Archives for posts with tag: manual lymphatic drainage

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.

http://ntpages.com.au/lisahiggins

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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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.

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

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.

 

 

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

The most commonly searched term on my blog is “lipoedema”.  There is little understanding out there of the condition and frustrated ladies take to the internet to see what they can find out for themselves, because there are precious few in the medical arena who have any understanding of the condition.

So I thought I’d write a blog on how you can get help – what I’ve found out over the last couple years as to what works and what doesn’t, keeping in mind of course that while one thing may work for you, it may not for someone else.  I’m not going to go into what lipoedema is today as I’ve written a blog on that before, here‘s a Wikipedia explanation.

The first place I send people is to LASS (Lipoedema Australia Support Society).  This is a group of fiercely strong women who are searching for answers and getting information out there in as many forms as possible.  This year a number of them did the unthinkable – they bared their bodies for photos to make posters to put in doctor’s surgeries (or anywhere else they felt it might raise awareness).  You have to understand that most of these courageous women have covered up for their entire lives.  They have a closed Facebook group that you can join and I’d strongly recommend this.  The group has many files with information on diets, treatments that women have tried, surgeons, therapists, compression, financial support available through the government, and much more. They are organising their second Lipoedema conference for June 2016, to be held in Melbourne.

Lipoedema ladies, photo courtesy LASS

Lipoedema ladies, photo courtesy LASS

I’ve learned (from the LASS FB page) that a Lymphoedema and Lipoedema Community Seminar is being held on the Gold Coast on the 10th September at the Beenleigh Distillery/Tavern, 114 Distillery Road Yatala, late notice I know, but if anyone is in the area you should check it out.

On to concrete things I’ve learnt.  Again and again I hear from various sources (including the patron of LASS and my lecturer, Prof Neil Piller) that water exercise is the BEST thing for lipoedema.  That could be as little as floating around in the water if your knees or hips can’t cope with too much more, walking in the water, swimming or doing water aerobics.

If you can’t get into the water, then walking is always good.  Or rebounding.  Or whatever exercise you are used to doing, the main thing is to keep your body moving and active as much as you are able within the constraints of the condition.

Diet.  Now here’s the thing.  There isn’t any one diet that has been proven to help, but there are many diets that have been tried with some success.  The RAD diet by Dr Karen Herbst seems to be very effective.  Prof Piller recommends an anti-inflammatory diet.  To me, they all seem to agree that eating a diet high in whole, unprocessed foods is going to be beneficial.

Treatment.  The most frustrating thing of all is the lack of treatment (other than of course the lack of diagnosis or belief that the condition exists).  Common sense tells us to keep up the exercise and watch the diet but what else has been proven to work?  Nothing.  But, most women do respond favourably to manual lymphatic drainage and compression (obviously if they can tolerate it).  Dry body brushing also seems to help.  There are  deep breathing exercises that have been proven to stimulate the lymphatic system (thank you Prof Piller for his research).  There has been discussion on vibration plates and Prof Piller has done some research and found that these can be beneficial if used on a very low setting for a short period of time.  Care must be taken with other pathologies such as weak knees or hips.

The Rolls Royce of treatment is WAL (water assisted liposuction).  The link is to a study published on PubMed.  This is a specialised form of liposuction which minimises the damage to the lymphatic system, uses local anaesthetic rather than a putting you completely under and harvests fat rather than general tissue.  There are a number of procedures over a few weeks and compression is worn afterwards to maximise the results.   Post operative recovery is excellent.  This treatment is not available in Australia yet but Germany is advanced and experienced in the procedure and the follow up recovery period.  German clinics and hospitals are at the forefront of lymphatic research and treatment.  The main form of liposuction used for lipoedema in Australia is called Tumescent Liposuction.

Where to from here?  That’s up to you.  If you haven’t been diagnosed yet, but suspect that you have lipoedema then I’d suggest finding a doctor, physiotherapist or massage therapist who can diagnose you.  Easier said than done.  There is a list of therapist and doctors on the LASS FB page that may be of assistance.  In Australia you can get a care plan to see a physiotherapist for five sessions that Medicare will subsidise.  Massage therapists are not covered by Medicare but most will be registered with private health funds which can offer rebates to help offset the costs.

I am more than happy to talk to anyone about options if you’d like to send me a message.  This condition is something I am passionate about and education is vital, there is not enough information available and it can be very confusing and overwhelming trying to sift through what is out there.

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

Recently I was contacted by a local chiropractor after I treated one of his patients for swelling in her foot.  She’d had treatment from him, from a podiatrist and had been to see a foot specialist but after two sessions of Manual Lymphatic Drainage her condition had improved significantly.  He wanted to know more and to see if there were ways we could refer to each other to enhance our individual treatments.  We did a “body swap” – he gave me a chiropractic treatment and I have him a lymphatic treatment.  And he offered to write a guest blog for me on a subject we both deal with – sinus.  Here’s what he has to say about using chiropractic for sinus treatment.  And here’s a link to a post I wrote a while back about Manual Lymphatic Drainage for sinus (among other things).

