severe lymphoedema L A O S A ERIKA VAN DER MESCHT Lymphoedema Prevalence WORLD HEALTH ORGANISATION ESTIMATED IN 2014 World wide 12 of the population lives with lymphoedema But in Africa NO EPIDIMIOLGICAL DATA ID: 929877
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Slide1
Educating patients and health care providers about how Complete Decongestive Therapy (CDT) can help reduce the risk of developing severe lymphoedema
L A O S A - ERIKA VAN DER MESCHT
Slide2Lymphoedema PrevalenceWORLD HEALTH ORGANISATION ESTIMATED IN 2014World wide 1-2% of the population lives with lymphoedema…..? But in Africa - NO EPIDIMIOLGICAL DATA…?120 million people suffer from lymphatic Filariasis2-3 Million people has Primary lymphoedema
20 Million cases as a result of breast cancer treatment (6%-83%)
L A O S A - ERIKA VAN DER MESCHT
Slide3Why is lymphoedema patients not diagnosed in South-Africa???Very few lymphoedema therapist available in South-AfricaTraining in SA was not available until 2015Doctors didn’t know about conservative therapy optionAvailabiliity of Compression products were limitedThus no early referrals and diagnoses of lymphoedema First line of treatment is just diuretics = which could potentially lead to worsening the lymphoedema
The result = Severe stage 2 and 3 lymphoedema
L A O S A - ERIKA VAN DER MESCHT
Slide4Congenital
Lymphoedema
Secondary arm Lymphoedema due to Breast cancer Therapy
Secondary
Trunkal
oedema
Post mastectomy
Venous insufficiency
with venous ulcer
L A O S A - ERIKA VAN DER MESCHT
Slide5Primary lymphoedema Pancreas and kidney transplant due to severe diabetesBorn with a heart defect C
ellulitis infections
Pelvic CA with lymph node dissection
L A O S A - ERIKA VAN DER MESCHT
Slide6Chronic oedemaOEDEMA THAT IS PRESENT FOR MORE THAN 3 MONTHS SHOULD BE DIAGNOSED AS LYMPHOEDEMA REGARDLESS OF THE CAUSE Because the lymphatic system is not managing to reabsorb the access fluid
And this can be treated with MLD and if necessary MLLB
L A O S A - ERIKA VAN DER MESCHT
Slide7COMPLETE DECONGESTIVE THERAPY 1. Manual Lymph Drainage(MLD). 2. Multi-layered bandaging system.
3.
Exercise therapy 4. Skin Care and Wound Care
5. Scar tissue management
L A O S A - ERIKA VAN DER MESCHT
Slide8Lymphatic contractile function after manual lymphatic drainage using near-infrared fluorescence imaging. (NIRFI)
Normal Lymphatic flow of the arm
Abnormal Lymphatic flow of a legL A O S A - ERIKA VAN DER MESCHT
Slide9Fluoroscopy Guided Manual Lymphatic DrainageManual Technique to visualize in real time with Near infrared imaging of the dermal lymphaticsIdentify patients at risk of developing lymphedemaMap out MLD treatment plans based on individual flow patterns
L A O S A - ERIKA VAN DER MESCHT
Slide10Case studyThis 69 year old lady - radical mastectomy of right breast with 11 lymph nodes removed in 2011. 2013 the cancer spread to the lymph nodes in her neck and another 4 lymph nodes were removed. Chemo- and radiation therapy in 2011 and in 2013She was thus a high risk patient to develop lymphoedema……
L A O S A - ERIKA VAN DER MESCHT
Slide11Treatment: MLDL A O S A - ERIKA VAN DER MESCHT
Slide12Skin careWashing arm and putting cream on before bandagingMaking sure nails are cleanCovering irritated areas of skin with elastic taping to avoid frictionPutting more padding over skin folds later in treatment
L A O S A - ERIKA VAN DER MESCHT
Slide13MULTI-LAYEARED SHORT STRETCH BANDAGES
Stocking net
2. Easifix S3. SoftbanComprifoam5. 6 cm
Comprilan
Short stretch bandage
6. 8 cm
Comprilan
Short stretch bandage
7. 10 cm
Comprilan
Short stretch bandage
8. 12 cm
Comprilan
Short stretch bandage
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L A O S A - ERIKA VAN DER MESCHT
Slide14ExercisesHead turns: Keep shoulders level, turn head to the right, back to the middle, then to the left. x5Look slowly up, then down, then rest in centre x3Shrug shoulders up, then down x5Roll shoulders forwards in large circles x5, then roll backwards x5
Lift both arms slowly out sideways to 90° (for the first two weeks) whilst taking in a deep breath in, lower your arms slowly as you breathe out x3(After 2 weeks start raising your arms higher up as far as you can)
Slow and gentle circular massage in the armpit on the non-surgical side, for 30 seconds to empty nodesSlow and gentle circular massage in groin on the same side as surgery to empty nodes x 30 seconds.Place hands on abdomen just above belly button. Take a slow deep breath in(like a balloon blowing up), relax and breathe out as you gently press on abdomen with hands x5Bend elbow and touch hand to shoulder, then straighten elbow x5
Circle wrist x5
Make a fist, then straighten fingers x5
Go back and massage
armpit for 30 sec,
relax with arm elevated
L A O S A - ERIKA VAN DER MESCHT
Slide15Elvarex Compresion Sleeve and GloveWith a Night DeviceFlat knit arm sleeve and glove Night device
L A O S A - ERIKA VAN DER MESCHT
Slide16Circumferential measurements (cm)
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Slide17Before After
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Slide18Excess skin:L A O S A - ERIKA VAN DER MESCHT
Slide19Excess skin hand:L A O S A - ERIKA VAN DER MESCHT
Slide20If she got treated earlier……..Eg. Jobst Bella lightPossibly no night device…?L A O S A - ERIKA VAN DER MESCHT
Slide21What if………Every patientt with compromised lymphatic system is immediately educated on risk reduction protocols (Torres, et al 2010 – effectiveness on early education and treatment) Products to treat lymphoedema was available to all patients, regardless of their financial statusAll first line practitioners knew about CDT and the effectiveness thereof
We can educate all health care varsity students on how to diagnose lymphoedemaWe could use the technology that is out there to reduce the risk of severe LE
L A O S A - ERIKA VAN DER MESCHT
Slide22Take hands and spread the word about Reducing the risk of lymphoedema and the treatment of Lymphoedema once it presents L A O S A - ERIKA VAN DER MESCHT
Slide23A patient once said to me….Thank you for giving me back my independence: I CAN DRIVE AGAIN I CAN WALK AGAIN I CAN START LIVING MY LIFE AGAIN, BUT OH HOW I WISHED I MET YOU LONG AGO….
L A O S A - ERIKA VAN DER MESCHT
Slide24ALL THESE PATIENTS BEG…..Please start talking about Lymphoedema
Thank you!!!
L A O S A - ERIKA VAN DER MESCHT
Slide25??
L A O S A - ERIKA VAN DER MESCHT