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ARTICLE

The Lymph Clinic and Covid-19

31 May 2020

Post Covid-19 Out-Patient management in The Lymph Clinic

This is the proposed protocol of The Lymph Clinic in anticipation of reopening our clinic doors post COVID-19 ceasing of clinical work March 24th. This proposed protocol is a reaffirmation of our commitment to a high level of ethical conduct and standards in conjunction with the mission and values of The Lymph Clinic: committed to the health and wellbeing of our clients, with compassion, kindness and integrity in a safe and secure environment.

Download the PDF for more information

WHO Confirmation of Participation in Covid-19 Infection Prevention and Control

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Self-management advice for patients with pre-existing lymphoedema during the COVID-19 pandemic

If you are currently being treated for lymphoedema, you may have difficulty accessing your therapist during the COVID-19 pandemic. This is in order to keep both patients and therapists safe from exposure. In addition, many therapists are being redeployed to other areas of the health services to assist in the effort to fight the virus.

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COVID-19 (coronavirus) Guidelines for people living with Lymphoedema and Lipoedema in Ireland

The purpose of this leaflet is to offer general advice to people living with lymphoedema or lipoedema in Ireland regarding coronavirus or COVID-19. These suggestions are designed to offer helpful advice and are not intended to replace any advice given to you by your healthcare professional.

We strongly recommend that you keep up to date with public health advice and directives in Ireland, and how coronavirus might affect you personally, by regularly visiting the Health Service Executive’s (HSE) coronavirus website at https://www2.hse.ie/coronavirus/

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Lymphoedema Resources

Links to a series of informatic videos

UK NHS Lymphoedema Network Wales specialists and patients have created this collection of 13 short films to help you understand and manage your lymphoedema. 





www.medic.video/ilf-lymph

www.medic.video/ilf-lymph-edu

www.medic.video/ilf-lymph-lva

www.medic.video/ilf-lymph-risk

www.medic.video/ilf-lymph-young

Sleep Guidelines

This clinical guide has been created by Mammoth and Physio Med and reviewed by a chartered physiotherapist recommended by The Chartered Society of Physiotherapy.

Each organisation is committed to the improvement of health and wellbeing within the population. This guide is designed to provide valuable information that will help practitioners advocate the importance of a restorative night’s sleep and how to achieve it.

Lymphatic Research and Biology


Read and share recently published articles with free access through June 25, 2020:

Alternate Electrode Positions for the Measurement of Hand Volumes Using Bioimpedance Spectroscopy
Dale O. Edwick, Dana A. Hince, Jeremy M. Rawlins, Fiona M. Wood, and Dale W. Edgar  

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Study of 700 Referrals to a Lymphedema Program
Christopher L. Sudduth, Reid A. Maclellan, and Arin K. Greene  

Read Now

Body Mass Index as a Major Risk Factor for Severe Breast Cancer-Related Lymphedema
Hélène Leray, Julie Malloizel-Delaunay, Amélie Lusque, Elodie Chantalat, Léonard Bouglon, Charlotte Chollet, Benoit Chaput, Barbara Garmy-Susini, Alexandra Yannoutsos, and Charlotte Vayssethe

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Genital lymphoedema films now available!


Lymphoedema can affect the area around the pelvis. This means that the genitals can become swollen, uncomfortable and affect daily functions. A new series of videos created by courtesy of the Lymphoedema Network Wales and produced by PocketMedic has useful explanations and helpful advice for men, women or children who may be affected by genital oedema.

Read more about the genital lymphoedema project and watch the films here -



https://lnkd.in/dS6PgPB #lymphoedema #lymphedema

Understanding Lymphedema: Keeping the train on the track.

By Dhruv Singhal, MD Illustrated by Megan Belanger, LMT, CLT. Foreword by Kathy Bates

In this entertaining and clever book by Dr. Dhruv Singhal of Harvard Medical School, with charming cartoons by Certified Lymphedema Therapist Megan Belanger, the mystery of how the lymphatic system works is revealed in simple terms. This book will serve to educate children and adults suffering with lymphedema as well as a model for physicians to better understand the disease process.

https://lymphaticnetwork.org/understanding-lymphedema-book/

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Dr Vodder Circulars

The importance of being extra safe as therapists while remaining compassionate for our patients

Coronavirus (COVID-19) and influenza are upon us. People most adversely affected by COVID-19 are the elderly and those with preexisting conditions. Those are the patients that come to us so we have extra responsibility to prevent contagion.

