Archives for posts with tag: lymphoedema

Continuing on from my “coming out” blog last week, I thought I might write about a few sessions I’ve had recently, just to give you an idea of how they differ from a typical massage treatment.

A client came in for her session and I could immediately see she was stressed and certainly not in the right head space to lie on the table to receive her manual lymphatic drainage for her lymphoedema arm. You could almost see the sparks firing off her – we’ve all felt that kind of energy when someone walks into a room.  There was no point putting her on the table until she had been given the opportunity to vent and I didn’t need to ask her any questions, she just let go. And I let her.  She’d had her young supervisor at work suggest to her that she needed to be more resilient.  My client had recently returned to the job having been working in another city and this was a new supervisor she had no history with.  Resilience was this lady’s middle name … breast cancer, teenaged daughters, lymphoedema, working through treatment, recently broken wrist on the lymphoedema arm which triggered her lymphoedema which had been under control, still working through. You name it, she just kept going.  Grrr.

After she vented I pulled out my trusty pyramid and “dinged” her.  She took a massive breath in and her entire body let go and relaxed.  A smile even appeared.  Followed by “what is THAT”?  I explained as best I could what I think happens when I strike the pyramid.

Now that she was more receptive I showed her the amazing garment I had ordered for her the previous week – the Mobiderm Autofit Sleeve.  Her eyes lit up and she quickly put it on and said, “oh yes, I can wear this”.  So we left it on and I got her onto the table and started our manual lymphatic drainage session.

We talked while I worked and I got the impression that what the conversation with the supervisor had triggered was a feeling of unexpressed grief.  I held onto that thought but not for long because a minute later she said, “I feel as if I was never allowed to grieve during my treatment because my daughter wouldn’t let me, she would tell me to get over it” (or words to that effect, I can’t remember exactly now).  So the resilience comment took her right back to when she was in treatment and unable to express emotion.

This led to me asking her what tools she used when she was stressed … meditation, deep breathing, mindfulness, tapping, going for a walk?  She had a think and said she used to go to mindfulness classes and those were great.  I suggested that she might find a mindfulness app and do it on her own and save some money and she remembered that she already had a number of them downloaded on her phone!

Next I asked her if she’d ever heard of tapping … why yes she had, but hadn’t done it for a long time. And bingo, I pointed her in the direction of some great YouTube videos to guide her through until she felt comfortable doing it on her own.

In between all this I had taken off her new garment and shown her the marks on her arm from where it had already started to work and she was amazed.

By this time, she was laughing and happy.

She went home in a totally different frame of mind to the one she came with – her arm feeling better and with her sleeve to wear at night while she slept and some ideas on how to help her manage her stress levels.  For me, it’s all about giving people tools to self-manage.

I even got a hug!

 

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I figured it was time I “came out”.  The truth is, I don’t just work on the physical body.  I’ve always been a little different to most people and I have kept that side of me separate from my work for all these years.  Or so I thought.

I’d always thought that if I said to my lymphatic clients that actually, I was working with them on an energetic level as well physically they would think I was nuts and never come back.  Then I had it pointed out to me (gently) that if I thought my clients didn’t realise it on some level I was deluding myself.  You see, my clinic probably looks a little different to most.

I like crystals.  There, I said it and now it’s in the public domain!  And I have lots of things  that might look a little different scattered around.  And I use energy sprays and sound and cards.  Who did I think I was kidding?

But make no mistake, I am very much working on the physical body and using my Vodder training to treat the many different conditions I see in the clinic … Lymphoedema, Lipoedema, autoimmune conditions, general oedema, pain, surgical swelling.  It is not an either/or situation.

Here are a few photos to show you what I mean.

And a link to a quick listen of my crystal pyramid, one of my favourite tools.

This is just an introduction, a coming out of sorts.  I’m going to write a few more blogs about what some sessions with me look like so you can get more of an idea.

I feel very strongly that we need to be treating the whole person, not just the symptoms we are presented with.  I’m sure most therapists feel this way as well, I’m just not sure how many are able to use all their different techniques freely.

