Firstly we took some measurements of her transplant leg (I didn’t tell her what the measurements were – there were times early on when Helen was measuring every day and it got a little disheartening for her when things didn’t reduce as quickly as she imagined and the measurements were more for my information so we could monitor her progression).  I have to say, her leg actually looks great, as does the scar, she feels the knee isn’t working quite the way she’d like and she’s still getting swelling after exercise (it resolves after a good night’s sleep).

And away we went with treatment, creating pathways from the groin area up to her axillas (armpits) and constantly clearing fluid upwards towards them.  I used the laser around the scar and medial knee where Helen says most of her issues are, then turned her over and worked the back of her thigh.  Interestingly, the skin on her leg was soft throughout until I got half way down the back of her thigh where there was almost a line (not one that you could see, but one I could feel) where the texture changed to a slightly more “spongy” texture.  Interesting.  All the while I was clearing fluid up to her axilla.  All too quickly we were out of time.

As Helen left she asked “so, who’ll write the blog, you or me?”.  You guessed it – me.  We have another appointment booked for next week so I’ll find out then how she felt after the treatment, although I’m sure she’ll post a comment on here before too long.

Thank you Helen for the opportunity to work with you and to be able to blog about it afterwards.

Three weeks in and I can’t quite understand where the time has gone.  Seriously, I feel like a day went missing this week.  Monday and Tuesday were spent listening to Professor Neil Piller, of Flinders University, talking about some of the conditions that can be treated with manual lymphatic drainage; some of the tests that can be run to see how the lymphatic system is working, which pathways the lymph is using; some of the equipment we can have in our clinics to help us tell what is going on with our clients’ bodies; some of the equipment we can use to help in our treatments; more anatomy and yet more physiology.  I think my brain is going to explode.

On Wednesday we had our first class with Koby Blanchfield, an accredited practical instructor with the Vodder School.  This week it’s all been about treating conditions and bandaging.  The only interruption to the practical work this week was another theory exam on Thursday morning on everything Prof Piller taught us.  Glad to be done with that one.

Here’s a photo of my poor daughter, bandaged up while watching TV on Thursday night.  My kids are very patient with me thank goodness.

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Bandaging my daughter for homework – please note the adorable pink bunny slippers in the background! How cute are they?

This weekend’s homework is more bandaging, studying all our basic treatments as well as all the “specials” in preparation for more scenarios next week.  

Maybe I can allow myself a sleep-in on Sunday!