How
do you treat Lymphedema?The gold standard treatment is a form of medical
massage that can be
called:Manual Lymph Drainage (MLD)Lymph Drainage
Therapy (LDT)Complete/Complex Decongestive
Therapy (CDT)The goal of
therapy is to activate fluid circulation, to drain stagnant areas, stimulate
the
immune system, reduce pain, and keep muscle spasms to a
minimum.To perform Lymphedema therapy,
one must be certified and
properly trained, look for your therapists credentials.Therapy feels like a
massage
only lighter. Your therapist will work on your body,
usually head to toe. He/she will drain the nodes which
again, feels
like a massage. The main nodes are the waterwheel (behind earlobe), clavicle
(near collarbone),
axilla (under arms) and the iliac/inguinal nodes
which are in the abdomen. A good deal of time is spent going
back
and forth to the main nodes to ensure good movement of fluids. Extra time will
be spent on areas of
swelling. Before you are worked on, the
therapist will take your medical history and measure your areas of
swelling. This is done so they can keep a record of how you progress to
a smaller level.You will be taught
to perform self bodywork, how to
care for your skin, possibly skin brushing, do's and don'ts, special
exercises
to promote lymph flow, and how to wrap yourself. You usually are wrapped after
each session.
After you maintain the same size for a period of
time, you will be ordered compression garments (sleeve,
stockings)
to wear instead of wraps.When NOT to go to or schedule therapy: You should not
schedule or
go to an appointment if: You have active or acute
infectionsYou have a fever or inflammed red skin and
possible
infectionThrombosis (serious circulatory problems)Major heart problems
(bodywork increases the
cardiac load)BleedingYou are unable to
urinateAlso if you have any unexplained lumps or possible
malignancies, you need to check in with your doctor and therapist. NEVER
forget to tell your therapist
about any problems you are having,
and ALWAYS have your therapist update your health records to any
new medications or problems.You should always have a current
prescription for bodywork. Most
therapist will not treat you
without a referral.ALWAYS check your therapists credentials before you have
bodywork done.
This is a must read:
A systematic review of the evidence for complete
decongestive therapy in the treatment of lymphedema from 2004 to
2011.
http://www.ncbi.nlm.nih.gov/pubmed/22920313
DIURETICS - HOW EFFECTIVE ARE THEY?Reputable
health authorities advise against using diuretics
in the treatment
of lymphedema pointing out that the therapy is generally not effective and can
be damaging
when used over a long period of time. The Canadian
Medical Association Journal, Clinical practice
guidelines for the
care and treatment of breast cancer: 11. Lymphedema (CMAJ 2001;164(2):191-9)
released in January of 2001 by Susan R. Harris, Maria R. Hugi, Ivo
A. Olivotto, Mark Levine, for the
Steering Committee for Clinical
Practice Guidelines for the Care and Treatment of Breast Cancer notes:
Diuretics,
which have been recommended in the past, may temporarily mobilize water, but
the increased
interstitial oncotic pressure exerted by the high
protein concentration of lymph fluid will cause rapid
recurrence of
edema. The diuretic effect in the rest of the body may cause adverse side
effects, such as
hypotension, dehydration and electrolyte
imbalance.The National Cancer Institute (NCI) points out that,
" Diuretics encourage vascular fluid depletion, but do nothing
for excess protein deposits and could
hasten connective tissue
fibrosis. Therefore, diuretics should be used with caution and only for
treatment of
excess vascular fluid due to other causes (1998).The
1995 consensus document of the International Society
of Lymphology
Executive Committee reports that although diuretics may be occasionally be
useful during
the initial phase of physiotherapy or in certain
unique medical situations, their use on a long term basis is not
generally effective. &Long-term administration of diuretics is
discouraged as being of marginal benefit and
potentially
complicated by fluid and electolyte disturbances.Managing your lymphedema takes
time and
practice. You're therapist will teach you how to properly
bandage or wear compressions combined with
self massage. Practice
makes perfect so have patience.Although there is no cure and lymphedema is
usually
progressive, we can hope for research and studies to arise
in the future to help those with the condition and
also measure to
prevent others from ever having it.Therapist HygieneIf you have open wounds or
leaking
fluid, your therapist may wear gloves. Gloves protect
contact with fluids, substances, and chemicals. If
working in the
mouth to drain nodes, a therapist will wear gloves. Be sure if you have any
known allergy to
latex you inform your therapist BEFORE bodywork
with gloves
Managing LymphedemaAt a GlanceYour doctor and nurse
are more likely to take your symptoms seriously
and be attentive to
your progress if they regularly measure the circumference of your arm and
compare it
with your unaffected arm, documenting the measurements
over time. You can usually control lymphedema
by practicing good
care and following basic guidelines.The health care professionals who
specialize in the
management of arm lymphedema are physical medicine
doctors (physiatrists), physical therapists, and
occupational
therapists. But don't assume that anyone in these specialties is an expert in
treating
lymphedema. Ask about experience and references before you
let anyone work on your edema problem.
Most metropolitan areas have
occupational or physical therapists with practices dedicated to managing the
physical, psychological, and activity-related side effects of
breast cancer treatment. If you can't find a
therapist who
specializes in breast cancer, look for a general occupational or physical
therapist in a
rehabilitation center or department who has
experience taking care of women with breast cancer
Title: Early
Intervention and Treatment Intervention for LymphedemaAuthors: Gergich N,1
Washington F,2
Pfalzer3 L, Soballe P1 and McGarvey C4Affiliations:
1. Breast Care Center, National Naval Medical
Center, Bethesda,
MD.2. University of Maryland School of Medicine, Baltimore, MD.3. University of
Michigan-Flint, Flint, MI.4.National Institutes of Health,
Bethesda, MD, Physical Therapy Dept.,Abstract:
DESIGN: This
observational (case-control) outcome study investigated the frequencyand
severity of
morbidities in a population of approximately 165
patients diagnosed withbreast cancer before and after
medical and
surgical treatment.METHODS: A subset analysis of a cohort of women of women
diagnosed
with subclinicallymphedema (LE) was conducted.
Pre-operative and follow-up arm volumemeasurements
taken at 80% of
limb length measured from ulnar styloid to tip ofacromion at 1, 3, 6, 9, 12 and
18 months
by optoelectronic volumeter
(Perometer®) from2001-2006. Quantitative girth measurements
were collected over this period using anoptoelectric limb
volumeter. The device is an framed infrared
scanning
system(Perometer, Pero-system MeBgerate GmbH, Wuppertal, Germany). This
instrument
wasdesigned specifically to measure girth (cm) and
volume (ml) of the upper or lowerextremities and has
been validated
for use in a clinical environment by Stanton1 andothers.ANALYSIS: 2-way
Repeated
ANOVA with Time and Limb as factors and mean
valuescalculated for Affected and Unaffected Arms.
RESULTS: 43 women
34-82 years old (mean =55.3 + SD 12.1) reported symptoms ofLE including
heaviness or increased limb volume. Intervention was introduced if
thevolume change equated to
approximately 100 ml or 3% volume change
compared to preopmeasure. At intervention the volume
increase in
the affected arm was significant (83.0ml + 118.8 [2.1 % + 5.2] p=0.001).
Baseline to onset of
lymphedema and interventionaveraged 7.6 mos.
Average time to follow up was 5.0 months, during which
time
thecohort demonstrated a significant (p=0.0000) mean volume decrease of 119.9
ml [8.6%]in their
affected arm by using the sleeve.CONCLUSIONS:
Pre-operative assessment, prospective surveillance and
earlyintervention may have prevented the onset of irreversible LE in
this small cohort.The garment
significantly reduced affected limb
volume to nearly that of the unaffectedlimb and therefore provides
effective treatment when sub-clinical LE can be detected.Further
research is warranted to confirm the long
term effectiveness and
costeffectiveness of this preventive model compared to a traditional impairment
based model.1. Stanton AW, Northfied JW, Holroyd B, Mortimer PS,
and Levick, JR. Validation of
anoptoelectronic limb volumeter
(Perometer). Lymphology. 1997 vol:30 (2): pp:77 -97
This page is a
mix of content from Lymphology magazine in the last article, exerpts from
Dr.Chikly
------------------------------------------------------------------------------------------------
MLD
can be used for other things too, to speed healing after surgery.
Hi
Charissa,
The answer is YES MLD is very successful for acne. I have
done many cases here, they are all very
pleased with the results.
Some of them are closed to 95% clear and 1 had 100% clear skin now. Most
will experience at least a 50% reduction of appearance of acne. I only
have 1 resistant case due to prolong
(12 years) antibiotics
consumption, I realise we have to do full detox to make things work but in
general
everyone else responded. 99% success rate from my
experience. :) Do your treatment regularly and use
gentle pH
balance skin care products. Harsh products will make things worse.
hugs,
veronica yap
Vodder MLD Lymphoedema Therapist
I am really interested
in feedback
about how successful the mld was for
acne.
Charissa
--------------------------------------------
Alternative
Systems of Medical Practice
Overview
Worldwide, only an estimated 10 to
30 percent of human healthcare is delivered by conventional,
biomedically oriented practitioners. The remaining 70 to 90 percent
ranges from self-care, according to folk
principles, to care given
in an organized healthcare system based on an alternative tradition or
practice.
Popular healthcare is the kind most people practice and receive at
home, such as giving herbal tea to
someone who has a cold.
Community-based healthcare, which reflects the health needs, beliefs, and
natural
environments of those who use it, refers to the
nonprofessionalized but specialized healthcare practices of
many
rural and urban people. Professionalized healthcare is more formalized;
practitioners undergo more
standardized training and work in
established locations.
Professionalized Healthcare Systems
The
professionalized healthcare practitioners often have conducted scientific
studies about the causes of
illness and explanations and results of
treatment. Each of the major professionalized systems has certain
characteristics: a theory of health and disease; an educational scheme
to teach its concepts; a delivery
system involving practitioners; a
material support system to produce medicines and therapeutic devices; a
legal and economic mandate to regulate its practice; cultural
expectations about the medical system's role;
and a means to confer
professional status on approved providers. These professionalized medical
systems
include traditional oriental medicine, acupuncture,
ayurvedic medicine, homeopathy, anthroposophy,
naturopathy, and
environmental medicine.
Traditional Oriental Medicine
Traditional
oriental medicine is a sophisticated set of many systematic techniques and
methods, including
acupuncture, herbal medicine, acupressure, qi
gong, and oriental massage. The most striking characteristic
of
oriental medicine is its emphasis on diagnosing disturbances of qi, or vital
energy, in health and disease.
Diagnosis in oriental medicine
involves the classical procedures of observation, listening, questioning, and
palpation, including feeling pulse quality and sensitivity of body
parts.
The professionalization of oriental medicine has taken diverse paths
in both East Asia and the United States.
Currently, the model in
the People's Republic of China, which was established after the 1949
revolution,
involves the organized training of practitioners in
schools of traditional Chinese medicine. The curriculum of
these
schools includes acupuncture, oriental massage, herbal medicine, and
pharmacology, though the
clinical style of making a diagnosis and
then designing a treatment plan is the one traditionally associated
with herbal medicine. The graduates of these colleges are generally
certified in one of the four specialty
areas at a training level
roughly equivalent to that of a Western country's bachelor's degree.
In the
United States, the professional practitioner base for oriental medicine is
organized around
acupuncture and oriental massage. There are about
6,500 acupuncturist practitioners in the United States.
The
American Oriental Body Work Therapy Association has approximately 1,600 members
representing
practitioners of tuina, shiatsu, and related
techniques. Many American schools of acupuncture are evolving
into
"colleges of oriental medicine" by adding courses in oriental massage, herbal
medicine, and dietary
interventions. They also are offering
diplomas, master's degrees, and doctor's degrees in oriental medicine.
The legal sanctioning of oriental medical practice is most extensive in
New Mexico, where the acupuncture
community has established an
exclusive profession of oriental medicine. Their legal scope of practice is
currently similar to that of primary care M.D.s and D.O.s (doctors of
osteopathy), and their State statute
restricts other licensed New
Mexico health professionals' ability to advertise or bill for oriental medicine
or
acupuncture services.
Extensive research has been done in
China through the institutions of traditional Chinese medicine, but only
in the past quarter century have biomedical scientists in China
characterized and identified active agents in
much of traditional
medical formulary. The use of traditional oriental herbal medicines and
formulas in China
and Japan has been studied for therapeutic value
in the following areas: chronic hepatitis; rheumatoid
arthritis;
hypertension; atopic eczema; various immunologic disorders, including acquired
immunodefiency
syndrome (AIDS); and certain cancers. It would be
useful to repeat these studies in the United States,
assessing U.S.
clinical populations according to high-quality research
criteria.
Acupuncture
Acupuncture involves stimulating specific anatomic
points in the body for theerapeutic purposes. Puncturin
the skin
with a needle is the usual method, but practitioners also use heat, pressure,
friction, suction, or
impulses of electromagnetic energy to
stimulate the points. In the past 40 years, acupuncture has become a
well-known,
reasonably-available treatment in developed and developing countries.
Acupuncture is used to
regulate or correct the flow of qi to
restore health.
Modern theories of acupuncture are based on laboratory
research conducted in the past 40 years.
Acupuncture points have
certain electrical properties, and stimulating these points alters chemical
neurotransmitters in the body. The physiological effects of acupuncture
stimulation in experimental animals
have been well documented, and
in the past 20 years acupuncture has become an increasingly established
healthcare practice. An estimated 3,000 conventionally trained U.S.
physicians have taken courses to
incorporate acupuncture in their
medical practices.
Acupuncture is one of the most thoroughly researched and
documented of the so-called alternative medical
practices. A series
of controlled studies has shown evidence for the efficacy of acupuncture in the
treatment
of a variety of conditions, including osteoarthritis,
chemotherapy-induced nausea, asthma, back pain, painful
menstrual
cycles, bladder instability, and migraine headaches. Studies on acupuncture
also have shown
positive results in the areas of chronic pain
management and in the management of drug addition, two areas
where
conventional Western medicine has had only a modicum of
success.
Ayurveda
Ayurveda is India's traditional, natural system of
medicine that has been practiced for more than 5,000
years.
Ayurveda provides an integrated approach to preventing and treating illness
through lifestyle states
that all disease begins with an imbalance
or stress in the individual's consciousness. Lifestyle interventions
are
a major ayurvedic preventive and therapeutic approach. There are ten ayurveda
clinics in North
America, including one hospital-based clinic that
has served 25,000 patients since 1985.
In India, ayurvedic practitioners
receive state-recognized, institutionalized training in parallel to their
physician counterparts in India's state-supported systems for
conventional Western biomedicine and
homeopathic medicine. The
research base is growing concerning the physiological effects of meditative
techniques and yoga postures in Indian medical literature and Western
psychological literature. Published
studies have documented
reductions in cardiovascular disease risk factors, including blood pressure,
cholesterol, and reaction to stress, in individuals who practice
Ayurvedic methods.
Laboratory and clinical studies on ayurvedic herbal
preparations and other therapies have shown them to
have a range of
potentially beneficial effects for preventing and treating certain cancers,
treating infectious
disease, promoting health, and treating aging.
Mechanisms underlying these effects may include free-radical
scavenging effects, immune system modulation, brain neurotransmitter
modulation, and hormonal effects.
Homeopathic Medicine
Homeopathic
medicine is practiced worldwide, especially in Europe, Latin America, and Asia.
However,
even in the United States the homeopathic drug market is a
multimillion-dollar industry. Homeopathic
remedies, which are made
from naturally occurring plant, animal, or mineral substances, are recognized
and
regulated by the Food and Drug Administration (FDA) and are
manufactured by established pharmaceutical
companies under strict
guidelines. Homeopathy is used to treat acute and chronic health problems as
well as
for disease prevention and health promotion. Recent clinical
trials suggest that homeopathic medicines have
a positive effect on
allergic rhinitis, fibrositis, and influenza.
Basic research in homeopathy
has involved investigations into the chemical and biological activity of highly
diluted substances. Some homeopathic medicines are diluted to
concentrations as low as 10-30 to 10-
20,000. This particular aspect
of homeopathic theory and practice has caused many modern scientists to
reject homeopathic medicine. Critics of homeopathy contend that such
extreme dilutions of the medicines
are beyond the point at which
any active molecules of the medicine can theoretically still be found in the
solution. On the other hand, scientists who accept the potential
benefits of homeopathic theory suggest
several theories to explain
how highly diluted homeopathic medicines may act. Using recent developments in
quantum physics, they have proposed that electromagnetic energy in
the medicines may interact with the
body on some level. Researchers
in physical chemistry have proposed the "memory of water" theory,
whereby the structure of the water-alcohol solution is altered by the
medicine during the process of dilution
and retains this structure
even after none of the actual substance remains.
Anthroposophically Extended
Medicine
Anthroposophically extended medicine is an extension of Western
biomedicine and also incorporates
approaches and therapeutics from
two alternative medicine movements: naturopathy and homeopathy.
Anthroposophically extended medicine is most prominent in Europe, but
there are an estimated 30 to 100
M.D.s in the United States who
practice it also. Hundreds of uniquely formulated medications are used in
anthroposophical practice, each seeking to match the key dynamic forces
in plants, animals, and minerals
with disease processes in humans
to stimulate healing. Much research in anthroposophically extended
medicine has been connected with attempts to understand the nature of
disease, assess treatments
qualitatively, and understand how the
essential properties of the objects under investigation could be applied
in therapy.
Naturopathic Medicine
Naturopathic medicine, as a
distinct American healthcare profession, is almost 100 years old. It was
founded as a formal healthcare system at the turn of the century by
medical practitioners from various
natural therapeutic disciplines.
By the early 1900s, more than 20 naturopathic medical schools existed, and
naturopathic physicians were licensed in most States. Today there are
more than 1,000 licensed
naturopathic doctors in the United
States.
As practiced today, naturopathic medicine integrates traditional
natural therapeutics - including botanical
medicine, clinical
nutrition, homeopathy, acupuncture, traditional oriental medicine,
hydrotherapy, and
naturopathic manipulative therapy - with modern
scientific medical diagnostic science and standards of care.
The
medical research base of naturopathic practice consists of empirical
documentation of treatments using
case history observations, medical
records, and summaries of practitioners' clinical experiences.
At present,
the two accredited naturopathic medical schools in the United States have
active research
departments. Naturopathic researchers have
investigated the pharmacology and physiological effects of
nutritional and natural therapeutic agents, and naturopathic physicians
have been active in the investigation of
new homeopathic remedies
and in the natural treatment of women's health problems. The most recently
completed naturopathic study in women's health tested the clinical and
endocrine effects of a botanical
formula as an alternative to
estrogen replacement therapy.
