Medical Forum / Diseases and Disorders / Cancer / January 2008
lymphedema
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J - 15 Jan 2008 09:59 GMT lymphedema - pain and swelling Skin has to kept soft? Skin has to be kept dry? Elevate legs while lying down or sleeping? Any success with that? Tried green tea? Is the pain a dull ache as if your oxygen to legs has been cut off? Pool therapy not possible because of your situation? Pain all the time or worse when lying down? What are they giving you for pain medication?
Which of these have you tried (or not) --------------------------------------------------------------------------
http://en.wikipedia.org/wiki/Lymphedema Treatment
The most common and accepted treatments of choice for lymphedema are Sequential Gradient Pump Therapy and Complete Decongestive Therapy (CDT).
[edit] Complete Decongestive Therapy (CDT)
CDT consists of manual lymphatic drainage (MLD),[1] short stretch compression bandaging, therapeutic exercise, and skin care. MLD was pioneered by Dr. Emil Vodder in the 1930s for the treatment of chronic sinusitis and other immune disorders, and is now recognized along with pneumatic pumps, and compression sleeves, as a primary tool in lymphedema management. Therapists can today receive certification through special classes conducted by various organizations specializing in MLD.
Initially, CDT involves frequent visits to a certified therapist with a doctor's prescription. Once the lymphedema is reduced, increased patient participation is required for ongoing care, along with the use of compression garments to further reduce the swelling.
[edit] Sequential Gradient Pump Therapy
Sequential Gradient Pump Therapy has been utilized for over 30 years throughout the world. Lympha-Press helped pioneer and perfect this technology with by utilizing a 12 chambered pneumatic sleeve with overlapping cells, to gently move the lymph fluid. There are several other manufacturers of these devices such as Bio Compression Systems, and Wright Linear. All of these devices are recognized treatments and approved by Medicare and most insurance plans in the USA. Patients may often receive treatment on a pump for 10-15 minutes before an MLD session to help break up fibrotic (hard) tissue. By softening or breaking up the fibrosis, the MLD Therapist can be even more effective with the given treatment. After completion of the appropriate number of MLD sessions, some patients will benefit from a home use of a sequential pump. A recent Stanford University medical studyshowed that patients receiving the combined modalities of MLD/CDT and pneumatic pumping had a greater overall reduction in limb volume than patients receiving only MLD/CDT.[2]
The MLD component of treatment consists of gentle, rhythmic massaging of the skin to stimulate the flow of lymph and its return to the blood circulation system. In the bloods passage through the kidneys, the excess fluid is filtered out and eliminated from the body through urination. The treatment is very comfortable and nonaggressive. A typical session will involve drainage of the neck, trunk, and involved extremity (in that order), and lasts approximately 40 to 60 minutes, depending on the severity and extent of the lymphedema.
[edit] Compression bandaging
Compression bandaging, also called wrapping, is the application of several layers of padding and short-stretch bandages to the involved areas. Short-stretch bandages are preferred over long-stretch bandages (such as those normally used to treat sprains), as the long-stretch bandages cannot produce the higher tension necessary to safely reduce Lymphedema and may in fact end up producing a tourniquet effect. During activity, whether exercise or daily activities, the short-stretch bandages enhance the pumping action of the lymph vessels by providing increased resistance for them to push against. This encourages lymphatic flow and helps to soften fluid-swollen areas.
[edit] Therapeutic exercise
In addition, specific therapeutic exercise while compression bandaging is worn is a valuable part of therapy, not only because it aids in the elimination of excess fluid, but also because some patients with chronic lymphedema or large, swollen areas will have poor strength or range of movement. Pool therapy using manual lymp drainage techniques will help to keep the tissue soft and assist in moving the lymphedema fluid. These patients benefit from exercise prescribed specifically for them by their physician to help improve their function and comfort.
[edit] Skin care
Skin care is an important component of CDT. People with lymphedema or who have had lymph nodes removed are at a higher risk for infections of the affected areas, and so need to be taught a specific regimen of thorough but gentle cleansing followed by moisturizing in order to keep the skin in the best health possible. Teaching higher risk sufferers about the signs and symptoms of infections is also important, since awareness is the key to early identification and treatment. Untreated infections can further damage an already impaired lymphatic system and lead to more severe lymphedema and skin ulcers.
