Archives for posts with tag: laser

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

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I want to introduce you to M.  He’s not my typical client, not that I really have those but you know what I mean.  Until May 2009 he was your typical (there’s that word again), active male, working hard and enjoying being outdoors and active.

He was up a ladder clearing out some guttering and he fell, landing on concrete, resulting in two months in a coma at Royal North Shore Hospital and then a few more months in recuperation at Ryde Hospital, until December.  Since then he’s been getting himself back – he’s had to learn to walk again and attends an exercise program called Walk On, three times a week.  He still walks with crutches but the Walk On guys have him walking short distances unaided – they work him HARD and he comes in with very sore muscles every week.  He sees physios and swims and is doing whatever possible to help himself.

M came to see me at the end of October last year because he had some swelling and pain in his lower leg for three weeks and after a clear Doppler his GP suggested some lymphatic drainage might help and sent him to see me.  That in itself is a minor miracle, a GP sending me a client, but I have to commend this particular GP, she’s sent me two clients recently – progress.

I did the usual upper body MLD clearing and focused on his left leg.  M was very sensitive to touch and had (and still has to a lesser degree) jerking responses, even when clearing his thigh his lower limb would be twitching, or sometimes his right leg.  I have to say that I did drop my lecturer a note about that and she assured me that this happens sometimes, it’s the increase in lymphatic flow making everything work a bit better and that includes nerves firing.  At the end of that first treatment he was amazed at the reduction in swelling.

He’s been coming regularly and we’ve added some laser to the treatment as the area around his lateral ankle is a bit firm and that has helped break down some of the fibrosis.  What we’ve been doing of late is adding ten minutes of remedial massage to his quads because he is worked so hard at Walk On that his muscles are sore.  Our treatments change according to what he needs on the day but it’s great to have a toolbox from which to choose.

Over the time we’ve had many discussions and I’m amazed by some of the things M still does, in spite of his limitations.  He related the story of being helped into the ocean while on holiday and a guy swimming out to him to tell him he shouldn’t swim because of the sharks – his response “I’m going to swim from one beach to the other and he should get out if he was worried about sharks”.  Well, the guy got out and M did his swim.

Or skiing again, using a special ski chair and going down so fast and doing such a sharp turn he broke one of the skis and had to get it repaired.  He’s given me some photos of him skiing with his instructor – pretty amazing huh.

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The moral of the story is, don’t be limited by what you think your body can and can’t do, anything’s possible.

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.

I just had to write about this result.

E is the lovely lady who tried to organise the grant from Bendigo Bank for me to purchase my laser.  She’s been a regular for over three years now, coming monthly to keep her lymphoedema under control and she’s had intensive treatment at Mt Wilga Hospital.  She wears her sleeve daily and bandages herself when she feels the need.  She also exercises regularly.  Lymphoedema is part of her daily life.

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This is me demonstrating on my boss how the laser works

E came in to see me last week to try out the new laser.  She’s had laser before at Mt Wilga and found it very benefical.  She was surprised to see the size of my LTU-940, it is a hand held device and so quite small and very portable and the one at Mt Wilga is a pretty big machine.

She’s been having some physio for the last few months, as she has some inflamed tendons in her shoulder but she had not had much relief and last week her physio suggested she get a cortisone shot.  She hasn’t been able to wipe down the kitchen benches or iron or even get into the pool for her aquaerobics. She had a call into her GP to discuss it, because she wasn’t too keen on the idea.  What I felt is that the laser would help both on a lymph and a muscular level – it was certainly worth a try.  She also had some sciatic issues on the opposite side to the arm, so sleeping was impossible as she couldn’t lay on the left because of the sciatica and couldn’t lay on the right because of the arm, so all in all, a very frustrated camper.

So, I laid her on the table and I started working from the top of her arm, three points in a row then coming 2cms down and working another three points in a row and so on down the upper arm.  By the time I got to her elbow she said the pain was almost gone!  At that stage I was able to raise her arm to work in the axilla and down the inside of her upper arm, then down the forearm (her tightest area is down the front of the forearm into the wrist).  We did 30 minutes of laser and one hour of manual lymphatic drainage.  At the end of the sesssion she had no pain!  She was in shock (so was I if I’m honest, didn’t expect such a big result).