Are You Having Sinus Troubles? – Dr Andrew Ullo (Chiropractor)

Do you wake up with a stuffy head and mucus in your throat? Do you have a headache behind the eyes? Do you suffer from cold like symptoms frequently? Then you may be suffering from sinusitis.

Your sinuses are eight hollow cavities in the bones of the forehead, cheeks and temples. Although they help you to breathe, they also prevent breathing sometimes, when they get inflamed and blocked with mucus.

Healthy, open sinuses are lined with mucus to help ensure that the air you take into your lungs is moist, warm and free from dust, dirt and other pollutants. Without this filter, the lungs, kidneys and blood can become permeated with toxins.

When the sinus lining is inflamed, swollen and full of mucus, the condition is called sinusitis. Sinusitis can commonly occur when you’ve had a cold and it clears up when the cold ends. However, if the drainage is blocked, pressure increases and can cause pain, discomfort, sinus headaches and swelling around your eyes, cheeks and ears. There are also some subtle signs of sinus difficulties, such as snoring, sore throat, coughing, sleep disturbances and a running nose.

How can Chiropractic care help with sinus issues?

Chiropractors understand the importance of a properly functioning nervous system and the mechanics of the body. So, decreasing the stress on the nervous system and removal of obstructions for the proper drainage of the sinuses, specifically in the neck and back, will help your body work more efficiently and allow the bodies fluids to drain without interference.

When you have restriction in your joints in your neck or cranial bones, you will find the muscles that attach to them to become stiff and the joints also become swollen and when these areas are restored from chiropractic adjustments, you can find it will dramatically assist with the recovery from the condition.

There are also specific chiropractic techniques designed to free up the sinus area from blockage. This generally involves a gentle massage of the nose, forehead and cheeks to release the pressure on the sinus cavities and allow the area to drain properly.

The other way that chiropractic can markedly help these problems is through increasing a person’s general health, and the strength of their nervous system. Evidently, when your body is in a better condition, it will have a stronger immune system and be able to fight infections and sicknesses more easily.

Consequently, if you get issues with your sinuses, whether it be sinusitis, regular colds, congestion or stuffiness, consult your Chiropractor or give the professionals at ABSOLUTE HEALTH SOLUTIONS a call today and see how they can help on 9948 2826.


Three weeks ago I had a new client come to see me.  Denise is a 63-year-old woman who had a sore, bruised and swollen thigh.

Her upper leg started to swell on Christmas Day for no reason at all.  She had a large lump/bump laterally on her knee.  She was sent for various tests … an MRI, ultrasound, x-ray … all were clear.

Then, about ten days before coming to see me, Denise developed bruises down her thigh.  No injury.  No trauma of any kind.  Her doctor took a sample of fluid from the swelling on her knee and found that it was actually dried blood – that was tested and given the all clear.  The last injury she could remember on her leg was a “cork” she’d received over forty years before.   Her doctor thought that perhaps the blood came from that incident but there was no conclusive evidence.

She had not been able to weight-bear the week before coming to see me, her leg had been too swollen and painful.  Her knee was so painful it had stopped her from playing lawn bowls and she couldn’t bend it to go up and down stairs.  Lawn bowls is the only exercise she’s been able to get since she had back issues three years ago, when she spent three weeks in hospital and walked for six months with a stick.

Denise was given a referral to see a knee specialist after a scan showed a possible bone on bone scenario, the report basically said she needed to get a new knee, but her GP disagreed with that finding and felt she needed another opinion.  The specialist looked at her scans and agreed, her knees were fine and they were not the cause of her problems.

She has multiple health issues including a prior clot that had made its way to her lung and polycystic and multi cystic kidney disease.  But none of these could be responsible for her leg swelling.

What brought Denise to me was a segment on A Current Affair called “Neck Pain No More” which featured Low Level Laser treatment for a number of conditions.  She had called the business featured in the segment and her name and number was taken but they were so overwhelmed with enquiries, they said they’d call her back (they still haven’t).  Two weeks later she was in my clinic because she had done a google search and found that I had a Low Level Laser.  I’d post a link to the segment but when I tried to watch it online I could find the text but the video was incorrect (I have written to ACA to ask them to fix it, they are working on it).

So, here are some photos of Denise’s leg when she came to my clinic that first day.

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We decided to do some manual lymphatic drainage as well as laser and Denise wanted to work intensively, as she was going away for three months and wanted to feel better before she went.  The trip was in two weeks from the day she came to me.  That first day we did 15 minutes of laser and the rest was lymphatic drainage.  At the start her knee was painful when I touched it but by the end of the session her pain levels were down.