This is why the following is important. Touch therapy practitioners have one of the highest risks of contracting or spreading microorganisms that cause disease in society as we frequently work with hands directly on the skin.

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COVID-19 (Coronavirus) Guidelines for the Lymphatic Disease Community

This strain of coronavirus is a new one and scientists do not yet know all there is to know about it. While these common sense points will always be helpful, it is important that you keep up to date with the advice being given by the Centers for Disease Control and Prevention (CDC) and NHS England and how it might affect you personally. These suggestions have been produced using the most up-to-date advice available to us from our Scientific and Medical Advisors and are not intended to replace or supersede advice you may have been given from your health care professional.

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Download this simple guide to Nordic Walking for Lymph fitness

Guidelines on Diet and Physical Activity for Cancer Prevention

June 10, 2020 by Hannah Slater

The American Cancer Society published new guidelines focused on staying at a healthy weight, staying active throughout life, adhering to a healthy eating pattern, and avoiding or limiting alcohol.

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COVID-19 (Coronavirus) Guidelines for the Lymphatic Disease Community

11 May 2020

This strain of coronavirus is a new one and scientists do not yet know all there is to know about it. While these common sense points will always be helpful, it is important that you keep up to date with the advice being given by the Centers for Disease Control and Prevention (CDC) and NHS England and how it might affect you personally. These suggestions have been produced using the most up-to-date advice available to us from our Scientific and Medical Advisors and are not intended to replace or supersede advice you may have been given from your health care professional.

Our experts tell us that in nearly all cases lymphedema (LE) (also spelled lymphoedema) alone does not make one more susceptible to the coronavirus. The only exception would be those very rare primary LE patients who have extensive lymphatic abnormalities involving the chest, i.e. lungs, and have generalised immune deficiency; we are assured those patients will know who they are.

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The importance of being extra safe as therapists while remaining compassionate for our patients

Coronavirus (COVID-19) and influenza are upon us. People most adversely affected by COVID-19 are the elderly and those with preexisting conditions. Those are the patients that come to us so we have extra responsibility to prevent contagion.

This is why the following is important. Touch therapy practitioners have one of the highest risks of contracting or spreading microorganisms that cause disease in society as we frequently work with hands directly on the skin.

Respiratory disease is airborne and transmitted by micro water particles that can be broadcast by a sneeze or cough, 3 to 6 feet. Molecules can linger on the face or in the hair if you or your client covers the mouth with the hand as one sneezes. It then is in the hand and the air. Then the patient lays down and the therapist does cranial work to the head. The therapist now has the germs on their hands and touches a door knob or itches their own nose or touches their own face and goes on to touch someone else.

Most of the time we are in session if we touch our face or hair, we are actually the transmitter of pathogens to ourselves or others. Molecules can linger on a door knob, arm of a chair, side of a treatment table, waiting room countertop, water cooler button, the pen the client uses to write a check or the one we use to do notes.

Click on the logo to visit the National Lymphoedema Framework Ireland website for a series of short films

nlfi

 

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Microvascular fluid exchange and the revised Starling principle

29 Feb 2016

The plasma, interstitial fluid (ISF), and lymph compartments are linked in series and, in the steady state, fluid flows continuously from one compartment to the next. Lymph drains back into the circulation chiefly at the major veins at the base of the neck. Accidental lymphatic fistulae in the neck indicate a total post-nodal lymph flow of up to 4 L/ day in humans. Later work revealed that roughly half the fluid content of afferent lymph can be absorbed by lymph node microvessels,1,2 raising the fluid turnover estimate to !8 L/day.3 This is a considerable fluid turnover; since human plasma volume is only !3 L, the entire plasma volume (except the proteins) leaves the circulation approximately once every 9 h.