Environmental Medicine
Environmental
medicine, like anthroposophically extended medicine, also can be viewed as an
extension of
modern biomedicine. Environmental medicine traces its
roots to the practice of allergy treatment and the
work of Dr.
Theron Randolph, in the 1940s, who identified a variety of common foods and
chemicals that
were able to trigger the onset of acute and chronic
illness even when exposure was at relatively low levels.
Environmental
medicine recognizes that illness in individuals can be caused by a broad range
of incitant
substances, including foods, chemicals found at home
and in the workplace, and chemicals in the air, water,
and food.
Today there are 3,000 physicians worldwide practicing environmental medicine,
and there are
several environmental control units in the United
States and one in Canada, where patients' sensitivities are
unmasked
through fasting and complete avoidance of potentially incitant
chemicals.
Research, in this field, has been directed at clinical treatment
of patients and at evaluation of the diagnostic
and treatment
techniques used by practitioners. Other studies have supported the use of the
approaches of
environmental medicine in treating arthritis, asthma,
chemical sensitivity, colitis, depression, eczema, fatigue,
and
hyperactivity.
The belief that humans can get sick from cumulative low-level
environmental exposure to certain incitants is
not well accepted by
the conventional medical community. However, because "sick building syndrome"
and
other chronic conditions that cannot be explained by other
phenomena are being seen with greater
frequency, environmental
medicine offers a theoretical groundwork for dealing with such phenomena.
Indeed, environmental medicine is in a position to be a leading force
in the investigation of ways to reduce
the incidence of these and
other disorders.
Community-Based Healthcare Practices
Community-based
healthcare practices are varied and are found throughout the United States.
Like other
healthcare specialists, community-based healers may
emphasize naturalistic, personalistic, energetic
explanatory models
or a combination. Traditional midwives and herbalists and, at the present time,
pragmatic weight loss specialists are probably the best known of
community-based practitioners who follow
the naturalistic model. In
addition, the Native American medicine man or medicine woman is a community-
based traditional healer with primarily naturalistic skills, that is,
the skills of an herbalist in particular. Some
medicine people are
also shamans, in which case they are often distinguished as holy men and
women.
In contrast to professionalized practitioners, community-based
healers often do not have set locations
such as offices or clinics for
delivering care but do so in homes, at ceremonial sites, or even right where
they
stand. Community-based healing of the personalistic variety
can also be "distant," that is, it does not require
that
practitioner and patient be in each other's presence. Prayers or shamanic
journeys, for example, can be
requested and "administered" at any
time, and charm cures are sometimes delivered by telephone.
Meanwhile,
community-based systems also thrive in urban areas. These systems include the
popular weight
loss programs and other 12-step programs. Often the
practitioners rent office space and emphasize contact
between
client and practitioner, and they may charge considerable fees. Since these
practitioners depend on
their healing practice for their
livelihood, they advertise and so may be easier to identify and contact for
study purposes.
Native American
Native American Indian
community-based medical systems have a number of rituals and practices:
sweating
and purging, usually done in a "sweat lodge"; the use of
herbal remedies gathered from the surrounding
environment and
sometimes traded over long distances; and shamanic healing involving
naturalistic or
personalistic healing. Tribes such as the Lakota and
Dineh (Navajo) also use practices such as the medicine
wheel,
sacred hoop, and the "sing," which is a healing ceremony rite that lasts from
two to nine days and
nights and is guided by a highly skilled
specialist called a "singer."
Formal research into the healing ceremonies
and herbal medicines conducted and used by bona fide Native
American Indian healers or holy people is almost nonexistent, even
though Native American Indians believe
they positively cure both the
mind and body. Ailments and diseases such as heart disease, diabetes, thyroid
conditions, cancer, skin rashes, and asthma reportedly have been
cured by Native American Indian doctors
who are knowledgeable about
the complex ceremonies.
Latin American
Latin American community-based
practices include curanderismo, which is a folk system of medicine that
includes two distinct components: a humoral model for classifying
activity, food, drugs, and illness; and a
series of folk
illnesses.
In the humoral component of curanderismo, things could be
classified as having qualitative (not literal)
characteristics of
hot or cold, dry or moist. According to this theory, good health is preserved
by
maintaining a balance of hot and cold. Thus, a good meal will
contain both hot and cold foods, and a person
with a hot disease
must be given cold remedies and vice versa. Again, a person who is exposed to
cold
when excessively hot may "take cold" and become ill.
The
second component, the folk illnesses, is actively in use in much of Mexico and
among less educated
Hispanic U.S. citizens. Studies have found that
as many as 96 percent of Mexican-American households
(more frequent
in the less Americanized communities) treated members for Hispanic folk
illnesses. Similarly,
high use patterns among Mexican migrant
workers have been found in Florida and Mexico.
Although no formal
effectiveness studies seem to have been done on this system, its wide
popularity and the
research suggesting the relevance of the folk
diagnoses, for biomedical practice, indicate the need for further
demographic and effectiveness studies.
Alcoholics
Anonymous
Alcoholics Anonymous (AA) is an example of an urban
community-based healing system for helping
people, whose lives are
damaged by the consumption of alcohol, to stop drinking. Founded in 1935 by
Bob Smith, M.D. and Bill Wilson, two alcoholics, it is a
patient-centered self-help fellowship of men and
women. AA has
burgeoned and today is widely considered the most successful existing method
for
supporting sobriety.
In contrast to most community-based
systems, a very large literature exists analyzing AA. Several models
attempt
to explain its success. One popular psychometric model interprets AA as a
"cult" and the
achievement of sobriety as a "conversion experience."
Another model, however, asserts that members
recover by integrating
their own experiences with alcohol with those of others in the group and by
learning
and practicing some new ways to behave. Through these new
ways, AA members feel as if they are living
apart from the urban
materialist norm; that the cause of alcoholism is not at issue; that people
should share,
not compete; and that the individual need not rise
above the rest (spiritual anonymity).
Studies have concluded that active AA
membership allows up to 68 percent of alcoholics to drink less or
not at all for up to a year, and 40 to 50 percent to achieve sobriety
for many years. More active or
dedicated members (those who attend
meetings more often) remain sober longer.
Bioelectromagnetic
Applications
Electromagnetic Fields
Bioeletromagnetics (BEM) is an
emerging science that studies how living organisms interact with
electromagnetic (EM) fields. Electrical phenomena are found in all
living organisms, and electrical currents in
the body can produce
magnetic fields that extend outside the body. Those that extend outside the
body can
be influenced by external magnetic and EM fields. Changes
in the body's natural fields may produce
physical and behavioral
changes.
Endogenous (internal) fields are distinguished from exogenous
(external) fields. The latter can be natural,
such as the earth's
geomagnetic field, or artificial, such as power lines, transformers,
appliances, radio
transmitters, or medical devices. Oscillating
nonionizing EM fields in the extremely low frequency (ELF)
range
can have vigorous biological effects that may be beneficial. Changes in the
field configuration and
exposure pattern of low-level EM fields can
produce specific biological responses, and certain frequencies
have
specific effects on body tissues.
Electromagnetic Research &
Studies
The mechanism by which EM fields produce biological effects is under
increasing study. At the cutting edge
of BEM research is the
question of how endogenous EM fields change with consciousness. Nonionizing
BEM medical applications are classified according to whether they are
thermal or nonthermal in biological
tissue. Thermal applications of
nonionizing radiation include radio frequency (RF) hyperthermia, laser and
RF surgery, and RF diathermy.
The most important BEM modalities in
alternative medicine are nonthermal applications of nonionizing
radiation. Major new applications of nonthermal, nonionizing EM fields
are bone repair, nerve stimulation,
wound healing, treatment of
osteoarthritis, electroacupuncture, tissue regeneration, and immune system
stimulation.
In the study of other alternative medical treatments,
BEM offers a unified conceptual framework that may
help explain how
diagnostic and therapeutic techniques such as acupuncture and homeopathy may
produce
results that are hard to understand from a more
conventional viewpoint.
Diet, Nutrition, Lifestyle Changes
Preventing
& Treating Chronic Disease
Throughout evolution, human beings adapted to
a wide range of naturally occurring foods, but the types of
food
and the mix of nutrients (in terms of carbohydrates, fats, and proteins)
remained relatively constant.
Food supplies were often precarious,
and the threat of death from starvation was a constant preoccupation
for
most early humans.
However, about 10,000 years ago the agricultural
revolution began making profound dietary changes in
many human
populations. The ability to produce and store large quantities of dried foods
led to preferential
cultivation of some foods, such as grains, which
constituted new challenges to the human digestive system.
Then,
about 200 years ago, the Industrial Revolution introduced advances in food
production, processing,
storage, and distribution. Recent
technological innovations, along with increased material well-being and
lifestyles that have allowed people more freedom in deciding what and
when they wish to eat, have led to
even further major dietary
changes in developed countries. Because changes in the dietary patterns of the
more technologically developed countries, such as the United
States, have been so dramatic and rapid, the
people consuming these
affluent diets have had little time to adapt biologically to the types and
quantities of
food that are available to them today. The longer
term adverse health effects of the diet prevailing in these
countries - characterized by an excess of energy-dense foods rich in
animal fat, partially hydrogenated
vegetable oils, and refined
carbohydrates but lacking in whole grains, fruits, and vegetables - have become
apparent only in recent decades.
Because of the recent, rapid rise in chronic illness related directly or indirectly to diet, the focus of nutrition
research has shifted away from eliminating nutritional
deficiency to dealing with chronic diseases caused by
nutritional
excess. Another concern among nutrition researchers is the accumulation of
evidence indicating
that a less-than-adequate intake of some
micronutrients, over a long period, may increase the risks of
developing coronary heart disease, cancers, cataracts, and birth
defects. In recent decades, the data on the
relationship between
certain dietary habits and nutritional intake have been growing exponentially.
Designing
interventions based on this wealth of research has become
increasingly more difficult and complex.
Dietary Supplements
The Federal
Government's approach to dietary intervention, formulated by boards composed of
nutrition
scientist, generally does not recommend supplementing the
typical American diet with vitamins or nutrients
beyond the
recommended daily allowances (RDAs), nor does it suggest that some foods never
be eaten. In
contrast, many alternative dietary approaches contend
that no amount of manipulation of the typical
American diet is
enough to promote optimum health or prevent eventual chronic illness. These
alternative
approaches represent a continuum of philosophies ranging
from the concept that supplementing the typical
American diet
somewhat beyond the RDAs is necessary to promote optimum health, to the idea
that
supplementation well beyond the RDAs is often required to
reverse the effects of long-term deficiencies.
Other approaches
advocate drastic dietary modification, either eliminating or adding certain
types of foods
or macronutrients, to treat specific types of
conditions such as cancer and cardiovascular disease. Finally,
there is the view that certain major staples of typical American diet,
such as meat and dairy products, are
basically unhealthy and should
be generally avoided.
There is a growing body of data supporting the notion
that the RDAs for mineral, such as calcium and
magnesium, may be
too low and that supplementation may be necessary to prevent the onset of
chronic
diseases. In addition, the RDAs for a number of vitamins
and micronutrients, such as vitamin C, vitamin D,
vitamin E, folate,
and beta-carotene, may not be adequate to prevent chronic illness. For example,
recent
studies have found that the RDA for folate may need to be
doubled for women as well as men.
Orthomolecular Medicine
Orthomolecular
medicine-the therapeutic use of high-dose vitamins to treat chronic
disease-promotes
improving health and treating disease by using the
optimum concentration of substances normally present in
the body.
Increasing the intake of such nutrients to levels well above those usually
associated with
preventing overt deficiency disease may have health
benefits for some people. There is at least preliminary
evidence
that orthomolecular remedies may be effective in treating AIDS; brochial
asthma; cancer;
cardiovascular disease, heart attacks, and stroke;
lymphedema; and mental and neurological disorders.
Alternative Diets
A
variety of alternative diets are offered for treating cancer, cardiovascular
disease, and food allergies.
Virtually all of these interventions
focus on eating more fresh and freshly prepared vegetables, fruits, whole
grains, and legumes. Allergy to food has become a major area of
research. Food intolerance is being
studied as a causal or
contributing factor in rheumatoid arthritis, and there is evidence that
food-elimination
diets may help many hyperactive children.
Some
alternate dietary lifestyles are believed to offer a greater resistance to
illness. These include several
variations of the vegetarian diet,
such as those consumed by Seventh-Day Adventists and proponents of the
macrobiotic diet. Studies have found a significant lowering of risk
factors for heart disease and certain forms
of cancer in these two
groups. Recent studies have also reported that certain cultural eating styles,
such as
the Asian and Mediterranean diets, appear to lower risk
factors for heart disease and certain forms of
cancer as well.
Although there have been few controlled studies of the benefits of many
traditional diets,
such as those originally consumed by Native
American Indians, diseases such as diabetes and cancer were
not a
problem for these populations until their diets became more Western, or
affluent.
Because dietary and nutritional therapy interventions affect an
array of biochemical and physiological
processes in the body,
evaluating their effectiveness may require equally complex methods.
Furthermore,
developing a comprehensive healthcare policy that
incorporates diet and nutritional interventions may
require taking
into account Federal feeding programs and dissemination strategies that might
present
barriers to the effective propagation of adequate
nutritional knowledge.
Herbal Medicine
Folk Medicine Traditions
All
cultures have long folk medicine traditions that include the use of plants and
plant products. Even in
ancient cultures, people methodically
collected information on herbs and developed well-defined herbal
pharmacopoeias. Indeed, well into the twentieth century, much of the
pharmacopoeia of scientific medicine
was derived from the herbal
lore of native peoples. Many drugs commonly used today are of herbal origin.
Indeed, about one-quarter of the prescription drugs dispensed by
community pharmacies in the United
States contain at least one
active ingredient derived from plant material.
The World Health Organization
(WHO) estimates that 4 billion people, 80 percent of the world population,
presently use herbal medicine for some aspect of primary healthcare.
Herbal medicine is a major
component in all indigenous peoples'
traditional medicine and a common element in Ayurvedic,
homeopathic,
naturopathic, traditional oriental, and Native American Indian
medicine.
Drug Regulation
Although, the discovery of useful therapeutics
from plants has changed the face of medicine and the course
of
civilization, many people, especially some in the Federal Government, evaluate
herbal remedies as though
they were either worthless or dangerous.
Today in the United States, herbal products can be marketed only
as
food supplements. An herb manufacturer or distributor can make no specific
health claims without FDA
approval. A growing number of Americans
are interested in herbal preparations.
Two features of European drug
regulation make that market more hospitable to natural remedies. First, it
costs less and takes less time in Europe to approve medicines as safe
and effective. This is especially true of
substances that have a
long use history and can be approved under the "doctrine of reasonable
certainty."
European guidelines for the assessment of herbal
remedies follow up on WHO's Guidelines for the
Assessment of Herbal
Medicines, which state that a substance's historical use is a valid way to
document
safety and efficacy in the absence of scientific evidence
to the contrary.
France, where traditional medicines can be sold with
labeling based on traditional use, requires licensing by
the French
Licensing Committee and approval by the French Pharmacopoeia Committee. Germany
considers whole herbal products one active ingredient; this makes
it simpler to define and approve the
product. The German Federal
Health Office regulates products such as ginkgo and milk thistle extracts so
that potency and manufacturing processes are standardized. England
generally follows the rule of prior use;
that is, years of use with
apparent positive effects and no evidence of detrimental side effects
constitute
enough evidence - in lieu of other scientific data -
that the product is safe.
In Japan, China, and India, patent herbal remedies
composed of dried and powdered whole herbs or herb
extracts, often
in tablet form, are the rule. Traditional herbals are the backbone of China's
medicine. Japan's
traditional medicine, kampo, is similar to and
historically derived from Chinese medicine but includes
traditional
medicines from Japanese folklore. Herbal medicines are the staple of medical
treatment in many
developing countries and are used for many types
of ailments.
European Phytomedicines
European phytomedicines are among
the world's best studied medicines, researched in leading European
universities and hospitals. Some have been in clinical use, under
medical supervision, for more than ten
years, with tens of millions
of documented cases. This form of botanical medicine most closely resembles
American medicine. In Europe there have been credible research studies
reporting positive effects on a
variety of chronic illnesses for
herbs such as Silybum marianum (milk thistle), Ginkgo biloba (ginkgo)
Vaccinium
myrtillus (bilberry extract), and Ilex guayusa. Many herbs in China have been
studied extensively
by methods that are acceptable from the Western
perspective; among these herbs are ginseng, fresh ginger
rhizome,
Chinese foxglove root, baical skullcap root, wild chrysanthemum flower, and
licorice root. A
number of Ayurvedic herbs also have recently been
studied in India under modern scientific conditions,
including
Eclipta alba, Indian gooseberry, neem, turmeric, and trikatu.
Reports of
positive effects of herbal preparations in developing countries and Native
American Indian herbs
are primarily anecdotal. However, since much
modern-day medicine is directly or indirectly derived from
such
folklore sources, it seems illogical to conclude that there are no more
significant treatments or cures for
major diseases to be found, in
the world, from plant sources.
Manual Healing
Overview
Touch and
manipulation, with the hands, have been in use in health and medical practice
since the beginning
of medical care. Physicians' hands were once
their most important diagnostic and therapeutic tool. Today,
however, many medical and health practitioners tend to retreat from
physical contact with the patient,
distanced by diagnostic
equipment and legal and time constraints.
Manual healing methods are based
on the understanding that dysfunction of a part of the body often affects
secondarily the function of other discreet, not necessarily directly
connected, body parts. Consequently,
theories and processes have
been developed for correcting secondary dysfunctions by manipulating soft
tissues or realigning body parts. Overcoming misalignments and
manipulating soft tissues bring the parts
back to optimal function,
and the body returns to health.
Osteopathic Medicine
One of the earliest
U.S. healthcare systems to use manual healing methods was osteopathic medicine.
In
1993 more than 32,000 American-educated and -licensed D.O.s were
practicing in the United States.
More than 60 percent of
osteopathic physicians are involved in primary care - family medicine,
pediatrics,
internal medicine, and obstetrics-gynecology. An
extensive body of work supports the use of osteopathic
techniques
for musculoskeletal and nonmusculoskeletal problems. Nearly all osteopathically
oriented
research has been funded from the private
sector.
Chiropractic Science
Chiropractic science is concerned with
investigating the relationship between structure (primarily of the
spine) and function (primarily of the nervous system) of the human body
to restore and preserve health.