The next morning at about 11.30 I got a text from her and she’s given me permission to write it verbatim here …

Hi Lisa, thank you so very much.  I had the best night’s sleep.  I tossed and turned a couple of times that I knew of but no where near the pain that I have had the last few weks.  Woke up at 9.40am and only because the phone rang.  Still feel the problem but so much better with no pain.  So a big thank you.  May need another next week for sanity.

I spoke with her this morning, four days after treatment and she’s still feeling much better.  Still not able to do her housework, but pain levels are way down.  She’s booked in for a follow up later this week.

Loving that laser!

I usually write my posts on Monday afternoons but this week I’m going to spend my time investigating my new laser – it was delivered at lunch time today and I’ve been itching to get it out.  Here’s a photo …

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LTU-904, purchased from RianCorp Pty Ltd.

Here’s a link to RianCorp’s page which talks about lymphoedema and clinical trials run on this laser and it’s effectiveness in reducing symptoms of lymphoedema … http://www.riancorp.com/Riancorp/lymphoedema.html

I have to thank one of my favourite clients for making this possible, she very kindly gave me a significant donation towards the purchase cost and I feel very honoured that she felt me worthy.  I wrote a post about her some time back, read it here https://ozhiggins.wordpress.com/2013/02/11/inspiring/.   And I also need to thank another of my favourites for talking through the pros and cons of the laser over the L-dex and for her time and effort trying to organise a community grant for the purchase of the laser – we weren’t successful, but it’s amazing that her husband fronted up to Bendigo Bank and asked for the grant on my behalf.  Have I mentioned before that I have some very special clients?

Over the last few weeks I’be been weighing up the pros and cons of a couple pieces of equipment and I think I’ve made my decision as to which one to purchase for my clinic.

The first is an L-dex machine.  I’d heard of these machines before and when I went to the lymphoedema conference in March they talked about how useful they were.  The L-dex measures the amount of fluid in the interstitial tissue and gives a good indication of whether lymphoedema is present in unilateral limbs.  It’s more useful as a guage in the early stages of lymphoedema as once the condition has progressed and the tissue has become fibrotic (hard) then the fluid content is less so your reading may actually be low, even though you can visibly see the swelling.  A normal reading is anywhere between -10 and 10.  Best case is to take a reading before surgery so you can compare straight away because even if your reading is say 8 after surgery, if it was -9 before then that is a big change (anything over a ten point change is an indication of lymphoedema being present).  All very technical.  You can read a bit more here http://international.l-dex.com/what-is-l-dex/.

I decided to investigate costs and found that there was a special offer on and I had the rep come in and demonstrate.  Well, she didn’t actually demonstrate in the end, she spoke about it and left the machine with me to trial for a week and a half. And that I did.  Two of my clients had had readings taken elsewhere recently and so it was really useful/interesting to be able to compare.  I have to say, the readings I took were quite different to the ones they had just had and I began to question the reliability of the machine.  Readings should be taken on the same machine and around the same time of day for consistency.  Hmm.  Not fully convinced.

But.  One of the two clients who had readings previously said that initially she was excited because she thought I had bought a laser.  So we talked about the benifits of L-dex versus laser.  With a laser you can actually treat areas of fibrosis and lymphatic cording.  Normally when I treat cording I have to do it manually, literally trying to snap the cord with stretching techniques and to this day I haven’t heard the “snap” that accompanies the breaking of the cord (nor do I want to, the thought scares the bejeebers out of me).  A laser breaks up the cording faster and easier and with less discomfort.

ImageLymphatic cording, photo courtesy cancerat35.blogspot.com

So.  Here was my thought process.  The L-dex – useful as a measurement tool and the medicos will like having an official looking print out with a number on it.  The laser – I can actually treat clients with it and they walk out feeling better.  A bit of a no-brainer really don’t you think?

So I’ve just emailed the suppliers to see when I can get one.  I’m getting the LTU-904.

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photo courtesy Rian Corp

Read more about it here http://www.riancorp.com/Products/low-level-laser-therapy-lllt.html.

I’d love to hear about your experiences with either piece of equipment and whether you think my decision is the right one.