We did four treatments the first week and three the second, increasing the amount of laser to 25 minutes.  Each day the swelling and bruising reduced.  Most days she felt her walking improved but the bending was still restricted.

By the fourth treatment she felt she could get out of chairs easier.  At the fifth treatment the bruising was almost gone and the ladies at the bowling club had “diagnosed” her with bursitis.  She had gone home and googled the condition and felt it fit for her.  I must point out, this is not a medical diagnosis, it’s peer diagnosis. But she was happy with that.

By the last treatment she could get in and out of her car much easier and the bruising was gone and swelling was down.  She was a happy lady when she set off on her trip.

Here are some photos taken on her final treatment.

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Visit my website here for more information on the different techniques I use.

A listing in the NLPR is the bees knees in the manual lymphatic drainage world.  For those not in the know, NLPR stands for National Lymphoedema Practitioners Register and it’s a listing on the ALA (Australasian Lymphology Association) website.  Getting a listing on this website is one of the many reasons why I upgraded my skills this year and it has been a process to get there (and I’m not quite there, but almost … I think).  Click here to read about the NLPR on the ALA website.  Professionals, particularly in the oncology world, point patients to the NLPR to find therapists so it is vital to have a listing, it adds credibility to your practice.

On the Monday after I finished my Vodder training I sent off my paperwork to rejoin the ALA (I had let me membership lapse last year).   I had a call from the ALA to give me a refund of part of my membership fee as I had sent in the full amount for a full membership, but as I’m not a physiotherapist I can only be an associate member, silly me, I did know that from years ago but it slipped my mind.  I kept checking to see if my name was listed on the register but after two months I decided to write an email checking to see how long it would take.  As I finished sending my email I received one from my trainer, Jan, who was frustrated that none of us who completed the training had put ourselves on the register.  Isn’t timing amazing?  I quickly forwarded her the email I had just sent and shortly afterwards received a reply from the ALA that pointed out that membership to the ALA and listing on the NLPR were two completely separate things!  Oh, ok.  Not one of the fifteen of us who were eligible to join had worked that out.  Hmm.

So.  I duly filled out the paperwork, attached all the required documentation and paid the additional fee.

And I waited.

And Eureka, on Friday I got a certificate from the ALA confirming my listing on the NLPR!  Yay.  Here it is.  I’m still not up on the website so I presume it will be listed in January (as that is when the certificate is current).  Small steps.

NLPR registration certificate

NLPR registration certificate

A few weeks ago (the day after the launch of the Lymphoedema Stories booklet) I had a gap in my schedule and decided to take a walk around my work neighbourhood with a few copies of the booklet and my business cards and introduce myself to a couple of the local medical practices.  I’ve sent numerous letters and emails to various medical groups over the years and to be honest, there’s never any response but I haven’t done the rounds in person.  That’s a whole other kettle of fish.

The first practice I went into I was greeted by a lovely receptionist who listened intently, exclaimed how useful it would be to have the information as they have a few lymphoedema patients and she took a couple booklets and some of my cards to distribute amongst the doctors.

In the second practice, a brand new premises (old practice, new digs) I was again very welcomed by the receptionist.  I showed her the booklet and asked if I could leave some for the doctors and she suggested that the best approach might be to book in to one of the “rep presentation slots” they schedule regularly and that way I could have access to the doctors directly.  She said there were seven doctors in the practice.  I thought, what a great idea.  So I booked myself in for about two months later which was the earliest we both had a gap at the same time.

Last Friday I sat and made up a short powerpoint presentation with a few dot points … the functions of the lymphatic system; benefits of manual lymphatic drainage; conditions it helps; lipoedema and some before and after photos that my clients had given me permission to share.  I calculated I’d probably have ten to fifteen minutes max in order to convince them of the benefits of lymphatic drainage.

Yesterday was the day and I felt very confident, which was a bit of a surprise for me – I don’t have a lot of experience with public speaking and I usually get very nervous before hand but it wasn’t like that this time.

In I walk at 11.45 for my presentation at 12 o’clock (have I ever mentioned that I am chronically early?).  I introduced myself to the receptionist who said “ah yes” then looked at me expectantly.  “I’m a little early” I offered in response to her quizzical look.  She replied “the reps usually bring lunch”.  Huh?!  After a second’s pause I replied “but I’m not a rep and I don’t have an expense account and you didn’t tell me that when I made the booking”.  “Well, the reps always bring lunch, I figured you’d know”.  “But I’m not a rep”.  “Well, the reps usually bring lunch”.  By that stage I was ready to hit the roof … not a great start.  So I asked if I should go and get some food and she said “it’s really up to you, but the reps usually bring lunch”.  Agrhhhh!