Chiropractic medicine applies such
knowledge to diagnosing and treating structural dysfunctions that can
affect
the nervous system. Chiropractic physicians use manual procedures and
interventions, not surgical or
chemotherapeutic ones. In 1993, more
than 45,000 licensed chiropractors were practicing in the United
States.
Chiropractic specialty areas are extremely pertinent to other
medical specialties, such as radiology,
orthopedics, neurology, and
sports medicine. Current chiropractic research interests include back and other
pain, somatovisceral disorders, and reliability studies.
Massage
Therapy
Massage therapy, one of the oldest methods in healthcare practice,
is the scientific manipulation of the soft
body tissues to return
those tissues to their normal state. Massage consists of a group of manual
techniques
that include applying fixed or movable pressure and
holding and causing the body to move. Primarily the
hands are used,
but sometimes forearms, elbows, and feet are used also. These techniques can
affect the
musculoskeletal, circulatory-lymphatic, and nervous
systems. Massage therapy encompasses the concept of
vis medicatrix
naturae - helping the body heal itself - and is aimed at achieving or
increasing health and well-
being. Touch is the fundamental medium of
massage therapy.
Massage therapists are licensed by 25 States, the District
of Columbia, and several localities. Most States
require 500 or
more hours of education from a recognized school program and a licensing
examination.
Massage therapy techniques include Swedish massage,
deep-tissue massage, sports massage,
neuromuscular massage, and
manual lymph drainage. Other physical healing methods include reflexology,
zone therapy, tuina, acupressure, Rolfing, Trager, Feldenkrais method
and Alexander technique.
Biofield Therapeutics
Biofield therapeutics -
laying on of hands - is also a very old form of healing. The earliest Eastern
references
are in the Huang Ti Nei Ching Su Wen (The Yellow
Emperor's Classic of Internal Medicine), dated
between 2,500 and
5,000 years ago. The underlying rationales cluster around two views: first,
that the
healing force comes from a source other than the
practitioner - God, the cosmos, or another supernatural
entity -
and second, that a human biofield directed, modified, or amplified in some way
by the practitioner is
the operative mechanism.
During biofield
treatment, the practitioner places hands directly on or near the patient's body
to improve
general health or treat a specific dysfunction.
Treatment sessions may take from 20 minutes to an hour or
more; a
series of sessions is often needed to treat some disorders. There is consensus
among practitioners
that the biofield permeates the physical body
and extends outward for several inches. Extension of the
external
biofield depends on the person's emotional state and health. Biofield
practitioners have a holistic
focus. About 50,000 practitioners
provide 18 million sessions annually in the United States.
At least three
forms of biofield therapeutics are used in medical care inpatient and
outpatient settings: healing
touch, therapeutic touch, and SHEN
therapy. No generally accepted theory accounts for the effect of these
therapies.
Mind-Body Control
Overview
Most traditional medical
systems make use of the interconnectedness of mind and body and the power of
each to affect the other. During the past 30 years there has been a
growing scientific movement to explore
the mind's capacity to
affect the body. The clinical aspect of this enterprise is called mind-body
medicine.
Mind and body are so integrally related that it makes
little sense to refer to therapies as having impact just
on the
mind or the body.
Mind-body interventions often help patients experience and
express their illness in new, clearer ways.
Distinctions between
curing and healing have little place in contemporary medical practice but are
important
to patients. Perceived meaning has direct consequences to
health. The placebo response is one of the most
widely known
examples of mind-body interactions in contemporary, scientific medicine, yet it
is also one of
the most undervalued, neglected assets in medical
practice. That the placebo response relies heavily on the
relationship between doctor and patient says a great deal about the
importance of the doctor-patient
relationship and the need to
provide further medical training on understanding and using this relationship.
The therapeutic potential of spirituality, as well as religion, also
has been neglected in the teaching and
practice of
medicine.
Interest in the mind's role in the cause and course of cancer has
been substantially stimulated by the
discovery of the complex
interactions between the mind and the neurological and immune systems, the
subject of the rapidly expanding discipline of psychoneuroimmunology.
The profound differences in the
psychological stances taken by
people who survive cancer suggest that there is extreme variation both
among cultures and within cultures.
Specific mind-body interventions
include psychotherapy, support groups, meditation, imagery, hypnosis,
biofeedback,
yoga, dance therapy, music therapy, art therapy, and prayer and mental
healing.
Psychotherapy
Psychotherapy directly addresses a person's
emotional and mental health, which is, in turn, closely
interwoven
with his or her physical health. It encompasses a wide range of specific
treatments from
combining medication with discussion, to simply
listening to the concerns of a patient, to using more active
behavioral and emotive approaches. It also should be understood more
generally as the matrix of interaction
in which all the helping
professions operate. Conventional psychotherapy is conducted primarily by means
of psychologic methods such as suggestion, persuasion,
psychoanalysis, and reeducation. It can be divided
into general
categories. All of the therapies can be undertaken either individually or in
groups.
Research indicates that psychotherapeutic treatment can hasten a
recovery from a medical crisis and is in
some cases the best
treatment for it. Psychotherapy also appears to be valuable in the treatment of
somatic
illnesses in which physical symptoms appear to have no
medical cause. These symptoms are often improved
markedly with
psychotherapy. In addition, psychotherapy has been shown to speed patients'
recovery time
from illness. This, in turn, leads to smaller medical
bills and fewer return visits to medical practitioners.
Support
Groups
Support groups, as the research literature demonstrates, can have a
powerful positive effect in a wide
variety of physical illnesses,
from heart disease to cancer, from asthma to strokes. Indeed, one study found
that women with breast cancer who took part in a support group lived
an average of 18 months longer (a
doubling of the survival time
following diagnosis) than those who did not participate. In addition, all the
long-
term survivors belonged to the therapy group.
Support groups
have two other major benefits:
they help members form bonds with each other,
an experience that may empower the rest of their lives; and
they are
low cost or even "no cost" (for example, Alcoholics
Anonymous).
Meditation
Mediation is a self-directed practice for
relaxing the body and calming the mind. Most meditative techniques
have come to the West from Eastern religious practices, particularly
India, China, and Japan, but can be
found in all cultures of the
world. Until recently, the primary purpose of meditation has been religious,
although its health benefits have long been recognized. During the
past 15 years, it has been explored as a
way of reducing stress on
both mind and body. It is often recommend it as a way of reducing high blood
pressure.
Some studies have found that regular meditation can
reduce healthcare use; increases longevity and quality
of life;
reduces chronic pain; reduces anxiety; reduces high blood pressure; reduces
serum cholesterol level;
reduces substance abuse; increases
intelligence-related measures; reduces post-traumatic stress syndrome
in
Vietnam veterans; reduces blood pressure; and lowers blood cortisol levels
initially brought on by stress.
Imagery
Imagery is both a mental process
(as in imagining) and a wide variety of procedures used in therapy to
encourage
changes in attitudes, behavior, or physiological reactions. As a mental
process, it is often defined
as "any thought representing a sensory
quality." It includes, as well as the visual, all the senses - aural,
tactile,
olfactory, proprioceptive, and kinesthetic.
Imagery has been successfully
tested as a strategy for alleviating nausea and vomiting associated with
chemotherapy in cancer patients, to relieve stress, and to facilitate
weight gain in cancer patients. It has been
successfully used and
tested for pain control in a variety of settings; as adjunctive therapy for
several
diseases, including diabetes; and with geriatric patients
to enhance immunity.
Imagery is usually combined with other behavioral
approaches. It is best known in the treatment of cancer
as a means
to help patients mobilize their immune systems, but it also is used as part of
a multidisciplinary
approach to cardiac rehabilitation and in many
settings that specialize in treating chronic pain.
Hypnosis
Hypnosis and
hypnotic suggestion have been a part of healing from ancient times. The
induction of trance
states and the use of therapeutic suggestion
were a central feature of the early Greek healing temples, and
variations of these techniques were practiced throughout the ancient
world.
Modern hypnosis began in the eighteenth century with Franz Anton
Mesmer, who used what he called
"magnetic healing" to treat a
variety of psychological and psychophysiological disorders, such as hysterical
blindness, paralysis, headaches, and joint pains. Since then, the
fortunes of hypnosis have ebbed and
flowed. Freud, at first, found
it extremely effective in treating hysteria and then, troubled by the sudden
emergence of powerful emotions in his patients and his own
difficulty with its use, abandoned it.
In the past 50 years, however,
hypnosis has experienced a resurgence, first with physicians and dentists and
more recently with psychologists and other mental health
professionals. Today, it is widely used for
addictions, such as
smoking and drug use, for pain controls, and for phobias, such as the fear of
flying.
One of the most dramatic uses of hypnosis is the treatment of
congenital ichthyosis (fish skin disease), a
genetic skin disorder
that covers the surface of the skin with grotesque hard, wartlike, layered
crust.
Hypnosis is, however, most frequently used in more common
ailments, either independently or in concert
with other treatment,
including the management of pain in a variety of settings, reduction of
bleeding in
hemophiliacs, stabilization of blood sugar in
diabetics, reduction in severity of attacks of hay fever and
asthma, increased breast size, the cure of warts, the production of
skin blisters and bruises, and control of
reaction to allergies
such as poison ivy and certain foods.
Biofeedback
Biofeedback is a
treatment method that uses monitoring instruments to feed back to patients
physiological
information of which they are normally unaware. By
watching the monitoring device, patients can learn, by
trial and
error, to adjust their thinking and other mental processes in order to control
bodily processes
heretofore thought to be involuntary--such as blood
pressure, temperature, gastrointestinal functioning, and
brain wave
activity.
Biofeedback is used to treat a very wide variety of conditions and
diseases, ranging from stress, alcohol and
other addictions, sleep
disorders, epilepsy, respiratory problems, and fecal and urinary incontinence
to
muscle spasms, partial paralysis, or muscle dysfunction caused
by injury, migraine headaches, hypertension,
and a variety of
vascular disorders. More applications are being developed
yearly.
Yoga
Yoga is a way of life that includes ethical precepts,
dietary prescriptions, and physical exercise. Its
practitioners have
long known that their discipline has the capacity to alter mental and bodily
responses
normally thought to be far beyond a person's ability to
modulate them. During the past 80 years, health
professionals in
India and the West have begun to investigate the therapeutic potential of yoga.
To date,
thousands of research studies have been undertaken and
have shown that with the practice of yoga a
person can, indeed,
learn to control such physiologic parameters as blood pressure, heart rate,
respiratory
function, metabolic rate, skin resistance, brain waves,
body temperature, and many other bodily functions.
Regular yogic meditation
also has been shown to reduce anxiety levels; cause the heart to work more
efficiently and decrease respiratory rate; lower blood pressure and
alter brain waves; increase
communication between the right and left
brain; reduce cholesterol levels (when used with diet and
exercise); help people stop smoking; and successfully treat
arthritis.
Dance Therapy
Dance therapy began formally in the United
States in 1942, and in 1956 dance therapists from across the
country
founded the American Dance Therapy Association, which has now grown to over
1,100 members.
It publishes a journal, the American Journal of
Dance Therapy, fosters research, monitors standards for
professional practice, and develops guidelines for graduate
education.
Dance/movement therapy has been demonstrated to be clinically
effective in the following: developing body
image, improving
self-concept and increasing self-esteem; facilitating attention; ameliorating
depression,
decreasing fears and anxieties, expressing anger;
decreasing isolation, increasing communication skills and
fostering
solidarity; decreasing bodily tension, reducing chronic pain, and enhancing
circulatory and
respiratory functions; reducing suicidal ideas,
increasing feelings of well-being, and promoting healing; and
increasing verbalization.
Music Therapy
Music therapy is used in
psychiatric hospitals, rehabilitation facilities, general hospitals, outpatient
clinics,
day-care treatment centers, residences for people with
developmental disabilities, community mental health
centers, drug
and alcohol programs, senior centers, nursing homes, hospice programs,
correctional facilities,
halfway houses, schools, and private
practice.
Studies have found music therapy effective as an analgesic, as a
relaxant and anxiety reducer for infants and
children, and as an
adjunctive treatment with burn patients, cancer patients, cerebral palsy
patients, and
stroke, brain injury, or Parkinson's disease
patients.
Art Therapy
Art therapy is a means for the patient to reconcile
emotional conflicts, foster self-awareness, and express
unspoken
and frequently unconscious concerns about his/her disease. In addition to its
use in treatment, it
can be used to assess individuals, couples,
families, and groups. It is particularly valuable with children who
often cannot talk about their real concerns.
Research on art therapy
has been conducted in clinical, educational, physiological, forensic, and
sociological
arenas. Studies on art therapy have been conducted in
many areas including with burn recovery in
adolescent and young
patients, with eating disorders; with emotional impairment in young children,
with
reading performance, with chemical addiction, and with sexual
abuse in adolescents.
Prayer and Mental Healing
Prayer and mental healing
techniques fall into two main types. In Type I healing, the healer enters a
prayerful, altered state of consciousness in which he views himself and
the patient as a single entity. There
need be no physical contact
and there is no attempt to "do anything" or "give something" to the person in
need, only the desire to unite and "become one" with him or her and
with the Universe, God, or Cosmos.
Type II healers, on the other
hand, do touch the healee and describe some "flow of energy" through their
hands to the patient's areas of pathology. Feelings of heat are common
in both healer and healee. These
healing techniques are offered
only as generalities. Some healers use both methodologies, even in the same
healing session, and other healing methods could be described.
Many
published reports exist, of experiments, in which persons apparently were able
to influence a variety
of cellular and other biological systems
through mental means. The target systems for these investigations
have included bacteria, yeast, fungi, mobile algae, plants, protozoa,
larvae, insects, chicks, mice, rats,
gerbils, cats, and dogs, as
well as cellular preparations (blood cells, neurons, cancer cells) and enzyme
activities. In human "target persons," eye movements, muscular
movements, electrodermal activity,
plethysmographic activity,
respiration, and brain rhythms have been apparently affected through direct
mental influence.
These studies assess the ability of humans to
affect physiological functions of a variety of living systems at a
distance, including studies where the "receiver" or "target" is unaware
that such an effort is being made. The
fact that these studies
commonly involve nonhuman targets is important; lower organisms are presumably
not subject to suggestion and placebo effects, a frequent criticism
when human subjects are involved.
Many of these studies do not describe the
psychological strategy of the influencer as actual "prayer," in
which one directs entreaties to a Supreme Being, a Universal Power, or
God. But almost all of them involve
a state of prayerfulness - a
feeling of genuine caring, compassion, love, or empathy with the target system,
or a feeling that the influencer is "one" with the
target.
Conclusion
In addition to preventing or curing illnesses, these
therapies by and large provide people the chance to be
involved in
their own care, to make vital decisions about their own health, to be touched
emotionally, and to
be changed psychologically in the process. Many
patients today believe their The mind-body approach is
potentially
a corrective to this tendency, a reminder of the importance of human connection
that opens up
the power of patients acting on their own
behalf.
More work needs to be done, but there is already a growing amount of
evidence that many of the mind-
body therapies discussed in this
report, if appropriately selected and wisely applied, can be clinically as well
as economically cost-effective, that they work, and that they are
safe.
Pharmacological and Biological Treatments
Pharmacological and
biological treatments are an assortment of drugs and vaccines not yet accepted
by
mainstream medicine. A sampling of biological and
pharmacological treatments currently being offered by
alternative
and medical practitioners includes the following:
Antineoplastons
Peptide
fractions originally derived from normal human blood and urine, presently being
used to treat certain
kinds of tumors as well as AIDS.
Cartilage
Products
Derived from cattle, sheep, sharks, and chickens, which are being
used to treat cancer and arthritis.
Ethylene Diamine Tetraacetic Acid (EDTA)
Chelation Therapy
Used to treat heart disease, circulatory problems, and
rheumatoid arthritis and to prevent cancer.
Immunoaugmentive Therapy
An
experimental form of cancer immunotherapy consisting of daily injections of
processed blood products.
714-X
A nitrogen-providing compound injected
into the lymph system near the abdomen to treat cancer and AIDS.
Coley's
Toxins
A mixture of killed cultures of bacteria from Streptococcus pyogenes
and Serratia marcescens, used for
treating cancer.
MTH-68
A
vaccine that uses an attenuated strain of the Newcastle disease virus of
chickens (paramyxovirus), which
may interfere with cancer-related
viruses.
Neural Therapy
A therapy that involves injecting local
anesthetics into nerve cell bodies, peripheral nerves, scars, and
elsewhere to treat chronic pain.
Apitherapy
The medicinal use of
various products of the common honeybee to treat a variety of diseases:
rheumatic
diseases such as arthritis; neurological diseases such as
multiple sclerosis, low back pain, and migraine;
dermatological
conditions (for example, eczema, psoriasis, herpesvirus infections); chronic
pain; and cancer.
Iscador
A liquid extract from mistletoe plants used to
treat tumors.
Biologically Guided Chemotherapy
A major impediment to full
investigation of alternative pharmacological and biological treatments is the
high
expense of conducting the trials. Most alternative treatments
lack sponsors and funding for clinical trials of
safety and
effectiveness. Many potentially useful alternative drugs or vaccines are
supported by data
indicating they may be useful in treating cancer,
AIDS, heart disease, hepatitis, and other major health
problems.
Source: National Center for Complementary &
Alternative Medicine
For More Information
Visit the National Center for
Complementary & Alternative Medicine
Visit the U.S. Food and Drug
Administration
------------------------------------------
COMPLIMENTARY
HOLISTIC REMEDIES FOR LYMPHEDEMA TREATMENT
by Diana Brady, Holistic
Nutritionist
Ultimate Health Center, Asheville, N.C.
1/06
Please note that the following article discusses holistic
nutritional supplementation that may be useful in
supporting a
patient's daily regime of self-care. This is not an endorsement by the NLN, nor
do we promise
results from the use of any of these items listed
below. We are committed to presenting all avenues of
possibility
for improvement of the condition and quality of life for all lymphedema
patients. Any and all
claims or opinions expressed in this article
are solely of the author. Ed.
--------------------------------------------------------------------------------
There
are many holistic remedies that can support and enhance CDP and manual lymph
drainage therapy.
Some of these therapies have been around for a
dozen or so years, with much clinical research to back
them. Others
are just now being reviewed in scientific journals, while still others are
being used in clinical
practice based upon empirical results alone.
All of the remedies are non-prescription and consist of
enzymes,
vitamins, herbs and homeopathic compounds. They are best used in conjunction
with the patient's
treatment regime and will vary from person to
person. I will briefly describe a few of the more popular
remedies and reference the clinical research. Suppliers and their phone
numbers will be provided at the end
of the article.