Substantial fluid movements between the plasma and interstitium account for the rapid swelling of acutely inflamed tissues (minutes), and for the oedematous swelling of venous thrombosis, cardiac failure, and lymphatic failure over hours to days. Conversely, haemodilution following an acute haemorrhage reveals a rapid absorption of ISF into the blood stream (!0.5 L in 15–30 min). Acute fluid transfers are important medically, because lasma volume is a majordeterminant of the cardiac filling pressure and thus cardiac output (Starling’s ‘law of the heart’).

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Lymphedema: Separating Fact From Fiction

Lymphedema in right arm of patient; from Boris M, et al. Oncology. 11:99-109,1997
The most recent survivorship data from the Surveillance, Epidemiology, and End Results (SEER) database demonstrate a significant increase in the number of US cancer survivors over the last 30 years, from roughly 3 million in 1973 to nearly 12 million in 2008.[1] As a result, issues of survivorship have stimulated new focus for clinical trials, not only to determine the most effective therapeutic regimen (surgery, drug, or radiation) but also to identify the one with the least influence on future quality of life. Lymphedema has long been a feared complication of surgical cancer treatment, and notably one that negatively impacts survivorship. Fear of lymphedema stems from patient concerns regarding the chronic, progressive nature of the condition and the clinician’s relative inability to predict or prevent its development. Furthermore, decades of physician and allied health teachings based on opinion and theory have perpetuated the myths shrouding lymphedema risk, prevention, and treatment.
A vast body of literature documents the occurrence of breast cancer–related lymphedema, with more than 1400 articles indexed in PubMed-MEDLINE databases alone. Importantly, lymphedema also exists after surgery for non–breast-cancer-related malignancies, but data documenting this occurrence are rare in comparison. Recently, Cormier et al found only 47 studies between 1972 and 2008 with more than 10 patients that prospectively evaluated lymphedema as a primary or secondary outcome after treatment for melanoma, bladder, sarcoma, penile, prostate, vulvar, cervical, endometrial, or head and neck cancers.[2] The authors’ analysis of these studies demonstrated the overall incidence of lymphedema to be 16.3% after melanoma, 10.1% after genitourinary cancers, and 19.6% after gynecologic malignancies, and notes that lymphedema rates are higher when the lower rather than upper extremity is affected. Given the abundance of breast cancer data, this review will focus on breast cancer–related lymphedema. However, the principles and controversies discussed are relevant regardless of the type of malignancy to which the lymphedema is attributed.

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The Big Picture: Every thing you wanted to know about lymphoedema

It’s often a surprise for both you and the health professional when a limb begins to show the early warning signs of lymphoedema or actually becomes swollen. It’s difficult to predict the effects of surgery and/or radiotherapy on the lymphatic system and thus whether a limb will swell not only because of anatomical variation between individuals but also as a consequence of other prior events on the local area lymphatic system. However, as the bottom line, if the lymphatic load becomes greater than the lymphatic transport capacity then that area, whether it be associated with a small lymph collector, a whole lymphatic territory or the whole limb, will become swollen.
Some of you may also have had prior damage to their lymphatic system, for instance soft tissue injury, frozen shoulder or problematic hip joint and of course on top of this we have heart and blood vessel issues and thyroid problems, inflammatory events, heritable conditions from your parents and problems with fat deposition and its removal (called Lipoedema – more about that later!), although the latter are primarily confined to the legs.
Being aware of the non-lymphatic side of the problem and directing specific treatment towards them before dealing with the lymphatic system issues is important for you if we are to achieve the best outcome for the specific lymphatic system treatment, which focuses on reducing the load on the remaining lymphatic system and/or improving its transport capacity. (I can’t emphasise the importance of this point too much!) Generally, your main role is in lymphatic load management while the lymphoedema therapist should have their main concerns with improving lymphatic flow and transport.
Once lymphoedema has developed there are no treatment or management miracles, thus prevention though early detection and risk minimisation is crucial. At the moment we do have the knowledge and tools undertake this but there is poor insertion into practice.
Not withstanding this, there are some strong emerging treatment options. Once the problem of lymphoedema or its risk is detected there must be ongoing good communication with the specialist
until you are discharged to the General Practitioner (GP), and then between the GP, the lymphoedema therapist, other members of the multi-disciplinary team and yourself to achieve optimal outcomes. As hard as it sometimes is your compliance is critical if good outcomes are to be attained.

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