I went and got some sushi and was back in time for 12.  It pays to be early right.

In I walk and she then tells me to set up in the kitchenette behind her and that’s where I’ll be presenting.  Honestly, three people could stand shoulder to shoulder in the space but they would be squashed, not a lot of room.  So I set up my little lap top on the bar fridge and waited.  At 12.10 a doctor walks in and says “what do you have for us”?  My response probably could have been a bit more civil, but I was in a bit of a grump by that stage.  I said “well, the foods there and …”.  Just then two female doctors walked in, one pregnant (not that that is really relevant) and one who was clearly the Alpha doctor.  So I thought to myself, three doctors at once, great, I’ll start.  Here goes.

Clearly I couldn’t go the whole presentation, even though it was short so I quickly introduced myself and what I did, mentioned a couple of functions of the lymphatic system and launched into conditions lymphatic drainage is used to treat.  I did use my slides for that and Alpha doctor was on me … chronic fatigue?  What’s that got to do with lymphoedema?  Well, nothing at all, but lymphatic drainage works to build the immune system for those with chronic illness.  Oh.  Acne?  How do you treat that?  Oh.  When I got to talking about lipoedema (which is the main thing I wanted to highlight as it’s an under-diagnosed condition that affects up to 11% of the female population) she had lots of questions, which was great.  I got to explain lots about it.  Her final comment on lipoedema was “well, if it’s a progressive condition why would patients come to see me about it?”  I tried my best to be calm … “because they don’t know they have it, because few medical people know about it, because if you can recognise it (I didn’t dare suggest that she might be able to diagnose it, I thought that was something that doctors did for a living) you can help them understand the condition and what they can do to slow down it’s progression”.  Oh.

To be fair to Alpha doctor, she took some of my cards, a copy of the Lymphoedema Stories booklet and an info sheet for GPs on lipoedema that I had brought along with me.

All three doctors left and I hung around for another twenty minutes just in case.  The pregnant doctor came back in with lunch, she couldn’t eat the sushi so went out to get her own.  I asked her if she thought any other doctors would be coming and she said probably not, she though I was pretty lucky to have got three!  Actually, that makes her sound mean but she was lovely and said it in a kind way.  And I appreciated her saying it.

I packed up my laptop and information and said my goodbye to the receptionist who again looked surprised.  “But there’s one more doctor who may come”.  “How long will she be” I asked, because I had back to back clients booked in from 1.30 and it was now 12.40 and I had a twenty-minute drive back to the clinic.  “Well, she has a patient in with her now and one more to see….”.  I thanked her for her time and left.

Do I think it was worth doing?  Yes.  Even though Alpha doctor was aggressive in her manner she asked relevant questions and took information away with her.  Will something come of it?  Who knows.  Would I do it again?  Yes.  But next time I’ll come with lunch!

 

I have to start this post by saying a big thank you to Kate, who has kindly given me some photos of herself to use to demonstrate how beneficial Manual Lymphatic Drainage is for bruising.

Kate is one of my regulars, but she usually comes for a remedial massage.  She is a very fit, energetic mother of three who trains hard in her spare time, in between mothering, being a wife and helping to run a small charity called “The Sisterhood”.

The Sisterhood collections donations and supports The Manly Women’s Shelter with items such as toiletries, cleaning goods and equipment and a regular delivery of organic, free range mince as well as home-made meals for their freezer.  The Sisterhood also organises micro finance loans, particularly lending to the Kiva Foundation, helping women in impoverished communities around the world.

As if her life isn’t busy enough, Kate and three friends recently participated in The 2013 Sunsuper Ride to Conquer Cancer benefiting The Chris O’Brien Lifehouse.  In case you’re wondering, that’s a 200km bike ride over two days!  A few weeks ago, while on holiday in Queensland and doing a training ride, Kate was knocked off her bike by a car.  Luckily she wasn’t hurt and after a week or so with her feet firmly on the ground and a couple osteopathic treatments she was back on her bike training.  About 10km before the end of the event Kate came off her bike, losing consciousness for a very short while and she was taken off to hospital for a thorough check.  So disappointing to be that close to the end and not be able to finish, but her team mates continued the ride at her request and completed it.  Amazingly, the only injury Kate sustained was bruising to her face and one small bruise on her leg.  Doesn’t that just show how fit and strong she is?

Kate had an appointment booked in with me for a remedial massage the Saturday after the ride but of course with her bruising there was no way she could lie face down so we did a lymphatic drainage instead.  She came in for a follow-up on the Tuesday.  She took the first photo a day or two after the race and the second photo was taken three days after her second treatment.  Spot the difference anyone?

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I know I usually post about people who are courageous in spite of their illness or circumstance, but this post is about courage of a different kind – courage to lead a life that gives back to those who are less fortunate.  Well done Kate – truly an inspiration.