INFLAMZYME FORTE
From American Biologics, Chula Vista, CA
This product is a specific combination of digestive enzymes, antioxidants
and co-factors designed to reduce
the accumulation of protein and
fats in the lymphatic system and connective tissue. It has similar effect to
benzopyrenes without the side effects.
It contains:
pancreatin, bromelain, papain, trypsin, chymotrypsin, lipase, amalyse, rutin,
zinc, superoxide
dismutase, catalase and l-cysteine. It must be
taken on an empty stomach, with the dosage of three to six
tablets
three times a day. It is recommended for use before, during and after
treatments; until the limb or
affected area is close to normal
size. At that point, the inflammation and proteins, fats, etc., causing it will
be
under control.
Inflamzyme Forte was created by and for the
American Biologics Medical Center in Tiajuana, Mexico. It
has been
used there very successfully for the past ten to twelve years. Clinical
research has been performed
by the Bradford Research Institute,
Chula Vista, CA.
LYMPHOTEND
From American Biologics, Chula Vista,
CA
This is a homeopathic remedy designed to relieve lymphatic congestion.
It works well in combination with
inflamzyne forte. Lympotend is a
specific combination of classic homeopathic remedies manufactured
according to the process defined by Dr. Samuel Hahnemann. Although each
of the component ingredients
has been used since the 19th century,
this particular combination is fairly new. Lymphotend has been used
in clinical practice worldwide for the past year and a half with
excellent results. This product should also be
used before, during,
and after treatments until the inflammation is reduced. The Bradford Research
Institute,
Chula Vista, CA is currently accumulating research data.
HORSECHESTNUT HERB
In a recent study of chronic diseases of the
veins, the herb, horsechestnut, was found to be very effective.
Horsechestnut was compared to that of compression stockings in 240
patients with chronic venous
insufficiency. Patients were randomly
assigned to receive either compression treatment, horse chestnut
(providing 50 mg of active component escini twice daily), or a placebo
for twelve weeks. Horsechestnut
was found to be as effective as
compression treatment, as determined by the reduction in swelling in the
legs. Both treatments were significantly more effective than the
placebo.
Research was conducted by C. Diehm, and reported in the Lancet,
1996; 347:292-294. This remedy is
currently being used in clinical
practice. More information will be provided at a later time.
DANDELION
LEAF EXTRACT
From Herbalist & Alchemist, Inc.
Herbalist all over
the world have considered dandelion a valuable herb for centuries. It has a
long folk use
throughout the world for a variety of ailments.
Dandelion root (Taraxacum officinale) is regarded as one of
the
finest liver remedies, both as food and as a medicine. The dandelion contains
much more nutritional
value than many other vegetables, being
particularly high in vitamins, minerals, protein, choline, inulin and
pectins.
Dandelion leaf has been used historically as a natural diuretic aiding in
excess fluid loss. Due to its
high content of potassium and other
electrolytes, there is little, if any side effects to the use of this natural
diuretic.
Recommended dosage is 30-60 drops, two or three
times per day either before or after meals. This can be
used
indefinitely, but should be used for several months, stopped for a week or so
and then started again. It
is more effective this way, as the body
does get used to the herb and it loses its potency.
BURDOCK/RED ROOT
COMPOUND
From Herbalist & Alchemist, Inc.
This is a special
formula designed to thin the lymphatic fluid, allowing it to flow more easily,
as well as
cleansing the lymphatic system itself. It is useful for
many conditions of stagnation in the body including
congested
lymphatics, swollen lymph nodes and low resistance to infections. It contains
burdock root
(Arcticum lappa), red root (Ceanothus spp.), figwort
herb (Scrophularia nodosa), violet herb (Viola
odorata), red clover
blossoms (Trifolium pratense) and echinacea root (Echinacea angustifolia).
Recommended dosage 10-30 drops daily for up to a year or two depending
upon the severity of the
condition. Breaks should be taken from
this compound periodically to ensure effectiveness
VITAMINS, MINERALS,
ANTI-OXIDANTS
It is important to ensure the use of a good multiple vitamin
along with potent anti-oxidants like pycnogenol
for an indefinite
period of time. There are many good products on the market. Some of the
manufacturers
that we prefer are: Phyto Pharmacia, Enzymatic
Therapies, AMNI, Solgar, Twin Labs, etc.
SUPPLIERS
American
Biologics, Chula Vista, CA
Consumers..............................800-227-4473
Health Care
Professionals...800-332-9345
Phyto Pharmacia, Green Bay, WI
800-553-2370
Herbalist and Alchemist, Inc. N.J.
800-611-8235
AMNI, CA 800-356-4791
Ultimate Health Center, N.C.
800-268-6905
PATIENTS with light to moderate lymphedema may use this
supplement program starting several weeks
before treatment and then
continue it through treatment, says lymphedema expert, Peter Glasser,
L.M.T.
Before Treatment:
Flor Essence tea (2 oz twice daily, 30
minutes before meals); for gentle detoxification when there is a
history of infections.
Harmony Multi Herbal Cleanse (1-6 capsules
twice daily, 60 minutes before rneals; increase water intake
to 4 -
12 glasses daily); for colon and body cleansing when there is no history of
infections. Add two
teaspoons of colloidal silver twice daily to
prevent an infection. *
Colon Formula (1-6 capsules twice daily, 30 minutes
before meals): use if you're not having one bowel
motion daily;
when once-daily regularity begins, then switch to Harmony Multi Herbal
Cleanse.
Basic Preventive (two capsules three times daily, at meals); a
well-rounded multivitamin with minerals.
PCO Phytosome (one capsule twice
daily, at meals); grape seed extract as an antioxidant.
Dandelion leaf/root
extract (30 drops three times daily, at meals); increases urination (works as a
diuretic).
Garlic extract, colloidal silver, echinacea (per directions);
natural antibiotics in cases of infection.
At Start of
Treatment:
Infla-Zyme Forte (3-5 capsules three times daily, 30 minutes
before meals on empty stomach): enzymes to
break up fat and protein
deposits in the lymph and tissues.
Lymphotend (ten drops three times daily,
on tongue, taken just before Infla-Zyrne Forte); homeopathic
remedy
to cleanse the lymph.
Burdock/red root herbal extract (10-40 drops three
times daily; start at ten drops, then increase); to
cleanse the
blood and lymph.
Garlicin Pro (one capsule twice daily); an internal
disinfectant.
Lymphatic System Cleanse (10-30 drops three times daily, at
meals; take for six days, omit seventh day,
then resume); contains
cleansing herbs.
Horse chestnut seed capsules (one capsule twice daily with
meals); to reduce swelling and strengthen lymph
vessel walls.
Vitamin C with bioflavonoids (1,350 mg, at meals); strengthens vascular
system.
Rutin (500 mg twice daily); to be taken with horse chestnut seed; a
bioflavonoid or vitamin C helper, helps
reduce swelling and
strengthens lymph vessel walls.
Optional: Flaxseed oil (1,000 mg daily, with
a meal); reduces inflammation.
Optional: Echinacea,/red root herbal extract
(30-40 drops three times daily); cleanses blood and lymph.
Optional:
CurcuMax (three capsules three times daily, 30 minutes before meals); contains
enzymes, herbs,
vitamins, and minerals to reduce
inflammation.
Optional: GingerMax (two capsules twice daily, before meals);
improves blood circulation.
* Using Harmony cleanse can sometimes trigger an
infection in lymphedema patients by moving toxins faster
than the
sluggish lymphatic system can eliminate them, says Glasser. For that reason, he
always includes a
course of colloidal silver to be used with
it.
------------------------------------------------
http://www.cancer.org/docroot/NWS/content/NWS_3_1x_Coumarin_and_Lymphedema.asp
Coumarin and
Lymphedema
Study Determines Coumarin Does Not Reduce
Lymphedema
Article date: 1999/03/04
The drug coumarin is not
effective therapy for women who develop arm lymphedema after being treated for
breast cancer, according to a study reported in the February 4,
1999, issue of The New England Journal of
Medicine. Lymphedema can
be a serious consequence of therapy for breast cancer, and coumarin has been
reported to be effective in treating lymphedema.
In this latest
study, researchers studied 140 women with chronic lymphedema in order to
confirm results of
a previous study, which showed that coumarin
reduced lymphedema.
"In our study we found coumarin did not alleviate
lymphedema, and coumarin-related hepatoxic effects
[liver toxicity]
were more common than has been previously reported," the authors wrote, adding
they
cannot explain the differences in the results of the two
studies.
All of the women studied had lymphedema after treatment for
breast cancer and characteristics of the
women in both studies were
similar. Standards for the study were arm and hand measurements and women’
s perceptions about their symptoms.
Although coumarin is marketed
in several foreign countries, the Food and Drug Administration (FDA) has
not approved its medical use in the US, said Charles L. Loprinzi, MD, of
the Mayo Clinic and one of the
researchers in the study, though he
said women have been able to get the drug through pharmacies
formulating it locally as well as from other countries. Dr. Loprinzi
also noted during his study coumarin was
removed from the market in
at least two countries because of death from liver toxicity.
The new
study should reassure women who are frustrated because coumarin is not
available here that they
aren’t missing out on an important therapy,
said Debbie Saslow, PhD, director of breast and cervical
cancer for
the American Cancer Society.
In the study, women in both groups gave
similar responses when asked about their symptoms of arm
swelling,
pressure, tightness, heaviness, loss of mobility, and the frequency of
infections.
Women who have lymphedema should see a doctor who recognizes
the condition and who is educated
about it, Dr. Saslow said. Other
recommendations from Dr. Saslow: For mild lymphedema, visit a trained
physical
or occupational therapist. For the early stages, compression sleeves are
suggested, but
compression pumps are controversial. For more severe
lymphedema there are trained people in this country
who can provide
more elaborate treatment.
Recommendations
The most important
thing for women who are at risk – women who have had radiation therapy or had
any
of their lymph nodes removed – is to be aware there is a risk
for lymphedema and to follow some of the
recommendations below, Dr.
Saslow said.
The recommended preventative measures are suggestions from
women who have had lymphedema.
Avoid infection by keeping the arm
clean, avoiding cuticle cuts and using gloves for washing dishes and
gardening.
Avoid
extreme temperatures from activities such as taking a sauna or putting hands in
ice.
Avoid carrying anything heavy such as a heavy purse with a shoulder
strap.
Never have blood pressure taken or have blood drawn from the arm at
risk.
Avoid anything constrictive such as a tight wristband or tight jewelry
on the arm at risk.
Avoid heavy lifting including heavy repetitive weight
lifting.
Dr. Saslow said some women associate the onset of lymphedema with
the change in pressure linked with
air travel, and women should
wear a compression sleeve when traveling by air. Another suggestion is to
examine the arm frequently for any redness, swelling, warmth,
heaviness, or bloatedness. The key, Dr.
Saslow said, is to catch
lymphedema early
Coumarin is a dietary supplement that has been studied as a
treatment for
lymphedema. In the United States, dietary supplements are
regulated as foods
not drugs. Supplements are not required to be approved
by the Food and Drug
Administration (FDA) before being put on the market.
Because there are no
standards for manufacturing consistency, dose, or
purity, there may be
considerable difference from one lot of dietary
supplements to the next.
Coumarin was once used in some foods and
medications in the United States. It
was found to cause liver damage, and
its use in foods and medications in the
United States has been banned since
the 1950s. Coumarin is available in
several countries, but has not been
approved for use in the United States or
Canada.
http://www.cancer.org/docroot/NWS/content/NWS_3_1x_Coumarin_and_Lymphedema.asp
-----------------------------------------------------------
Horsechestnut
Herb in the Treatment of Lymphedema
by Diana Brady, Holistic
Nutritionist
Please note that the following article discusses holistic
nutritional supplementation that may be useful in
supporting a
patient's daily regime of self-care. This is not an endorsement by the NLN, nor
do we promise
results from the use of any of these items listed
below. We are committed to presenting all avenues of
possibility
for improvement of the condition and quality of life for all lymphedema
patients. Any and all
claims or opinions expressed in this article
are solely of the author. Ed
--------------------------------------------------------------------------------
The
swelling and edema characteristic of lymphedema is the result of damaged lymph
nodes/vessels, often
combined with radiation in the case of
secondary lymphedema (secondary), or as a result of inborn missing
lymphatics or partially functioning lymphatics (primary) which leads
into protein accumulation in the
interstitial tissue, causing
swelling. This manifests itself in various parts of the body, most commonly the
arms
and legs.
Bandaging and compression garments are used
successfully to reduce and control edema through pressure.
Plant
compounds that improve tissue integrity are also used to treat edema, but work
in a different manner.
One particular herb, horsechestnut seed,
contains a plant compound (escin) that strengthens the tissues of
the lymph vessels, capillaries and veins. When these tissues are
strengthened, there is less leakage of fluid
into the surrounding
tissue. Edema is therefore reduced at its source.
A recent study at the
Department of Internal Medicine in Germany proved the efficacy of this herb in
clinical
testing. Results were published in the February 1996 issue
of the Lancet, by D. Diehm (vol. 347, pp.292-
4). The effectiveness
of horsechestnut seed extract was compared to that of compression stockings in
240
patients with chronic venous insufficiency. Patients were
randomly assigned to receive compression
treatment, horsechestnut
extract (containing 50 mg. of escin twice daily) or placebo for twelve weeks.
Horsechestnut seed was found to be as effective as compression
treatment, determined by the reduction in
swelling in the legs of
the patients. Both treatments were significantly more effective than the
placebo.
Based upon this study, Peter Glasser, LMT, MLDT, ICMT, began
incorporating horsechestnut into his
treatment program with
encouraging results. His patients were at different stages of treatment when
the
horsechestnut was introduced, and results have varied from
patient to patient. Here are a few of the results
reported by just
a few of his patients:
The first patient to include horsechestnut in her
regime was a 69 year old woman with secondary
lymphedema of the
left arm. She had 11 CDP/Manual Lymphatic Drainage treatments nine months ago,
along with Mr. Glasser's complete program of herbs, vitamins and
enzymes. She also had one maintenance
treatment every two weeks for
five months before starting the horsechestnut herb. In addition, she was
bandaging nightly or using CircAid garment, and wearing a Juzo
compression sleeve with custom hand
piece.
By this time her
affected arm was measuring the same and even less in some areas than her
affected arm.
After a few days of taking 10 drops of horsechestnut
once a day, she stopped bandaging, using CircAid
and the
compression garment. When she came in for her next bi-monthly treatment, there
was very little
increase in swelling from her last visit (0.1 cm to
0.4 cm).
The patient continued this routine for over three months, but
the dosage was increased to 10 drops twice a
day. Each time she
came in for a treatment, her arm measurements were the same or slightly higher
with the
increase ranging from 0.1 cm to 0.4 cm. There was only one
time when she overexerted herself and her
measurements increased
between 0.1 cm to 1.3 cm. Her dosage was increased to 30 drops two times daily
to try and compensate for her active lifestyle. This appears to be
the appropriate dosage for her. When she
overexerts herself now,
she simply relaxes for a while and allows the swelling to reduce itself without
compression garments. The only time she uses the compression
garment and CircAid is when she flies. She
is extremely happy with
these results.
A patient with secondary lymphedema of both legs and into
the abdominal area began treatment seven
months ago. At this time
she came in only for maintenance treatments but was enthusiastic about trying a
holistic protocol. Along with this, she was treated in the clinic
once or twice a month for two months, and
then once a month. At
that time she was put on 10 drops of horsechestnut twice a day. It took two
weeks
for any noticeable improvement in the edema, but after two
weeks, the edema began to decrease and she
was able to stop wearing
her compression garments. However, when the weather became warm, the
edema
increased. Her dosage was increased to 30 drops twice a day and that controlled
the swelling. She
reported feeling much better on the increased
dosage and is very happy with the results.
Three months ago, a gentleman
with primary lymphedema of the left leg started on five drops of
horsechestnut twice a day. At the time he was wearing a full thigh
stocking with a knee-high stocking over
this for better compression.
His work requires him to be on his feet all day. With the addition of the
horsechestnut, his leg does not get as hard at the end of the day as it
did before the herb was added. He
reports that the tissue is soft
and supple, even after a long day on his feet. His dosage has been increased to
10 drops twice a day in an attempt to achieve the same results
without having to wear the extra knee high
stocking.
Other
patients who have tried the horsechestnut herb have all reported that they feel
better, that their edema
is reduced and is maintaining. It does
take some time to ascertain the correct amount of horsechestnut herb
for
each individual. However, it is well worth the effort, according to patient
reports thus far, as well as
physical measurements. Mr. Glasser is
currently experimenting with a topical ointment containing aloe vera
gel
and horsechestnut herb.
The type of horsechestnut used by Mr. Glasser is
manufactured by GAIA herbs. It is important to get the
highest
quality product on the market. GAIA can be purchased at many health food stores
or can be
ordered directly from the manufacturer at:
1-800-831-7780. Emerson Ecologics also distributes the herb.
They
can be reached at: 1-800-654-4432.
http://www.uhealth.net/article6.htm
Life Extension
Magazine March 2005
PROFILE features people who exemplify the Life
Extension Foundation way of life: a commitment to
enhanced health
and nutrition, as well as an abiding respect for body and mind.
Individualized care best for lymphedema patients
Posted On: August 10, 2012 - 3:30pm
COLUMBIA, Mo. – Millions of American cancer survivors
experience chronic discomfort as a result of lymphedema, a common side effect of
surgery and radiation therapy in which affected areas swell due to protein-rich
fluid buildup. After reviewing published literature on lymphedema treatments, a
University of Missouri researcher says emphasizing patients' quality of life
rather than focusing solely on reducing swelling is critical to effectively
managing the condition.
Jane Armer, professor in the MU Sinclair School of Nursing
and director of nursing research at Ellis Fischel Cancer Center, said many
insurance providers and health care professionals assess whether lymphedema
patients need treatment based solely on how swollen their limbs are. However,
several studies have shown that the volume of fluid doesn't necessarily
correspond with patients' discomfort.
"Practitioners need to treat the swelling while considering
patients' distress. We don't want to burden them with unnecessary or ineffective
treatments," Armer said. "Health care providers should focus on managing
symptoms and choose carefully among various treatments to provide individualized
care plans that comfort patients, which may require modifying existing
protocols."
In their literature review, Armer and her colleagues found
that Complete Decongestive Therapy (CDT), a comprehensive approach for treating
lymphedema involving skin care, exercise, manual lymphatic drainage and
compression of the swollen limbs, may be the best form of specialized lymphedema
management.