[edit] Skin care
Compression pumps are often used in the treatment of lymphedema, but special care needs to be taken to ensure that the involved trunk quadrant is properly treated with manual lymphatic drainage before the application of a compression pump. If adequate treatment of the trunk is not carried out beforehand, the edema may be pushed into the upper portion of the arm or leg, or into the genitals. If a patient's lymphedema worsens during a course of compression pump therapy, reassessment for adequate trunk MLD is necessary. However, newer compression pump garments provide compression well into the trunk and/or abdomen and groin areas. Although very beneficial, many patients find it inconvenient or expensive to attend regular MLD treatment sessions. A 2002 Stanford University article suggests that for patients with upper-limb lymphedema, those who received both MLD and compression pump therapy experienced greater overall limb reduction.
Even after MLD, the patient may only be bandaging or receiving compression up to the axilla (arm pit area) or groin. Unless the patient is monitored during post MLD self bandaging, there is a possibility of the lymph fluid pooling in the truncal regions. For this reason, reassessment for adequate trunk MLD may need to be re-evaluated as necessary.
Surgical techniques [not included here]
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Kinesio Taping A new adjunct treatment is being taught to therapists utilizing a special type of tape called Kinesio Taping.[citation needed] It is used to help soften edemas. me says - www.kinesiotaping.com/ low confidence; but might be worth a try?
Anne - 20 Jan 2008 00:40 GMT | lymphedema - pain and swelling | Skin has to kept soft? [quoted text clipped - 117 lines] | | Surgical techniques [not included here] J -
Thanks for all the information. I will try to answer what questions I can, but for the most part, other than diagnosing it as lymphedema, and telling me to put my feet up when I can, the various docs (surgeon, oncologist, internist, cardiologist) have offered no other advice or treatment. Not sure if they just don't care or if it's an insurance issue, but it sure means poor quality of life for me.
Anyway - putting feet up (especially for long periods such as when asleep) does help a bit, but less so now than before. Pain is several different things: numb and tingly in foot (though they blame that on chemo), cold foot at times, external pain from extreme swelling (like a balloon about to burst), and a dull ache from a huge limb that feels half dead and like it has to be dragged around.
Pool not possible. Haven't tried green tea. What sort of dosage are we talking ? Pain worse when standing. Not great when sitting either. A bit less when lying down. Pain meds (which are for the cancer, not edema) are vicadin and dilaudid. But Advil actually works better. The only thing that really touches the pain (but only lasts for a few days) are the steroids I get with the chemo. None of the other techniques you mentioned were suggested to me or tried.
Any suggestions ? Any way to compel these guys to give me a referral to a specialist ?
J - 20 Jan 2008 11:03 GMT > "J" <nswex@nalid;non> wrote in message > | lymphedema - pain and swelling [quoted text clipped - 70 lines] > Any suggestions ? Any way to compel these guys to give me a referral to a > specialist ? I don't know, Anne, but thanks for answering my questions. I had a plan of action in mind, but have since abandoned it, in favor of something else.
If it were me, I'd try: 1) continue elevating leg during sleep and any other possible times.
Morning: 2) Drink 1/2 cup of green tea (a few hours before medication so as to not interfere with same). Green tea comes in bags - Earl Grey is my favorite. Go to washroom before starting next step.
3) use neoprene barbell; elevate the leg and roll it over the knee and down the thigh towards the torso. Same for down the sides of the leg and underside. (the ends must be round, not hexagon) OR there's a type with a handle; might work better one-armed. Looks like this http://www.daybreakfitness.com/Dumbbells_Weights-2_2lb_Soft_Dumbbell_Set.html They're available in different weights. If you type "soft dumbell set" (without the quotes) into a search engine, you may see Amazon $12.00/set 1.5lb weights They're probably available at local stores. I'd buy 2 different weights. I'd use that to do my own massage for half an hour every morning. 4) drink other 1/2 cup of green tea, while keeping leg elevated. 5) I'd wear tights for compression stockings the rest of waking hours.
Evening: Do the same for the lower leg for half an hour every evening.
If this plan seemed to be working, I might try heavier barbell for half an hour or same weight barbell for an hour.
