Archives for posts with tag: Mobiderm

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

Advertisements

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!

IMG_1794.jpg

http://lisahiggins.ntpages.com.au

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!

http://www.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:

.

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