Let’s start a dialogue – got questions?

 

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One of my clients, Chris, has very kindly given permission for me to share her photos and reports to write this blog.

Chris is what I’d call a very “motivated” client.  She is determined that she will kick lymphoedema’s butt, no matter how many times I tell her that she can control it with good maintenance but it will always be a part of her life.  She believes in positive thought and who am I to knock that?

Chris first came to see me in January 2016 at the age of 72, complaining of swelling and discomfort mainly in the left lateral chest wall and through to her back as well as her upper arm.  She had had a squamous cell carcinoma removed in the area (as well as many others in different parts of her body), along with a total axillary clearance and radiation to the area.  The swelling became noticeable almost as soon as the radiation finished in October 2015.

She had a number of physiotherapy sessions prior to coming to see me but hadn’t found these beneficial. I checked her self-clearing technique (she was directing fluid to the armpit so we adjusted that and I showed her how to do deep breathing as well).

Over the last year we have used a number of techniques.  Manual Lymphatic Drainage is the main therapy used but I have also added Low Level Laser and deep fibrosis techniques.

Chris uses a Mobiderm arm sleeve day and night (she finds this more comfortable than elastic compression sleeves).  There are days that she does use her normal compression sleeve as well, but she finds the Mobiderm more effective.

I have fitted her for a compression vest which she also wears daily, with Mobiderm swell spots inserted in the areas of greatest fibrosis. Photo below

Chris uses her own low level laser daily at home – she has a Pulse Laser.

Once a week she applies kinesiotape down her arm and across her back – she takes this off just before coming to her MLD sessions and reapplies once she gets home.

She swims daily in the ocean when it is warm enough and does a lot of walking (she delivers pamphlets every day) and running.  She is incredibly fit, active and full of energy (she credits the energy to taking lots of spirulina, but I can’t vouch for that – she’s just full of life!).

After a few months of treatment Chris went to Mt Wilga Hospital for a three week intensive course of treatment. She now has a very personal relationship with Dr Helen Mackie!

Even though visually you cannot tell Chris has lymphoedema, she is aware of it constantly and it affects her daily life.  So she went to see Dr Mackie and the surgical team at Macquarie Hospital in October 2016, to see if perhaps there was a surgical solution to her issue.

She spent about four hours with the team, being measured with different diagnostic tools and when using Indocyanine Green (ICG) Fluorescence Lymphography, they found she had some issues in the dorsum of her hand but that her arm was ok. There was also an issue in her lateral chest (where she had the most discomfort) and no evidence of functional lymphatic vessels, with no lymph movement down to the lower abdomen. She did however have a strong pathway across her chest to the opposite side, as well as one on her back going in the same direction. And the scans showed up lots of fibrosis in the chest wall which needed to be broken up with deep friction massage.

Armed with that information, we were able to tailor her treatment with a real focus on breaking up the fibrosis using laser and deep work, as well as stretching of the arm/shoulder area.

Chris had follow up scans on 23rd March 2017 and the difference was quite astonishing! She had a new pathway going from her armpit down into the abdomen and the fibrosis had reduced significantly. So much so that they felt she wasn’t a surgical candidate and she should continue the conservative treatment in the pathways that are now available!

If only more people had access to scanning using ICG – it has been a very useful tool for customising Chris’ treatment and has been beneficial in her progress which in turn has made her much more comfortable with her lymphoedema.  There have even been times when she’s chosen not to wear all her compression for a few hours and she’s enjoyed the freedom that’s given her.

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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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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’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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I had a request after my last video for one that dealt with legs post cancer surgery, so here it is. Feel free to ask any questions if you need clarification. And if you would like to see videos on any other topics I’m open to suggestion.

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Some of my clients who have lymphoedema post breast cancer have said they’ve been following my video showing how to do their own clearing and I’ve had to remind them that for those who have had lymph node removal or radiation the process is slightly different.  So I thought it would be best for me to make another video showing how to create pathways and clear the arm properly.

 

 

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