"Patients have different medical needs and come from
culturally diverse backgrounds. They have different goals, support systems, pain
levels and treatment tolerances. All these factors influence patients' responses
to care, which affects their well-being," said Marcia Beck, a review co-author
and an MU graduate who now works at Truman Medical Centers in Kansas City,
Mo.
"Caring for lymphedema patients should be flexible and
adjusted to maintain patients' quality of life," said Ausanee Wanchai, another
co-author who received her doctorate at MU and now teaches at Boromarajonani
College of Nursing in Buddhachinnaraj, Thailand.
In a separate literature review, the researchers found that
Intermittent Pneumatic Compression (IPC) therapy, in which sequential inflatable
devices surrounding swollen limbs are used to increase lymphatic circulation, is
beneficial as an adjunct therapy for chronic lymphedema patients who have
limited or no access to medical care; patients can use the compression devices
in their homes.
Armer said further research is needed to demonstrate the
usefulness of various lymphedema treatments, such as CDT and IPC. The literature
reviews were the third and fourth in a series of 12 to be published in
conjunction with the American Lymphedema Framework Project (ALFP). As director
of the ALFP, Armer works alongside clinical experts and investigators to
increase awareness of lymphedema and related disorders. The ALFP was founded in
2008 and is headquartered at the MU Center for Lymphedema Research, Practice and
Health Policy. Its steering committee and staff currently are partnering with
the International Lymphedema Framework (ILF) in producing an updated edition of
the ILF Best Practice Document from 200
Developing a Successful Treatment for Lymphedema
By Paul
Gains
PROFILE: PETER GLASSER
"Lymphedema causes massive
swelling, usually in the arms and legs.
left untreated, it can lead to
hypertension and stroke."
Millions of Americans suffer from lymphedema,
a debilitating condition in which lymphatic fluid accumulates
in
the interstitial tissues. Lymphedema causes massive swelling, usually in the
arms and legs. Left untreated,
it can lead to hypertension and
stroke.
Lymphedema sufferers are often sent home and told to apply
bandages and compression garments to the
extremities. Although this
helps to squeeze fluids out and reduce the swelling, it is a temporary fix at
best.
Fortunately, a holistic treatment pioneered by Peter Glasser, a North
Carolina-based massage therapist, is
proving successful with
lymphedema patients from across the continent. The treatment involves the
administration of supplements and herbs, most notably horse chestnut
(Aesculus hippocastanum), in
combination with a specific massage
technique called manual lymph drainage.
An Accidental
Discovery
In 1995, Glasser moved to Asheville, NC, where he opened a
practice called the Ultimate Health Center
(www.uhealth.net) with
his wife, Diana Brady, a holistic nutritionist. A New Jersey native, Glasser
learned
about lymphedema while studying massage, and became
intrigued by the lack of information about the
condition.
"I saw
a news broadcast one evening on lymphedema and they mentioned massage as part
of the treatment
program. It's called manual lymph drainage and it
piqued my interest," Glasser recalls. "I called and asked
what
lymphedema was and what they knew about it. I went for an interview and then
for two weeks of
training to be certified in the treatment of
lymphedema."
Glasser, a licensed massage therapist, has established
himself as something of an authority on lymphedema,
which has a
variety of origins. It can be caused by a genetic condition, though some people
develop
secondary lymphedema because of surgery, radiation
treatment, or injury. In many cases, it is directly
related to
cancer surgery.
A lot of women get it when they have breast cancer and
their lymph nodes are removed," Glasser explains.
"With radiation
treatment, there's more stress on your lymphatic system. You see it with
hysterectomies,
which can cause lymphedema in the legs. In men,
prostate surgery can cause it in the legs. These are the
main
causes of secondary lymphedema."
While treatment centers have sprung up
around the country in recent years, Glasser believes his is the only
facility
that specializes in the holistic treatment of lymphedema. He criticizes the
mainstream medical
establishment for failing, through either
ignorance or complacency, to warn patients that surgery might cause
the condition.
"It's a case of the lesser of two evils." Glasser
says. "Many patients complain that their doctors never tell
them
there is a possibility they will develop lymphedema. When they come back and
complain to their
doctors, they're told, 'you're still alive,
aren't you?' "The doctors should be up front and tell patients that
there is that possibility, but a lot of doctors don't know much about
lymphedema. There is very little training
on the lymphatic system
in medical school, so a lot of doctors don't know what to do for the
swelling.
People will go out and get a pump or get compression garments,
and they're told to wait and it will get
better." As Glasser's
hands-on experience in treating lymphedema has grown, so has his practice. In
addition to his wife, the Ultimate Health Center now employs
several other massage therapists, a
physiotherapist, a physician's
assistant, and a medical doctor who doubles as the center's medical director.
"I was always interested in finding a better way for patients,"
Glasser recalls. "I would hear a lot of
complaints from patients on
the amount of bandaging they had to do every night on their arms and legs.
They didn't want to do it for the rest of their lives.
"I
started reading more about herbs and came across an article in The Lancet about
horse chestnut being
used in Germany and Austria for varicose veins
and hemorrhoids. I thought that if it could improve blood
vessels,
then it could help lymphatic vessels. So I started experimenting with horse
chestnut extract, which
was then still hard to find in this
country.
Soon I found that my patients' conditions were improving." Life
Extension products figure prominently in
Glasser's
practice.
He recommends that his patients take two capsules of Venotone
(horse chestnut) with a quarter teaspoon
of Life Extension's Rutin
Powder twice a day. This strengthens their lymphatic vessels and helps reduce
the
edema.
"We also recommend Life Extension's two-per-day
multi-vitamin and Super Digestive Enzymes, which help
reduce
fibrotic tissue and edema," says Glasser.
Patients' Lives
Transformed
The Ultimate Health Center's reputation has spread quickly
throughout the US. Although most of the
center's patients are from
North Carolina and bordering states, Glasser has treated lymphedema sufferers
from as far away as California and Canada.
"I had lymphedema
for almost 20 years, but the doctors couldn't tell what it was," says
52-year-old Susan
Philips, one of the center's long-time patients.
"Finally in 1999, I went to a major teaching hospital in
Winston-Salem, NC. They started working on me and could get the liquids
squeezed out of my legs, but
my legs would fill right back up. I
had gotten to the point where I could hardly walk. My calves were larger
than my waist." Philips was referred to the hospital's occupational
therapy department, whose staff was well
aware of Glasser and his treatment
protocol. But getting an appointment at the Ultimate Health Center
proved difficult, as Glasser was taking on more patients.
"He
had a long waiting list, so I originally saw him in July 1999 but didn't start
manual lymph drainage
treatment until that October," says Philips.
"I did begin taking horse chestnut in July. I had already lost
inches of swelling off my legs by the time I saw him in October, just
from taking the supplements." Like
many of his other patients,
Philips is now on what Glasser calls a maintenance program, which involves
taking horse chestnut daily. She also applies it to her skin each day.
While she originally took treatments at
the center six times a
week, those have been scaled back to twice a month.
Over the years,
Philips has lost most about 150 pounds. Glasser believes from that this has
extended her life.
Philips says that while her legs have returned to normal
size, they are still deformed from enduring 20 years
of lymphedema.
Doctors now almost believe her condition is hereditary, since her younger
brother and
sister also suffer from lymphedema.
Another
long-time patient, 69, year-old Vicki Stokes, developed lymphedema after a
radical hysterectomy.
Doctors discovered she had cervical cancer,
thus necessitating the surgery. According to Stokes, however,
the
doctors went too far.
"My oncologist was not familiar with the lymphatic
system at all," Stokes explains. "I diagnosed myself. He
removed an
unreasonable amount of lymph nodes from each side, saying that he was trying to
prevent a
recurrence.
"So I got on the Internet and found
out about lymphedema.
"I belong to an online support group with people
from Israel, India, South America, and all over the world.
That's
where we share information. The doctors remove lymph nodes. Mine were all
healthy. That causes
lymphedema."
Twice a year, she makes
the journey to Asheville from her home in San Diego for a weeklong maintenance
treatment, and she showers praise on Glasser and his
team.
Despite his success to date, Glasser continually seeks ways to
improve his treatments. Although he tells
patients to follow his
protocol for six months to a year, he often sees them improve much more
quickly. He
ascribes that rapid improvement to the quality of the
horse chestnut and other supplements he prescribes.
"I started using
Rutin Powder along with the horse chestnut," Glasser explains. "Rutin is a
bioflavonoid that
works well in combination with horse
chestnut.
When I first started, horse chestnut was an extract. I would
tell patients to take 30 drops with a little bit of
water, twice a
day. Then it started coming in capsules, so I started advising patients to take
one capsule,
twice a day, and I found that it works better."
Because horse chestnut is a powerful herb that can cause
nausea and
other gastrointestinal problems, Glasser advises his patients to take it with
meals.
Glasser recommends that patients who are already on blood
thinners to forego horse chestnut. He also
advises pregnant women
not to use horse chestnut.
As Glasser and his staff continue to treat
lymphedema patients, they are learning more about its prognosis
and
adjusting their treatment protocols accordingly.
Glasser believes there
are millions of people with lymphedema who can be treated with horse chestnut
and
relieved of this crippling condition. While his patients have
Glasser to thank for regaining their health, he is
quick to share
the credit.
"The way my wife and I see it, Life Extension is the leader
in the philosophy that aging and disease can be
prevented or
corrected," Glasser says. "That's a philosophy that I happen to
share."
Medline:
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-horsechestnut.html.
Horse
chestnut appears to be fairly safe, as long as it is standardized and
does
not contain significant levels of esculin (constituent of horse
chestnut
that is toxic except at low or moderate doses). The same caution
is sounded
by James A. Duke, a leading world authority on herbs, in his
book The Green
Pharmacy.
http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-
5fe33da65dd4&chunkiid=21758
Safety Issues
Whole horse
chestnut is classified as an unsafe herb by the FDA. Eating the nuts or
drinking a tea made
from the leaves can cause horse chestnut
poisoning, the symptoms of which include nausea, vomiting,
diarrhea, salivation, headache, breakdown of red blood cells,
convulsions, and circulatory and respiratory
failure possibly
leading to death.19 However, manufacturers of the typical European
standardized extract
formulations remove the most toxic constituent
(esculin) and standardize the quantity of aescin. To prevent
stomach irritation caused by another ingredient of horse chestnut, the
extract is supplied in a controlled-
release product, which reduces
the incidence of irritation to below 1%, even at higher doses.20
Properly prepared horse chestnut products appear to be quite safe.21
After decades of wide usage in
Germany, there have been no reports
of serious harmful effects, and even mild reported reactions have
been few in number.
In animal studies, horse chestnut and its
principal ingredient aescin have shown a low degree of toxicity,
producing no measurable effects when taken at dosages seven times higher
than normal.21,22 Dogs and
rats have been treated for 34 weeks
with this herb without harmful effects.
Individuals with severe kidney
problems should avoid horse chestnut.23-25 In addition, injectable forms
of horse chestnut can be toxic to the liver.26 The safety of horse
chestnut in young children and pregnant
or nursing women has not
been established. However, 13 pregnant women were given horse chestnut in a
controlled study without noticeable harm.29 Furthermore, studies in
pregnant rats and rabbits found no
injury to embryos at doses up to
10 times the human dose, and changes of questionable significance at 30
times the dose.21
Horse chestnut should not be combined with
anticoagulant, or blood-thinning, drugs, as it may amplify their
effect.27,28
--------------------------------------------------------------------------------
Interactions
You Should Know About
If you are taking aspirin, clopidogrel (Plavix),
ticlopidine (Ticlid), pentoxifylline (Trental), or anticoagulant
drugs such as warfarin (Coumadin) or heparin: Do not use horse chestnut
except under medical
supervision.
----------------------------------
Self-Care:
Massage
Introduction
Living Well With Lymphedema
Performing
self-massage is an important role that you play in managing your
lymphedema!
The primary purpose of self-massage, also known as lymphatic
massage, is to improve the flow and
drainage of lymph by
stimulating the lymphatic vessels. Your lymphedema therapist will instruct you
in a
program of daily self-massage. Since this is an important and
your should perform self-massage regularly as
directed by your
therapist. [1]
Self-Massage Basics
If you have an infection, or any
indication that you are developing an infection, you may need to modify or
skip your self-massage until the infection is under
control.
Self-massage is a gentle technique that should never hurt or make
the skin red.
Self-massage is not the same as conventional muscle massage.
Do not allow anyone, other than a trained
lymphedema therapist, to
instruct you in how to perform massage using deep strokes on lymphedema
affected tissues.
Self-Massage is best performed first thing in the
morning before bandaging or exercising, and at other times
as
specified by your therapist.
Self-massage should be performed in a time and
place where you can be relaxed and will not be disturbed.
The time
devoted to self-massage varies depending on your condition and the instructions
of your
lymphedema therapist.
Most self-massage strokes use very
little pressure and the hands do not slide over the skin. Instead they
move and stretch the skin to stimulate the lymphatic capillaries
located just under the skin. Therefore, oils
and lotions that make
the skin slippery are not used during self massage.
Self-massage movements
are repeated from five-to-seven times in the same position. This matches the
subtle pumping motion of the lymphatic vessels in a rhythm of
five-to-seven pulsations per minute.
Self-massage begins at the terminus.
This clears the terminus so that lymph flowing upward from other parts
of the body can move freely into the terminus where it will rejoin the
circulatory
system.
------------------------------------------
Aloe
The
gel extracted from aloe (Aloe vera) leaves is a cost-effective, natural way to
treat a variety of seasonal
ailments: it can be used topically for
the treatment of windburn, skin irritations or inflammation, and rashes.
Look for a whole, living plant at your local garden store, cut open the
leaf and apply the gel generously as
needed. Or, choose a lotion
(look for those with a high percentage of aloe gel) or a gel product. Although
aloe is great for minor heat burns, you should always contact
trained medical personnel to treat burns with
significant
blistering.
--------------------------------------------
avoid
deep massage strokes on pregnant womens legs, also lymphedema
There
is truth to this, the really deep pressure can damage nodes on someone with
lymphedema or
pregnant, keep in mind alot of people do get deep
tissue massage on their limbs and legs BUT they are not
people with
lymphedema, those are more sports oriented. Deep cross fiber friction work,
speading and
other techniques are good to break up scar tissue,
relax spasmed muscle which do block lymph flow are
good techniques
BUT only done by a knowledgeable, qualified person, they have to be done the
right away.
Avoid Deep Massage Strokes on Pregnant Women's
Legs!
A Spa Site Guest Article by Elaine Stillerman, LMT, the author of
"MotherMassage: A Handbook For
Relieving the Discomforts of
Pregnancy" and "The Encyclopedia of Bodywork" and the developer and
instructor of the professional certificate program MotherMassage:
Massage During Pregnancy, taught at
massage schools and spas across
the country.
Contact
Elaine Stillerman, L.M.T.
Massage
Therapist
108 E. 16 Street
Suite 401
New York, NY 10003
Tel: (212)
533-3188
Fax: (212) 533-3148
http://mothermassage.net/
Related
Resources
• Elaine Stillerman's NY Massage Practice
• MotherMassage®:
Massage During Pregnancy Professional Certification Course Description
•
Breech Presentation, a Spa Site Guest Article by Elaine Stillerman, L.M.T.
•
Spas that Offer Maternity Treatments
Related
Books
MotherMassage
The Encyclopedia of
Bodywork
Several weeks ago, I got a frantic call from a colleague
and former student. She was distressed about a
pregnant client she
had just massaged.The client wanted her to massage her sore legs deeply, but my
colleague explained to her that she couldn't because of several
physiological changes in her circulation. The
disgruntled client
then called me up to complain. I assured her that her massage was administered
correctly.
"Well," she said in a huff, "I don't care what you
think, I'm going to find someone who will work deeply on
my legs."
I told her that anyone who would do so probably didn't understand the changes
in her body and if
she did, would be acting
irresponsibly.
During pregnancy, several physiological changes in her
circulatory system caution the use of deep massage
work. As a way
to prevent hemorrhaging during labor, her body increases her coagulating
activity (the
creation of fibrin) 4-5 times. The potential of
developing blood clots is 5-6 times greater than when she is
not
pregnant. In some cases, these thrombi cause pain, heat, muscle spasms and are
symptomatic.
However, sometimes the presence of thrombi is
asymptomatic: there is no over-riding pain or discomfort.
These
clots are generally found where the blood is most stagnant - the iliac, femoral
and saphenous veins of
the legs. Deep massage strokes, ischemic
compression (i.e. acupressure, shiatsu), deep vibration,
tapotement
or friction could dislodge these clots are send them coursing through the
circulatory system. The
result could be a stroke, or coronary or
pulmonary thrombosis.
Another equally important consideration is the
increase in interstitial fluid. By the third trimester, the fluid
within her tissues can increase as much as 40%. It is no wonder, then,
that her legs are tired and sore. But
the only way to effectively
increase removal of the fluid is through lymphatic drainage technique. This
massage technique is light to enhance the lymphatic drainage of the
superficial lymph vessels. The direction
of this light pressure is
always towards the heart and the massage starts at the proximal portion of the
leg
(knee to hip) to open the channels and then continues from
ankle to knee to hip and finally from the feet
(distal) up the leg
to the hip.
Traditional Swedish massage strokes, or any other deep
technique, can actually inhibit lymphatic drainage.
These strokes
(i.e. deep effleurage) cause an increase in arterial blood flow. You can see
this when the skin
turns red after an area has been massaged
(hyperemia). This increase of arterial blood flow causes an
increase
in blood capillary pressure and subsequent increase in ultra filtration of
water. Therefore, more
water accumulates within the tissues causing
an increase in lymph load and lymphedema. Another reason to
avoid
deep Swedish massage strokes on pregnant women's legs is that the superficial
lymphatics are
vulnerable to external pressure and damage can be
done to the anchoring filaments and endothelial lining of
the lymph
vessels.
As a spa director or massage practitioner, you want to do what is
right and best for the client. When a
pregnant client tells you her
legs bother her, the best way to treat them is to address the cause of the
problem: fatigue and soreness from swelling. Even if her legs aren't
swollen, it is still important to massage
them following lymphatic
protocol to avoid dislodging potential blood clots: lightly. The fact that the
lymph
load is decreasing from this safe and appropriate care will
provide her with much needed and welcomed
relief."