If the "tights" leg stretches out of shape, I'd wear it backwards, so the tighter one was on the lymphedema leg. (New pair if it's both legs - I'm unsure from what you wrote).
That is what I would try. J
Anne - 21 Jan 2008 06:22 GMT [snip]
| That is what I would try. Thank you for all the suggestions !
xela56 - 21 Jan 2008 15:48 GMT > [snip] > > | That is what I would try. > > Thank you for all the suggestions ! If you do a google search for lymphedema clinic in your home state of NJ, there seems to be plenty of clinics. As for a referral have you tried asking? Alex
J - 23 Jan 2008 19:19 GMT > "J" <nswex@nalid;non> wrote in message > [snip] > | That is what I would try. > > Thank you for all the suggestions ! You had this conversation with Mike Radcliffe last March. It sounded familiar, but I failed to check back - :p to me. J
Anne - 25 Jan 2008 03:38 GMT | > "J" <nswex@nalid;non> wrote in message | > [snip] [quoted text clipped - 5 lines] | It sounded familiar, but I failed to check back - :p to me. | J Huh ? I'm confused. Of course my memory isn't what it was either.
J - 25 Jan 2008 20:32 GMT > "J" <nswex@nalid;non> wrote in message > | [quoted text clipped - 9 lines] > > Huh ? I'm confused. Of course my memory isn't what it was either. This is the one I was referring to. http://talkaboutsupport.com/group/alt.support.cancer/messages/135184.html Anyhow, it was worth throwing it out there again in case someone else had ideas to help. J
J - 27 Jan 2008 10:34 GMT > "J" <nswex@nalid;non> wrote in message > | [quoted text clipped - 9 lines] > > Huh ? I'm confused. Of course my memory isn't what it was either. Anne, A while back you said that Sloan Kettering wasn't covered by your insurance. A breast cancer patient contacted Hillary Clinton and got something covered that had been denied her. The polls close Feb 5th? Make a list of what you need and get it to her State Headquarters ASAP http://www.hillaryclinton.com/hq/
Send them this showing what is needed for lympedema http://en.wikipedia.org/wiki/Lymphedema What Laura aka susieboo describes sounds like too much for a person alone to do. So if you feel it would be better to enter Sloan Kettering for 2 or 3 months, say so. If you would lose income (which covers rent and insurance), list how much you would need to cover. If you need a better wheelchair, list it. If you need a lift, from bed to wheelchair; list it. If workplace needs some washroom improvements, list them; sterile place to change dressings; apartment sized washer and drier, list them. Sloan Kettering has a list of herbs and a service called "Integrative Medicine" The list of herbs is over-whelming to go through and know which might help your lymphema without conflicting with something else. They should know. They should know what would help you with pain and/or the lymphedma treatment might improve your pain. If you haven't had time away for many years, list one of those holidays we posted about some time ago.
(Have a rough draft of your monthly budget ready - have your insurance policy ready, in case she needs a copy)
Tell her you'll post for photops if it will help her campaign. A sign on your lawn. Calling for donations, as time enables, from hospital bed, whatever whe wants in return. If she doesn't want you telling others, then promise not to. But tell her "it takes a whole village to help some cancer patients; and I'm one of them. Please help me".
Get it out to her ASAP. The time she wants to make an impression is now before the polls close. Do it for you. If she helps a bit, great. If she helps a lot, wonderful, if she helps (or gets helps from others as well) with everything, woohoo! Don't give up; Try. J
xela56 - 27 Jan 2008 20:22 GMT There is federal law manadating breast reconstruction.
http://www.cms.hhs.gov/HealthInsReformforConsume/06_TheWomen'sHealthandCancerRig htsAct.asp
There is no law mandating that lymphedema be a covered service. And there is no law mandating private insurance companies to pay for care in certain hospitals.
I don't think Hillary can help, not a federal issue.
Ann,
I would hold my doctors feet to the fire and ask them for a treatment plan for the lymphedema, if they can't give you one, they should refer you to an appropiate provider.
