31 May 2020
Post Covid-19 Out-Patient management in The Lymph Clinic
WHO Confirmation of Participation in Covid-19 Infection Prevention and Control
Self-management advice for patients with pre-existing lymphoedema during the COVID-19 pandemic
COVID-19 (coronavirus) Guidelines for people living with Lymphoedema and Lipoedema in Ireland
Links to a series of informatic videos
Lymphatic Research and Biology
Genital lymphoedema films now available!
Understanding Lymphedema: Keeping the train on the track.
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.Read more ...
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
Read more ...
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 15â€“30 min). Acute fluid transfers are important medically, because lasma volume is a majordeterminant of the cardiac filling pressure and thus cardiac output (Starlingâ€™s â€˜law of the heartâ€™).Read more ...
Lymphedema in right arm of patient; fromÂ 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. 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 clinicianâ€™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 cancerâ€“related lymphedema, with more than 1400 articles indexed in PubMed-MEDLINE databases alone. Importantly, lymphedema also exists after surgery for nonâ€“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. The authorsâ€™ 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 cancerâ€“related lymphedema. However, the principles and controversies discussed are relevant regardless of the type of malignancy to which the lymphedema is attributed.
Itâ€™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. Itâ€™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 â€“ 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 canâ€™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.
Copyright Â© 2016 The Lymph Clinic. All Rights Reserved
Website Design by The Digital Department