Elaine
Stillerman, LMT is the author of MotherMassage: A Handbook For Relieving the
Discomforts of
Pregnancy (Dell, 1992) and The Encyclopedia of
Bodywork (Facts On File, 1996). She is the developer
and instructor
of the professional certificate program MotherMassage: Massage During
Pregnancy, taught
at massage schools and spas across the country.
-----------------------------------------
Instructions to drain
the face:
start at forehead middle, drain both sides towards the
temple
keep going down and over as indicated by arrows. You want to
drain
all areas. After each arrow set, drain the waterwheel
(nodes behind the
ears) and clavicle (collarbone area nodes) and
axilla (underarm) nodes. Do
each area with 20 strokes (each
line). When you finish, make sure to drain
the thoracic duct
sides of the body, iliac nodes and inguinal nodes. the
thoracic duct is
the sternum area between your breasts. Iliac nodes are
each
side of the bellybutton and inguinals are groin, crease of the
leg
nodes.
---------------------------------------------
THE IMPORTANCE
OF BODY AND LYMPHATIC DETOXIFICATION
IN THE TREATMENT OF LYMPHEDEMA
by
Diana Brady, M.A., Holistic Nutritionist
Please note that the following
article discusses holistic approaches and/or alternative nutritional/herbal
supplementation that may be useful in supporting a patient's daily
regime of self-care. This is not an
endorsement by the NLN, nor do
we promise results from the use of any of these items listed below. We
are committed, and at request of our members, to presenting all avenues
of possibility for improvement of
the condition and quality of life
for all lymphedema patients. Any and all claims or opinions expressed in this
article are solely of the author. Ed.
--------------------------------------------------------------------------------
"Every
tissue in the body is fed by the blood, which is supplied by the intestines.
When the intestines are
dirty, the blood is dirty and so are the
organs and tissues. It is the intestinal system that must be cared for
first before any effective healing can take place," according to Dr.
Bernard Jensen, D.C., Ph.D. This
thought was echoed by Joseph D.
Beasley, M.D. and Jerry Swift, M.A. authors of the 1989 Kellogg
Report, "In today's conditions, most adult patients have to be
detoxified and nutritionally restored before
specific diagnosis can
be formulated" 1.
Today's conditions refer to the amount of external
and internal toxins bombarding us every day. External
toxins were
quantified in 1989 by U.S. Environmental Protection Agency, Office of Toxic
Substances 2 to
be the following:
* 551,034,696 pounds
of industrial chemicals
were dumped into public sewage storage.
*
1,180,831,181 pounds of chemicals were
released into the ground,
threatening our natural aquifers.
* 188,953,884 pounds of chemicals
were
discharged into surface waters.
* The total amount of air
emissions pumped
into the atmosphere was 2,427,061,906 pounds.
*
A grand total of 5,705,670,380 pounds of
chemical pollutants were released
into the environment in 1989.
Toxic chemicals easily find their way
into our body through the air we breath, the food we eat and the water
we drink. Obviously these toxins must be eliminated before they can
disrupt normal metabolic systems and
processes. Yet, although the
body is designed to eliminate toxins, it cannot always handle the overload
present in today's environment. In addition to external toxins, our own
bodies produce internal toxins
through normal metabolic processes
such as digestion, muscle movement and cellular activity.
Consequently, annual and bi-annual detoxification is routinely
recommended by many health care
professionals regardless of health
status. However, healthy detoxification takes on an even more important
role in a disease, lymphedema, characterized by a breakdown in the
detoxification mechanism itself.
Lymphedema is characterized by edema
and blockage of the lymphatic system. The lymphatics have three
very important functions, according to Dr. Gerald M. Lemole, Chief of
the Department of Thoratic and
Cardiovascular Surgery, Deborah
Heart and Lung Center, Browns Mills, New Jersey:
"First of all, the
lymphatics return protein to the bloodstream. As much as 50 percent of our
serum protein
can leak out of our bloodstream during a 24-hour
period, and it is the job of lymphatics to return this
protein to
the blood. Second, the lymphatics clear the spaces between our cells and carry
away toxins and
foreign particles such as bacteria, large proteins,
cholesterol, and viruses. We were taught that the liver and
kidneys
clear away toxins, but it is actually the lymphatics that clear away the fluid
that bathes each cell of
our body. Third, the lymphatics are an
integral part of our immune system. The white cells, called
lymphocytes, circulate in and out of the lymphatics and help destroy
foreign particles like bacteria, viruses
and parasites.
"The
trouble begins when the lymphatic system becomes blocked or the flow of lymph
slows down
appreciably. It's like the kitchen sink: if the drain is
clogged but you leave the water running, the water will
eventually
run all over the floor." Not only is the lymphatic fluid blocked, but so are
all the toxins, bacteria
and viruses that the lymphatic fluid
normally drains from the body. It is no surprise that lymphedema patients
suffer from other varied health ailments. The stagnant lymph fluid is a
breeding ground for bacteria, parasites
and viruses; and a cesspool
of toxic waste.
Peter Glasser, MLDT, LMT, ICMT of Ultimate Health
Center, Asheville, N.C. uses herbal cleanses as an
integral part of
his treatment for lymphedema. The results show improvement, not only in the
lymphedema,
but also in the overall health and well being of the
patient. Peter has also found that when an herbal cleanse
is
initiated before treatment begins, treatment time itself is shortened and
results improved. His typical
treatment period is between two to
four weeks, with 90% of his patients requiring only two weeks of one
treatment
per day.
It is critical to undertake an herbal cleanse under the care
and scrutiny of a qualified health care practitioner.
Each
individual may react different to the cleansing process itself, and to the
herbs contained within the
cleanse. A cleansing program needs to be
established for the circumstances and needs of the individual
patient, and closely monitored for any adverse reactions.
The
herbal cleanses remove some of the toxins in the blocked lymphatic fluid and
start the process of
lymphatic drainage. Patients have reported a
decrease in swelling of affected limbs and a softening of
hardened
tissue before treatment even begins. Some patients chose to use an herbal
cleanse after their CDP
treatments, and still noticed improvements
in their lymphedema and overall health.
The herbal cleanses preferred by
Mr. Glasser include both a commercial tablet and a specially prepared
liquid
formula. The commercial tablet is available in most health food stores as
Nature's Secret A.M./P.M.
Multi-Cleanse. The liquid formula is
specifically created for Mr. Glasser by Herbalist and Alchemist of New
Jersey and GAIA herbs.
The A.M./P.M. herbal cleanse contains:
alfalfa leaf, black cohosh root, burdock root, cayenne fruit,
cascara sagdrada bark, chickweed herb, dandelion root, echinacea
angustifolia leaf extract, fennel seed,
fenugreek seed, ginger root,
guar gum, hawthorn berries, horsetail herb, marshmallow root, milk thistle
extract, mullien leaf, papaya leaf, peppermint leaf, plantain root,
psyllium seed, red clover leaf, safflower oil,
slippery elm bark,
yarrow flower and yellow dock root 4. The herbal cleanse works by cleansing the
body ,
blood and lymphatics. Waste is eliminated by stimulating
additional bowel movements. The amount and
type of bowel movements
needs to be monitored so that they do not exceed two to three per day, and do
not become too watery. Additionally, because toxins and bacteria
are being mobilized, some symptoms of
detoxification should be
expected . They include: flu like symptoms, fatigue, flatulence and in some
cases, a
slight rash.
Mr. Glasser normally recommends going
very slowly with the cleanse, monitoring progress and including
what is considered a "natural antibiotic," such as colloidal silver, in
the regime. The "natural antibiotic" is to
ensure that as the
bacteria are mobilized from the system, they are destroyed before they can
multiply. Also,
included in the regime is a good multi-vitamin,
pycnogenol and dandelion root/leaf. The multi-vitamin
provides
necessary vitamins and minerals to strengthen and revitalize the body,
pycnogenol combats free
radical production in the blood and lymph
system, and dandelion helps the liver and kidneys deal with the
elimination of toxins while also aiding in edema reduction.
The
custom liquid formula contains herbs historically used to cleanse the lymphatic
system 3: echinacea,
cleavers, golden seal and poke root. This
formula is taken three times a day with the usual starting dose of
between 10 to 30 drops. To date, no side effects have been reported
using the liquid formula.
Either one or both of the herbal cleanses is
and excellent way to start the process of lymphatic drainage.
The
benefits obtained can shorten the treatment time and help the patient achieve a
greater level of overall
health and well being.
REFERENCES
1. Beasley JD, Swift JJ. The Kellogg Report. Institute of Health
Policy and Practice, The Bard College
Center. 1989;Ch 4:171.
2. U.S. Environmental Protection Agency, 1991. Toxics in the Community:
National and Local
Perspectives. The 1989 Toxics Release Inventory
National Report. Office of Toxic Substances,
Washington, D.C.
3. Hoffman, David. The Holistic Herbal. Element Books, Inc. Rockport,
1995; 32.
4. Herbal Research Publications. Naturopathics Handbook of
Herbal Formulas. Herbal Research
Publications, Inc., Ayer,
Massachusetts. 1996;
133-15
-------------------------------------------------
TIPS FOR
HEALTHY EATING WHILE TRAVELING:
Bring your own sandwiches and fresh
fruit in a cooler or picnic basket.
Keep an assortment of dried fruit
handy for snacking, it will satisfy your sweet tough while providing disease
fighting antioxidants. Better yet make your own trail mix with
dried fruit, mixed nuts, sunflower seeds.
Pack single servings of precut
baby carrots, celery, or bell peppers in resealable bags to snack on. Use
small plastic containers to pick dips such as low fat ranch dressing,
peanut butter or hummus.
Freeze grapes the night before so they are
chilled for your trip. They make great bite sized snacks and taste
great with small cubes of low fat cheese.
For convenience, pick
up prepackaged fruit slices or vegetables at the grocery store. Some even come
in
their own containers with utensils and dipping sauces. You can
also buy peanut butter in a squeezable
tube. It tastes great on
apple slices or granola bars.
Many fast food restaurants offer fruit and
vegetable options instead of fries. You can also usually request a
fruit cup or side salad for an additional service of fruits or
vegetables. *Note McDonalds now has a fruit
and nut
salad!.
Switch from soda to low fat milk or water or experiment with
various flavors of herbal teas.
As an appetizer, order a salad with low
fat dressing or oil and vinegar.
Opt for tomato juice, vegetable juice
or water on the airplane.
Order a small fruit smoothie at the juice
bar.
Don't necessarily skip your favorite dessert or fried foods. Eat
smaller portions of these and make them
treats, not regular menu
items.
Watch portion sizes. Share an appetizer or antree or choose two
appetizers instead of an entree.
Prepare half of your meal yourself and
snack on fruits and vegetables
Diet Reading
With so many diet
programs and pills on the market today you may be asking yourself which dieting
plan
you should consider purchasing. Our goal is to provide you
with the most unbiased diet reviews for both the
good diet programs
as well as the bad diet programs on the web.
Celebrity film stars are
different from people around, with cooks, fitness trainers and continual other
people
to assist them, they lead a life which is completely
different. So the Celebrity Diets aught to be different too!
To the
celebrities their million-dollar image is so important that the Celebrity Diets
can go to any extent, no
matter how bad the diet is, to sustain
that Star look. Celebrity Diets can be very strict and can even extend
to long fasts, which otherwise can be harmful to the common
workingman.
Looking curiously at some of the secret Celebrity Diets, one
very popular one is Hampton diet. It's a plan
designed by Dr. Fred
Pescatore (M.D) and is basically a low carbohydrate eating plan centered upon
whole and organic foods and good fats such as macadamia oil. Every
famous celebrity is associated with a
book, a DVD, infomercial, and
other publicized diet plans. And others keep appreciating the Atkins and the
Hampton diet.
One thing should be very clear. Celebrities
can advice about acting maybe and its also acceptable, but
advice
about a diet plan should come from a health care professional such as a
registered dietician. Most
Celebrity Diets are faked and as per the
reputation of the so-called Celebrities to promote. The words
might
appear harsh, but they are very true. Following a celebrity diet just out of
mere appreciation for the
Star can cause detrimental results. Also,
Celebrity Diets promote very quick programmes, which are hard
to
follow, and ballyhoo all types of ideas in the diet plan. And if people who are
not technically trained to do
so design these so called Celebrity
Diets, then the results can be really detrimental.
Again, Celebrities
are paid huge cash in order have that good look and can thus meet the expense
of hiring
personal chefs, masseur and other people to do whatever
they wish. Ordinary people, or common men,
must seek help of a diet
plan that is affordable, practical and also includes food that are
available.
There is no need to feel awful and depressed because one has
to cut out upon the Celebrity Diets, its simply
because the
Celebrity Diets are not worth following. The Celebrity Diets, just like their
celebrities, are good
to look at and lucrative from far away, what
remains inside these Celebrity Diets and their celebrities is an
abysmal mystery, otherwise why do they are always on the get to a
simple lifestyle at every opportunity.
Celebrity Diets, be happy
where you are among the
Stars!
-----------------------------------
Non-Surgical
Weight Loss
ST. LOUIS (Ivanhoe Newswire) -- For the first time in this
country, doctors are performing a weight loss
procedure without a
single incision. It's a new experimental option for obese patients who want to
drop the
pounds without having major surgery.
A nine pound
weight loss in two weeks amazes Carrie Williamson. The 30-year old has been
overweight
since she was a child.
"I had done Meridia,
Weight Watchers," Williamson recalled to Ivanhoe. "You name it, I did
it."
That's why she volunteered to be the first American patient to
undergo a new form of stomach stapling
surgery without incisions.
It's called transoral gastroplasty, or TOGA.
"The thing that's unique
about this is that it's all done through the mouth," J. Christopher Eagon,
M.D., an
assistant professor of surgery at Washington University
School of Medicine in St. Louis, told Ivanhoe.
Washington University
surgeons 'stapled' Williamson's stomach by passing flexible instruments down
her
esophagus, to the stomach where a restrictive pouch was
created.
"The jaws open up, pull a portion of the stomach into the jaws,
and then close it down and fire the stapler
and that creates that
tubular type of anatomy," Dr. Eagon explained.
The pouch collects food
as it enters the stomach, giving the patient a feeling of fullness after a
small meal.
"Because you take in so little food, you have to make sure
you take enough protein -- enough nutrients,"
Williamson
said.
In the pilot study, patients on average lost 40 percent of excess
body fat within a year of the procedure.
Doctors say that's
slightly less than gastric bypass, but patients recovered quickly and had a low
risk of
complications.
Williamson is blogging about her
experience in the TOGA study. She writes: "I did the bike for 30 minutes
… more than I ever thought I could do!"
"I had surgery on
Wednesday and went back to work on Monday," Williamson said.
A
schedule-friendly procedure that has many of the weight loss surgery benefits
without a single incision.
Researchers in Mexico and Belgium
successfully tested TOGA weight loss over the past year. TOGA
patients stayed overnight in a hospital after the procedure, but
doctors believe it will eventually be
performed on an outpatient
basis. The TOGA study is investigating 275 cases across the United States.
Volunteers who want to enroll must be 18 to 60 years old and be at
least 100 pounds overweight.
FOR MORE INFORMATION, PLEASE
CONTACT:
Toga Clinical Study
http://www.togaclinicalstudy.com
------------------------------------------------------------
The
Fat Flush Diet can be subdivided into three phases. In the ultimate phase the
Fat Flush Diet
recommends 40 percent carbohydrates, 30 percent
protein and 30 percent fat, a ratio that is best suited
when most
toxins are out of the human body. However in the incipient stages, first two
stages, there remain
a lot of restrictions to achieve proper
functioning of the Fat Flush Diet plan. Discussing the phases one by
one,
beginning with the toughest and the strictest...the first phase.This first
phase of the Fat Flush Diet is like
a purification phase, cleansing
the liver and nourishing it in the proper way to achieve effective weight loss.
Restrictions include strictly upon not using herbs or spices except
for the fat flushing herbs and spices
outlined in The Fat Flush
Plan, margarine, alcohol and sugar too are restricted. Leaving aside flaxseed
oil,
all oils and fats are restricted too. Even vegetables like
grains, bread, cereal or starchy vegetables such as
beans,
potatoes, corn, parsnips, carrots, peas, and pumpkins are removed from the
first phase of the Fat
Flush Diet. Neither dairy product is spared
in the plan.
Coming down to the second phase of the Fat Flush Diet, it
incorporates more food preferences, including
the option of adding
some small amount of carbohydrates. Finally coming round to the third phase of
the
Fat Flush Diet, some dairy products as well as starch
containing vegetables are included along with some
grains too. This
is the final phase of the Fat Flush Diet plan where the human body is
effectively trained for
the Fat Flush process enhancing weight
control and keeping healthy in the same time. The Fat Flush Diet is
a progressing diet plan that continues from a very strict plan onto a
trained and later conventional diet in its
final phases. However
people following this Fat Flush Diet plan reportedly have had a lot of health
benefits
and this assures the success of the Fat Flush Diet.
Anyways, the diet remains to be popular among people
irrespective
of its strictness thereby proving that discipline is the foundation of a
healthy empire named LIFE!
The grapefruit diet promises that you can
lose up to 50 pounds in as little as two and a hald months time.
Are you kidding? Not only is this type of weight loss very unhealthy,
but is also nearly impossible without
totally depriving your body of
nutrients.The grapefruit diet consists of eating four meals throughout each
day. Meal 1 would consist of a half grapefruit, 3 eggs(any style), and
two slices of bacon! Healthy? I don't
think so. Meal 2 would consist
of another half grapefruit, any piece of meat you want, and a salad with any
type of dressing. Is salad dressing healthy? No. Meal 3 consists of
the exact same thing as meal 2, but add
1 cup of coffee into your
meal. Finally Meal 4 consists of either 1 eight ounce glass of tomatoe juice or
1
eight ounce glass of skim milk. This is one of those diets that
many of you may have tried in the past and
found that it didn't
work. Although the grapefruit diet seems very easy, it doesn't produce results
and is far
from a healthy and permanent way of dieting.
The
reason why the Mediterranean Diets are being so popular is because research
reveals that the people
of the Mediterranean live the longest of
lives! Starting from Italy, Crete, Spain to France. The imperative
portions of the Mediterranean Diets are perhaps the spectral blend of a
variety of component foods like
lofty quantities of cereals, olive
oils, dry fruits, garlic, herbs and also sea food. Poultry is also included in
the
Mediterranean Diet more often than red meat; also Wine is
moderate component of the Mediterranean
Diet. In total the
Mediterranean Diet is a different mixture of nutrient foods. The Mediterranean
Region
covers 3 continents with above 17 countries and for years
all these countries have had their influences upon
the
Mediterranean Diet whose age old recipes are a stupendous mingle of all the
cultures of these countries.