J - 20 Jan 2008 16:21 GMT > "J" <nswex@nalid;non> wrote in message > [quoted text clipped - 11 lines] > a > specialist ? They probably don't have experience so don't know who to refer you to. Check your insurance policy for carefully worded phrases. (inclusive or exclusive) Seems to me that if an oncologist or GP wrote a letter saying that the extra weight of the lymphedema is disabling and (risks) putting a strain on your heart, might ensure coverage.
Ask on the lymphedema list at ACOR Looking for people, in your area, who've had lymphedema treatments, which treatments. who did them and were they satisfied and did insurance cover. They might have tips for you. http://www.acor.org/mailing.html?l=l
J
AKA Susieboo - 25 Jan 2008 22:24 GMT Hello everyone i dont usually post in here but for my 2cents worth here goes.;-) my husband had lymphodema for months before we were refered to a lymphodema clinic..we had 'home' wraps done before that and he got a really bad infection MRSA from it..(and RN was doing the treatment..;-(,so he had to go to wound clinic where they applied a 'silver' patch..with in 3 days that wound was healed and almost gone..i dont know what was in it,all i know is it worked..since then he had to go to a clinic for lymphedema..where they massaged ,compressed, then used moister creams (to prevent more drying and cracking)..we did those treatment 4x a week for 2 months..BUT..after going there it was worth it, they gave him compression stockings,(sorry not freebies though). not the support hose known a 'teds'..these stocking was like gramas girdle..very very hard to get on until they adhere to you feet and legs....you have to take them off at night and do it over every day..(and elevate feet at night to prevent re-occuring swelling)...he got a tremondous amount of relief with all this..this being said..my husband is a big man ,was very obese and this past december was taken to hospital with respitory destree..BECAUSE 1 DR took him off his diuretic..stupid mistake..as of today with his therapy back on ,he has lost over 100 lbs and is in re-hab doing great..it sounds like a LOT to deal with here, but thought maby you could understand what we went through and could help a little ..if you haave any questions at all,plz feel free to email me or respond in here.. im not always in news groups cause i was just dianosed with a cancer myself.(my christmas gift)..grrrr and trying to deal with that also.. hope this helps some Laura
turtletrot1 - 30 Jan 2008 20:21 GMT > lymphedema - New doay from Medscape:
http://www.medscape.com/viewarticle/568789?src=mp
J - 31 Jan 2008 10:53 GMT > > lymphedema - > > New doay from Medscape: > > http://www.medscape.com/viewarticle/568789?src=mp I'll add these here, in case anything there helps Anne or others.
http://www.annieappleseedproject.org/letreatun.html Lymphedema Treatments Are Poorly Utilized Medscape Ob/Gyn & Women's Health
http://www.oncolink.com/coping/article.cfm?c=5&s=23&ss=104&id=980 About Gynecologic Cancer and Lymphedema Your Certified Lymphedema Therapist will discuss which of these treatments is best for you. The Abramson Cancer has a team of professionals who specialize in lymphedema. Talk to your doctor or nurse about giving you a prescription to see a member of our Lymphedema Team. Abramson seems to be at Upenn http://www.penncancer.org/
http://www.lymphnet.org/lymphedemaFAQs/questions/question_01_08.htm Some questions and answers. http://www.lymphnet.org/resourceGuide/resourceGuide.htm Resource Guide, including map of the US showing locations of doctors, Treatment centers, inpatient treatment centers, Treatment/Diagnositc Centers, Therapist locations Also see " Radio Show on Lymphedema" Sunday, Feb 3rd - on the right side.
Also see "For Patients" section for Support Resources - also Net/PenPals - numerous females with LE in both legs, looking to connect with others.
http://www.encyclopedia.com/doc/1G1-169439554.html Lower-extremity lymphedema in a patient with gynecologic cancer.(CLINICAL CHALLENGES)(Case study)(Clinical report) ____________________________________________________________ If Anne's place of treatment does not have specialists, maybe the onc isn't interested because there's no money in it for him or her? Maybe she has to get a prescription from her primary doctor? ______________________________________________________________ I also (just) posted something on sci.med.diseases.cancer where some doctor was telling a woman her mother was too much work and was charging an extra fee for RT Bad attitudes need change of doctors? ------------------------------------------------------------------------------------------------
There's also a lymphedema list at ACOR (under L) http://www.acor.org/mlists/mlists.html
J
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