From Turkey, Portugal, Spain, Egypt
and Arabia all with different ways of living and thinking have
contributed to the making of this great Mediterranean Diet that
outshines all other diets in it's diversity. The
Arabs brought the
richness of spices to the Mediterranean Diet. They also added the Mediterranean
Diet
with nuts, saffron, rice and fruits. Taking a closer look at
the Mediterranean Diet, it can be observed that
this diet is a
perfect and wholesome natural diet without the dependency upon manufactured
foods.
The followers of the Mediterranean Diet, on principle, take
reduced amounts of saturated fats and whatever
fats the
Mediterranean Diet provides the body with are monounsaturated in nature that
primarily does not
elevate cholesterol levels in the blood. Thus
Mediterranean Diets have the miracle of reducing the rates of
heart
diseases and subsequent death rates. The credit to this can be partially
admitted to the Mediterranean
Diet without dispute. The consumption
of the so called monounsaturated fats, fruits, dry fruits and high
quantities of cereals makes the Mediterranean Diet a good plan to
supply the human body with essential
nutrients, vitamins and no foul
components and thereby the Mediterranean Diet prevents diseases very
efficiently.
However not enough is known whether these goods are only due to the
Mediterranean Diet or
due to the climatic factors and lifestyles of
the Mediterranean Countries too, and to what extent. Thus the
Mediterranean Diet is not officially suggested very often as much of
the research still lays ahead, however
there no denying that the
Mediterranean Diet does have some good effects. Hence the Mediterranean Diet
remains to enthrall people around the world with the wonders it can
do to the human race.
The name Subway Diet seems a bit puzzling to the
common reader, but it is certainly a twister in it's own
way! Also
Subway Diets have a great story behind them. It's a popular story about a
college student named
Jared Fogle, who weighed around 410 pounds.
He, Jared Fogle, one day noticed an advertisement in
Subway about
low fat subs. He followed the idea and the meals really helped him
drastically.
This was the story about Subway diet. Now looking at the
facts about Subway diets. The key idea is a
good selection of
low-calorie subs that can comprise a person's lunch, frequent snacks during
even weight
loss plans in order to reduce junk food intake and
dinner. However only the subs are not sufficient. People
need to
include vegetables and fruits, for instance, to supplement the Subway diet and
make it complete.
The only fact that proved it is that Subway diets
are not properly planned and are the least scientific of all
diets.
Neither does the Subway diet plan follow any calorie-measured path. Thus it is
an intuition-based
program that can cause a lot of problems with
people with diseases such as heart problems and diabetes,
which
really need a specialized and properly planned diet and not just Subway diet.
Subway diets are good
to follow casually, but if followed seriously
them they should be properly supplemented with other foods to
provide the correct calorific intake a human body requires. Otherwise
the Subway diet instead of helping
weight loss plan would cause a
person to lose strength and energy. Hence no fruitful results would come out
of the Subway diets in any way.
The most active ingredients
in Trim Spa are ephedrine and caffeine. Like other ephedrine/caffeine-based
products, Trim Spa works by inducing thermogenesis (the production of
heat), which speeds up your
metabolism and burns calories. It also
has an appetite-suppressing effect, so you feel less hungry and
therefore eat less Trim Spa now offers an ephedra free version of
their popular ephedra
pills.
--------------------------------------------------------
DO's
and Don'ts:
DO'S and DON'TS of LYMPHEDEMA:
Outdoors
DO
protect your arm from sunburn. Always wear sunscreen.
DO avoid insect
bites. Wear something to guard yourself from insect bites whether it be bug
repellent or
long sleeves and pants.
DO wear gloves when
gardening, shovelling, and yard work.
DO exercise and do stretches
before outdoor work. Be careful you don't over exert.
DO NOT allow
outdoor pets to scratch or bite you. Be sure if you do happen to get
scratched, you clean
it properly and quickly to avoid infection and
make sure your tetnus shots are up to date.
DO NOT expose your affected
areas in outdoor hot tubs.
DO NOT play sports that can injury you with
falling, bumps, bruises, etc.
Indoors
DO wear gloves when doing
housework or cooking. If you do happen to get cleaning products on
yourself, wash immediately and look for irritation. Apply
antibacterial or necessary ointment to prevent
infection from any
breaks in the skin. This also applies to burns. The OVGlove works wonders for
taking
pans out of the oven for those with arm/hand
lymphedema.
DO NOT allow pets to bite you or scratch you even in play.
Always be careful when handling any pets.
DO NOT iron or sew without
proper hand protection whether it be a thimble or glove when
ironing.
Hygiene
DO make sure you keep your affect areas clean
and use moisturizing lotions to keep the skin supple.
DO make sure you
wash and apply any ointments, lotions, and antibacterial remedies immediately
after a
cut or scratch.
DO dry your body thoroughly after
bathing, and be sure the water is warm, not hot. It is good practice to
do skin brushing wet work or dry work before or after bathing. Skin
brushing helps remove dead dry skin
and also stimulates the
superficial lymph nodes under the skin to promote lymph flow. While in the
tub, you
can make it a practice to save time (for women) to do
breast exams. Everyone can also check their body
over for any odd
moles or patches of skin (skin cancer check). You can also save time by doing
some self
massage as well.
Grooming and
Accessories
DO wear a well fitted bra. There are actually bra's made
for lymphedema, one company makes a
compression bra. The company
is named Bellise. Be sure the straps on your bra do not cut in your
shoulders
and the edges of the bra don't have anything to irritate the skin (sharp edges
on lace, etc). Some
prefer to go bra-less. Some also use stick on
patches. Be careful of the adhesive on these as it can irritate
the skin. If you wear a prosthetic, be sure it's a light weight
one.
DO NOT use a disposable razor if you can help it. Electric razors
give a smoother shave which is less
likely to harm the skin with
little cuts or abrasions. Be careful with cutting finger and toe nails as
well.
Cutting the cuticles isn't advised with arm/hand lymphedema.
If you have hard, brittle nails (Toe or Finger)
please see your
doctor or podiastrist. You may have a fungal or some type of infection that
should be
treated. (Lamisol is the treatment of choice).
DO
NOT wear tight jewelry of any kind on your affected areas. For abdominal
lymphedema, body
piercing is not an option, it's a danger.
Anklets, bracelets, rings and other jewelry can cause irritation and
become tight with swelling. It is also advised not to carry a heavy
purse, bag, laptop bag or briefcase over
the shoulder of an
affected arm.
Travel
DO wear compression garments when
travelling. Make sure you get up and move around as much as you
can. Remember to stretch and do range of motion exercises if possible,
and to deep breathe. Also
remember to take your special supplies
(Soap, creams, bandages, etc) with you.
Medical
DO NOT allow
blood to be taken from any arm affected with lymphedema, nor allow vaccines or
shots to
be given in the arm. IV's are also troublesome, as well
as blood pressure cuffs. The vaccine or shot causes
a prick in the
skin which is a risk for infection as well as trauma to the area. The blood
pressure cuff exerts
a force on the area traumatizing it as
well.
----------------------------------------------
COMPREHENSIVE
TREATMENT GUIDELINES
Establishing Disease Management Guidelines
for
LYMPHEDEMA
Cyndi Ortiz
Contributing Authors:
Phyliss
Tubbs-Gingrich, RN, LANA-CLT
Wade Farrow, MD, CWS, FCCWS
Cheryl L.
Morgan, PhD
Lawrence L. Tretbar, MD, FACS
Benoit Blondeau, MD
Disease
Management Practice Guidelines
Lymphedema
Cyndi Ortiz, with Phyliss
Tubbs-Gingrich, RN, LANA-CLT, Wade Farrow, MD, CWS, FCCWS, Cheryl
L. Morgan, PhD, Lawrence L. Tretbar,
MD, FACS, Benoit Blondeau,
MD
COPYRIGHT 2005 All Rights Reserved
Lymphedema:
Goals and
Objectives:
Goals and objectives in current medical practice for lymphedema
are concentrated on assisting affected
individuals with successful treatment
and long-term disease management of chronic intractable lymphedema,
with a
focus on patient independence. Lymphedema is a chronic disease due to an
obstruction, interruption,
or
malformation of the lymph system.
Currently, there is no cure for lymphedema. The physical results are
chronic
edema caused by excess fluid that accumulates in the interstitial tissue. This
fluid is high in protein
content, which distinguishes it from other types of
swelling. This fluid also has not yet been filtered and has a
high content
of bacteria and other waste products not normally found in this tissue. Health
risks include
progressively degenerative edema, tissue fibrosis, fibrotic
skin changes, blisters, wounds, re-occurring
cutaneous
and
sub-cutaneous infections (cellulitis), osteomylitis, deformed limb(s),
decreased mobility due to inactivity,
repeated hospitalizations for
infections, severe weeping of lymphatic fluid from swollen wounds
(lymphorrhea),
and in severe cases can even result in amputation, or
death due to sepsis. The psychological affects due to
appearance, pain,
reduced function, can be devastating to the quality of life of affected
patients.
As with many chronic diseases, untreated lymphedema tends to
worsen over time, resulting in increased
complications and morbidity over
time without treatment. When this chronic diseases are not
effectively
managed, the disease process progresses causing significant and
expensive health complications. Collateral
affects resulting from physical
limitations and complications can interrupt a patient’s normal lifestyle
activity
including employment, family relationships, social activities, and
exercise activity. Patients report a lack of
desire
to socialize
due to appearance, difficulty purchasing clothes and shoes that fit properly,
which in turn, causes
depression. The change in physical abilities
contribute to depression causing a feeling of being needy or
worthless.
Prior to experiencing lymphedema, many individuals report being able to perform
normal daily
functions as well as actively assisting friends and family in
meeting their needs. Once the disease progresses
to a
point of
affecting function, they are no longer able to participate in normal daily
activities such as cleaning
their
home, shopping for groceries,
caring for children or family, or other menial but important activities
healthy
individuals take for granted.
Goals and objectives must include
the education of medical practitioners in properly diagnosing upon
early
onset, education of medical professionals in properly identifying risk of
onset, early diagnosis,
appropriate
treatment, and educating
patients about the management of this life long disease. Treatment and
disease
management that are geared towards individual needs will create an
environment for successful long-term
management. This environment should
consider and provide treatment and tools that facilitate effective
results,
compliance, independence, exacerbation prevention, and
complication prevention. Treatment and
management
that is
individual needs based not only should include effective treatment, but
providing an individualized
treatment plan allows patients to enjoy a
psychological view that gives them control over their disease. This
improves
compliance by increasing their ability to maintain normal lifestyle activities,
while implementing
disease management into their daily regime.
Because 20
to 45% of cancer survivors who are treated with surgery, radiation, and/or
lymph node
removal develop lymphedema at some time in their lives, patient
education and early intervention for “at risk”
cancer patients is essential.
Some develop lymphedema immediately after treatment, and some years later.
Many
cancer survivors never develop lymphedema; therefore, those who
do may have an existing obstruction or
minor
congenital defect
of the lymph system prior to treatment, which predisposes them to experiencing
lymphedema.
Education for at risk cancer survivors provides them
with the necessary information for early recognition, so
they
are able to obtain treatment immediately upon symptom
onset.
Early intervention is essential in achieving treatment success. As
with any chronic disease with early
intervention, desired goals are achieved
at an accelerated rate, thus reducing the need for lengthy
treatment,
preventing expensive and debilitating health complications, and
better enables patients to continue with
normal
lifestyle
activities. Failure of medical practitioners in properly diagnosing early on,
ordering the proper
treatment,
and long-term disease management
can facilitate disease progression that can not only lead to
health
complications but facilitates employment loss, and other devastating
life changing events. In order to achieve
effective results and better
enable long-term success, several factors must work together in order to ensure
longterm
disease management success: education, early
intervention, effective treatment, and effective needs based
home management
tools that will allow independent, successful, and long-term home disease
management.
Treatment and management should include a comprehensive
approach that addresses each individual’s
physical,
mental, and
social objectives. Considerations during the treatment and long-term management
planning
should
not only include the patient’s objectives, but
their level of motivation, physical abilities, system of support,
employment
and social activity schedules. A realistic approach to disease management
should include the
evaluation of each patient’s ability and motivation to
implement management into their daily regime, and
should
involve
the necessary tools that are realistic in independent
application.
Prevalence In the United States:
Lymphatic obstruction
resulting in lymphedema can be caused by a congenital malformation, a
surgical
procedure(s), trauma, a benign or malignant tumor, radiation, lymph
node removal, sentinel node biopsy,
and
disease. Because those
affected are considered an underserved population, a lack of knowledge in the
medical
community has resulted in many individuals who
experience lymphedema to remain undiagnosed. Estimated
figures are available
however, they may be significantly lower than those who truly experience
lymphatic
disease.
Current Cases Estimated in the United States due to
reasons other than cancer or cancer treatment:
An estimated 2.5 Million
current cases of lymphedema that exist in the United States resulting
from
congenital malformation, trauma, surgical procedures, or disease.
Approximately 26% of cancer survivors
treated
with surgery
and/or radiation will develop lymphedema at some time in their lives. The
National Cancer
Institute
reports in a survey of 1151 women
treated with radiation for breast cancer, 23% reported lymphedema at
zero
to
two years after treatment and 45% of these women developed lymphedema at
fifteen or more years after
treatment. In patients treated with surgery
alone, 20% developed lymphedema at zero to two years and
30%
at
fifteen or more years after surgery. The National Cancer Institute
further documents patients with
lymphedema
reported an impaired
quality of life.
Lymphedema is seen more prevalently in cancer affecting the
stomach, colon, anal/rectal system, urinary
tract,
respiratory
system, biliary and gallbladder systems, bones and joints, soft tissue, skin,
breast, genital (both
male
and female) system, lymph system as
is seen in lymphoma, and sometimes the brain, other nervous system,
or
endocrine system. There are approximately between 2.02 million to
4.5 million cancer survivors in America
who
experience
lymphedema, with 156,214 to 351,481 new cases of lymphedema in cancer survivors
yearly. As
cancer treatment improves and more individuals survive cancer,
these numbers will continue to rise.
Total Americans estimated to experience
lymphedema as of 2006 is an estimated 5.1 million to 7.5
million
Americans:
Due to cancer or cancer treatment: 2.1 million to 4.5 million due
to cancer or cancer treatment
Due to trauma, infection, surgery, or disease:
2.5 Million
Due to congenital malformation: 500,000
We suspect these
numbers may be higher due to discrepancies in the definition and a lack of
uniform
diagnostic
criteria. Information concerning cancer
patients, for example, is somewhat limited to breast cancer while
lymphedema
resulting from other types of cancer and from other causes have not been well
reported and
documented.
Economic Impact:
As the disease process
continues to remain untreated and therefore progressively worsens,
individuals
who experience lymphedema become less mobile, less active, and
are eventually unable to maintain
employment. Individuals who were gainfully
employed are able to contribute to the government’s economy
via
income tax, and to the American economy in purchases of consumer
goods above and beyond items that
meet
the needs of minimal
survival. When lymphedema is not effectively treated and managed, allowing the
disease
to progress to severe levels affecting mobility,
affected individuals who are unable to maintain gainful
employment and are
forced to use disability benefits. Thus, they are no longer contributing to the
government’s
economy via income tax and instead are now being
supported by government sponsored long-term disability
benefits for both
income and medical care, and are limited to purchasing only items needed for
survival.
Americans who are not receiving effective treatment have proven to
experience obesity due to a lack of
mobility and exercise. Untreated
lymphedema leads to isolation, impairs patient’s ability to perform activities
of
daily living, and exercise, leading to weight gain and
obesity. Obesity has proven to significantly increase the
cost of health
care.
In an article published in 2004 by Reuters Health News, results of a
study showed a reduction in
compliance with disease management medications
when health insurance benefits reduced coverage. When
a
lack of
health insurance coverage prevents or hinders individuals who experience a
chronic disease from
implementing effective disease management, and the
disease process continues to exacerbate, individuals
experience health
complications that are much more expensive to treat, increasing the overall
national cost of
health care. The rise of health care costs is passed on to
American consumers via higher
insurance premiums and tax dollars, and
increased deductibles and co-insurance. This, in turn, affects
spending
in the economy, as expenditures turn towards health care
expenses, and away from consumer goods.
All of this can be avoided by taking
a common sense approach to health care by implementing improved
coverage and
treatment guidelines for effective disease management of chronic diseases
including
lymphedema.
This common sense approach is similar to
effective vehicle maintenance in utilizing the thought process of
regular
vehicle maintenance that may prevent a more expensive vehicle accident in the
future. Using the same
thought process of repairing a vehicle brake system
will prevent an expensive vehicle accident that can occur
with brake system
failure, we must also apply a common sense approach to health care
delivery.
Lymph System Overview:
The lymph system is an integral part of
the circulatory system and its function is to collect and
return
interstitial fluid, defend the body against disease, and absorb
lipids from the intestine and transport them to
the
blood. The
lymph system consists of the spleen, lymph nodes, lymph ducts, lymphatic
vessels, and lymphatic
capillaries. The lymph system runs parallel to the
blood capillaries and extends into most tissues, and while it
does not
communicate directly with the vascular system, it is
connected to the
vascular system by filaments that are attached to the outer surface of the
capillary wall. The
lymph system is present in almost all tissue, but is not
present in some, such as the central nervous system
and
cartilage.
With arterial inflow, protein plasma, a blood
component, is released into the interstitial tissue to deliver
moisture,
nutrients, and oxygen. Some excess fluid is collected during vascular outflow.
At the lymphatic
capillary end, the lymph system collects what the vascular
system does not collect, which consists of larger
molecules including
proteins, fat, and debris. The capillary end contains overlapping endothelial
cells that
form
“swinging tips” that open and close by constant
interaction of the capillary blood pressure, the plasma colloid
oncotic
pressure, the interstitial fluid pressure and the interstitial colloid oncotic
pressure. A pressure
gradient is
created by fluid pressure
differentials. The overlapping endothelial cells, open allowing fluid intake
but not
fluid
outflow. Once fluid enters the lymph system, the
fluid becomes lymph fluid.
The head and neck drain into the jugular then the
supraclavicular trunk. The upper extremity drains into
the axillary nodes,
which then drain into the subclavian trunk. The foot and lower leg drain into
the popliteal
and then inguinal nodes. The pelvic, abdominal wall, and
viscera return to the bloodstream primarily through
the thoracic duct. The
major node group that drains the body wall are external iliac, common iliac,
internal
iliac,
and visceral groups. The lymph flow is produced
by respiratory movements, muscle contraction, and the
stretching of lymph
vessels. In the normal lymph system, as the vessels become stretched with
lymph, the
smooth muscle wall of the vessel then contracts, pushing fluid
into the next segment.
Diagnosing Lymphedema and Determining the
Cause:
One or several factors can cause imbalance in extracellular fluid
volume. When one or more of the
pressure differentials is disrupted, the
fluid does not adequately eliminate from the interstitial tissue and
edema
results.
Edema due to lymphedema arises from a chronic failure in lymphatic function
caused by
malformation,
obstruction, or interruption of the
lymphatic system that results in the disruption in fluid differential.
Excess
fluids, proteins, immunological cells, and debris in the interstitial
tissues cause inflammation. If untreated, the
disease progressively becomes
worse. The accumulation of proteins result in tissue fibrosis or hardening
and
thickening of the interstitial tissue, which makes elimination more
difficult.
Obvious signs and symptoms indicative of insufficient lymphatic
transport include progressive chronic
edema, stasis dermatitis, blisters,
weepy wounds, and reduced extremity function. Some individuals
experience
pain, while others do not. When chronic edema is present,
other possible causes are ruled out. These
include:
congestive
heart failure, deep vein thrombosis, kidney failure, venous insufficiency
(sometimes is seen
concurrent with lymphatic dysfunction), abnormal hormone
levels, side affects of some prescription drugs,
and
occasionally
other temporary obstructions, i.e. ovarian cysts. A Venous Doppler may be
administered to
rule out
DVT, arterial insufficiency, and
vascular insufficiency. Lymphangiography may show where the
lymphatic
blockage is and the extent of the blockage, however not all labs
offer this diagnostic test, nor are they readily
available in all major
cities.
There are two types of lymphedema; primary which is caused by
congenital or hereditary defect, and
secondary, which is acquired resulting
from secondary factors such as surgery, trauma, disease, radiation, or
other
reasons. Primary Lymphedema is caused by developmental abnormalities, which may
be part of
chromosomal abnormalities (i.e. Turner’s Syndrome) or inherited
single gene defects, or by other
malformations
during gestation.
Other congenital abnormalities resulting in lymphatic dysfunction can include
Downs
Syndrome or Spinal Bifida, or other developmental malformation. Onset
occurring at birth is congenital
lymphedema, onset after birth but before
age thirty-five is Lymphedema Praecox. Onset occurring after
age
thirty-five is called Lymphedema Tardum. Some patients present with symptoms of
lymphedema as
adults
after an incident of trauma is reported.
Congenital abnormalities may have been present at birth but not
significant
enough to present symptoms until trauma, severe illness, or other event (some
report after flying
on
an airplane) occurred. These individuals
report no symptoms prior to the incident, but recall paternal or
maternal
relatives having symptoms. Obtaining previous medical
history and family history can assist in diagnosing the
patient who may have
a congenital malformation, but no symptoms until adulthood.
Secondary
Lymphedema is acquired and results from obstruction, interruption, or
obliteration of the
lymphatics. Cancer, trauma, severe infections, disease,
lymph node dissection, lymph node removal,
radiation,
sentinel
node biopsy, lymphoma, filariasis, and thrombosis can result in secondary
lymphedema. Some
medical
professionals also attribute lymphatic
dysfunction to other diseases, such as fibromyalgia, and reflex
sympathetic
dystrophy, although further evaluation of
this is
warranted. An evaluation was conducted on patients with unilateral lower
extremity lymphedema
using a
color Duplex Doppler scanner and
the results published in Lymphology 1999 March;32(1):11-4. Results
showed
soft tissue edema from lymphatic stasis gradually impedes
venous return. Chronic venous insufficiency, if not
treated, may also cause
fluid overload resulting in lymphedema. This further complicates the treatment
and
outcome. Patients with both chronic venous insufficiency and lymphedema
are more at risk of amputation
because due to a reduced blood flow, the skin
begins to die, and infection is more of a risk.
Complications include
re-occurring infections which include fungal, cellulitis, streptococci
and/or
staphylococci, and
osteomylitis. Infections result from lymph
stasis, decreased local immune response, tissue congestion,
accumulated
proteins, and other debris. Excess edema causing is high in bacteria, which
places affected
individuals at high risk of severe cutaneous and
subcutaneous infections. This excess fluid furthers the
obstruction of
healing as it prevents blood capillaries from delivering oxygen and nutrients
to keep the skin
healthy and respond positively to topical wound treatments.
Lymphorrhea or weepy wounds occur with
severe
lymphedema and
result from permanent tissue damage, and the skin’s inability to accommodate
excess fluid.
Excess lymph fluid begins to weep through the damaged skin
causing a blister that then results in a weepy or
a
heavily
draining non-healing wound. Other complications affecting the skin include
lymphoceles, papillomas,
and hyperkeratatosis.
Staging of lymphedema as
reported in the Lymphology 36, 2003, The International Society of
Lymphology
(ISL) Consensus Document, reviews the staging of lymphedema in
four stages as follows:
Stage 0 – “refers to a latent or sub-clinical
condition where swelling is not evident despite impaired
lymph
transport.”
Stage 1 – “represents an early accumulation of fluid relatively
high in protein content (e.g. , in
comparison with “venous” edema) and
subsides with limb elevation. Pitting may occur. “
Stage II – “signifies
that limb elevation alone rarely reduces tissue swelling and pitting is
manifest. Late in
Stage II, the limb may or may not pit as tissue fibrosis
supervenes. “
Stage III – “encompasses lymphostatic elephantias is where
pitting is absent and trophic skin changes
such as acanthosis, fat deposits,
and warty overgrowths develop.”
“Within each Stage, severity based on volume
difference can be assessed as minimal (<20% increase) in
limb volume,
moderate (20-40% increase), or severe (>40% increase).”
Lymphedema can
affect any part of the body. It most often affects either the upper or lower
extremities.
It can, however, also affect the head, neck, chest, back,
abdomen, hips, buttocks, and both male and female
genitalia. Congenital
defects can result in edema affecting the part of the body where the lymphatics
are
malformed. Secondary lymphedema can occur as follows:
Head and Neck:
regional lymph node removal and/or radiation. Surgical removal of a tumor
possibly
interrupting lymphatic flow. Disease, infection and regional trauma
may also cause regional lymph damage.
Upper Extremity: regional lymph node
removal, sentinel node biopsy, lymph node dissection, surgical
interruption
of lymphatic vessels, and the application of radiation. Disease, infection, and
regional trauma
may
also cause regional lymph damage.
Back and
Chest: Lymphedema can affect the chest and back area due to radiation,
congenital
deformation, regional lymph node removal, trauma and disease. It
is most often seen in post-mastectomy
patients.
Abdomen, Hips, Waist and
Buttocks: Abdominal surgical procedures including hysterectomy in which
inguinal
vessels and/or nodes were incised, and/or nodes removed.
Lymphatic interruption may occur without lymph
node removal. Disease,
infection, and regional trauma may also cause interruption to the inguinal
lymphatics
resulting in chronic lymphedema.
Male and Female
Genitalia: Occurs primarily due to the application of radiation, but can also
result from
rectal surgery interrupting medial vessels of the thigh, disease
or infection. The female genitalia tissue does
contain superficial inguinal
vessels that drain into the supermedial superficial inquinal nodes.
Surgical
interruption may also contribute to female genital
lymphedema.
Lower Extremity: Because the lower extremities drain into the
popliteal and inguinal nodes, any surgical
interruption of those vessels and
nodes can cause lymphedema. Regional trauma of the inguinal vessels
and
nodes, or popliteal nodes, disease infection, or radiation may result in
and interruption in lymph flow.
Surgical
procedures, such as vein
harvest, knee surgery, tumor excision, hysterectomy, or any surgical
procedure
interrupting lymphatic vessels and/or nodes can cause an
interruption severe enough to result in lymphatic
dysfunction. Because
intercostals and vertebral nodes are located in and around the spine, some
patients
who
have undergone surgical procedures involving the
spine result in lower extremity lymphedema.
Long term lower extremity
paralysis can be complicated by lymphedema due to the lack of a muscle
pump
assisting in gradient fluid differential due to reduced venous return, the
involvement of gravity, and
sometimes a trauma contributing to the paralysis
result in lymphatic dysfunction.
Not all individuals who experience surgical
procedures, radiation, trauma, disease, or infection develop
lymphedema. The
explanation for this may be due to a previous unknown factor of reduced
lymphatics
which
would interfere with the normal increase in
lymphatic uptake compensation for damaged or interrupted
lymphatics. If
there is an undisclosed predisposition of reduced lymphatics, this would result
in remaining
lymphatics to be insufficient in increased uptake performance,
when trauma to the body occurs.
Early Intervention and
Prevention:
Patients who have undergone treatment of cancer, surgical
procedures, and those who have been
diagnosed with venous disease should
receive a consultation for educational purposes for prevention and to
ensure
treatment during early onset of lymphedema. Patients whose cancer treatment
included the following
procedures are at high risk of developing
lymphedema:
1. Lymph node dissection
2. Sentinel node biopsy
2. Lymph
node removal
3. Radiation
4. Major surgical procedures
Prevention of
lymphedema includes:
1. Keeping the skin clean and moisturized
2. Avoid
having blood drawn from the affected extremity.
3. Avoiding hot showers,
saunas, or steam rooms.
4. Avoiding bug bits by using insect
repellents.
5. Protecting the skin from sun burn.
6. Avoid lifting heavy
objects and over strenuous activity.
7. Wearing a compression stocking when
flying on an airplane.
8. Use an electric razor to shave affected
extremity.
9. Education on signs and symptoms of onset and
complications.
10. Avoid sleeping on the “at risk” side of the body.
The
sooner treatment begins with a chronic disease, the less likely serious health
complications will
occur. Teaching “at risk” individuals to watch for signs
and symptoms of lymphedema will better ensure
early
treatment
intervention. Treatment applied immediately after onset has proven to achieve
more effective
longterm
results, exacerbation of the disease
process, and expensive health complications.
Treatment:
Criteria Used for
Review:
Various treatment modalities and technologies exist and are very
effective. Current clinical studies
published to date have been conducted on
many treatment options, however, much of the information in
these
studies is subjective and not objective, there are too few
subjects included in the studies, subjects are not
evaluated over a long
enough period of time, some published studies show conflicting results Some
studies
fail
to disclose important variables and factors in the
studies.
Some of the important variables and factors not reported in
current medical studies include length of time the
disease has been present,
condition of tissue, whether or not radiation was applied directly to
affected
edematous areas which may result in the requirement of increased
therapy, level of patient compliance, and
additional therapies that were
applied to some subjects and not others during the study. This overview will
seek
to address objective information and review the
physiological affects and benefits of various treatments
versus
subjective information provided in some of the available
published data.
Initial Evaluation:
Once the proper diagnosis has been
obtained, the treating therapist should gather the following
information
during the patient’s initial evaluation: health history, signs and symptoms,
disease etiology,
history of
complications including current,
social demographics, employment status, the system of social and
emotional
support, nutritional status, and specific treatment goals.
Treatment should be adjusted to meet the patient’s
physical needs while
considering level of motivation of compliance, and ability to be compliant.
Daily
schedule,
social activities, financial status, and mental
capacity should be considered when developing a treatment
plan,
and setting specific reasonable and attainable goals.
Contraindications should be ruled out, which include
deep
vein
thrombosis, renal failure, and active cancer unless providing palliative care,
active infection, and
congestive
heart failure. Allergies to
creams, foam, and bandaging products should be obtained and alternatives
considered
when allergies are present. Treatment may not be applied
to areas with localized trauma, and
hyperthyroidism
prohibits
neck treatment.
Treatment should be applied by a licensed medical
professional who have received at least 135 hours of
specialized training in
the disease etiology and treatment of lymphedema which includes combined
decongestive
therapy. Combined decongestive therapy includes the
application of manual lymph drainage and external
compression. Because
lymphedema is accompanied by health complications, specialized training is
required.
When a non-medical and/or insufficiently trained individual
attempts to treat a medical disease, further
complications can ensue causing
physical harm to the affected individual.
A two phase treatment approach
that includes an intensive treatment phase, followed by a long-term
disease
management phase is optimal. The first phase involves direct one on one
application of manual
lymph
drainage and short-stretch
banding.
Manual Lymph Drainage:
In the overview of normal lymphatic
function, fluid enters the lymph system in two ways: pressure
gradient
dynamics, and as the lymph vessel are stretched with lymph fluid, it is pushed
into the next deeper
segment. When the lymph system is dysfunctional, this
action can be done manually by the application of
manual lymph drainage.
Manual lymph drainage is a
specialized massage technique, in which lymphatic
receptors are manually stretched. Because the lymph
system
operates by the outward pressure differential pushing the
fluid into the lymph collectors, manual therapy
physically manipulates the
lymphatic collectors by manually doing what the lymph system is unable to do on
its
own.
Manual lymph drainage further assists the body in
redirecting fluid away from damaged or impaired
lymphatics and towards
working lymphatics. Fluid can be redirected around scarring that may be
“blocking”
lymphatic flow. Therapy begins proximally in order to clear a
path for distal fluid, allowing for a place to
send
excess fluid.
The jugular/subclavian vein junction at the base of the neck is cleared first
as this is the main
pathways of lymph elimination.
Deep breathing
exercises performed during this therapy assist in stimulating deep lymphatic
flow.
Lymphatic flow is increased with lymphatic output of the thoracic duct
and lymphatic trunk by deep
diaphragmatic breathing exercises. This also
contributes to peripheral lymphatic increased flow. Exercise is
also
beneficial in moving lymph fluid as the intrinsic contraction
of muscles and movement of veins during exercise
helps to mobilize lymph
flow.
External Compression:
Stimulation of the lymph system with manual
lymph drainage does assist in clearing, redirecting fluid,
and stimulating
stagnant lymphatic flow, it does not actually significantly reduce edema due to
excess fluid.
External compression must be applied in order to produce
significant reduction and maintain reduction.
Tissue
compression
helps prevent fluid refill, softens hardened tissue, and aids in fluid
re-absorbtion by acting as a
resistive force. External compression assists
in edema reduction by helping to move fluid out of the interstitial
tissue
and into the vessel system for elimination.
Phase One – Intensive Therapy
Phase:
The initial treatment phase should include direct one on one
therapist’s application of manual lymph
drainage. Optimally, therapy is
applied for twenty consecutive days or more if needed to achieve
reduction
goals. Some individuals who have very mild lymphedema and are
treated immediately at onset may require
less
however, treatment
plans should be
-6-developed to meet each individual’s needs. Patients with
severe cases who may have hardened fibrotic
tissue
that is more
difficult to eliminate, wounds, or other health complications may require more
therapy. It is
essential to address the disease adequately during the
intensive therapy phase so that complications do not
arise
and
home disease management is achievable for the patient.
The therapist should
treat the disease in its entirety during the intensive phase, and assist the
patient in
keeping the disease maintained at home. Failure to adequately
treat affected patients during the intensive
therapy phase will result in
treatment failure because when significant reduction is not achieved, wounds
are
not
healed, and a patient is left to complete treatment on
their own. This is much like a surgeon handing a patient
the scalpel halfway
through surgery, and asking the patient to complete the surgery, and suture
their own
incision. Unfortunately, inadequate insurance coverage many times
results in the non-completion of
necessary
and essential
therapy. This causes treatment failure and the result almost always is the
requirement to return
to
therapy after a exacerbation of edema
and/or serious and expensive health complication has occurred.
During
therapy, each visit should consist of at least the following:
1. Therapist
application of manual lymph drainage. The therapist should not only apply
manual lymph
drainage on the affected extremity, but it is essential to
first apply therapy to stimulate the
jugular/subclavian vein. This is needed
to stimulate and prepare it for receiving fluid. Therapy is then
applied
proximal to distal. When bilateral extremities are affected, therapy
focuses on one extremity at a time, with
treatment starting with the worst
extremity first. After the most severe extremity is adequately
treated,
therapy begins on the second extremity.
2. Diaphragmatic
breathing exercises.
3. Application of Short-stretch bandaging -
gradient.
4. Exercises specifically designed to assist in promoting working
pressure against the bandages can be
done to increase lymphatic flow.
Modifications can be made in bandaging techniques to address
phlebolymphatic
components of the disease as well.
5. During the intensive treatment phase,
the therapist is also educating their patient on this process, so
that
therapy can continue self-application of therapy during the home management
phase. Patients should
also
be educated on the importance of
good skin care, prevention of complications such as exacerbation
and
complications.
Time of application:
Each therapy visit for
combined decongestive therapy is based on the severity of the patient’s
condition.
Considerations include whether or not there is a wound present
that will need addressing, the stage of the
lymphedema, and whether or not
there is hardened fibrotic tissue to address. Fibrotic tissue is difficult
to
eliminate and requires more attention during manual lymph drainage. More
severe and advanced stages of
lymphedema require longer therapy times, while
early stage lymphedema may not require more than forty-
five
minutes of lymph drainage.
Other considerations include
areas of the body that are affected. Some affected individuals
experience
lymphedema in more than one region, therefore, more time is
required to address all affected areas. For
example, a patient who
experiences lymphedema in the chest, back, and upper extremity will require
more
therapy time than a patient who experiences lymphedema affecting only
the upper extremity.
The average treatment time for lymphedema is typically
as follows, but should be adjusted
according to the patient’s specific
health needs:
Manual Lymph Drainage (MLD): 60 minutes
Diaphragmatic
breathing exercises 5 minutes/intermittently during MLD
Application of
short-stretch bandage 15 to 30 minutes
Exercise 15 to 30
minutes
Education 15 minutes
Wound Management in Presence of Severe
Oedema: Severe oedema due to chronic lymphedema or severe
venous
insuffieiency with secondary lymphedema results in massive buildup of
interstital fluid. Swollen limbs
are more prone to loss of skin integrity
and skin breakdown. In the case of ulceration or trauma, the
excess
interstitial fluid must be reduced in order for wound healing to
occur. There are several reasons why
reduction
of excess
interstitial fluid is critical to wound healing. First, fluid buildup leaks
into open wounds, following
the
path of least resistance. The
ulcer then becomes an outlet for reducing the interstitial fluid, similar to a
faucet
being turned on. Draining ulcers are much less likely to heal due to
the fact that the leakage of the fluid
actually
creates a
hemodynamic steady-state situation. Therefore, without reduction of
interstitial edema, healing
cannot
occur as the ulcer is an
outlet for fluid.
Secondly, there is dramatic decrease in oxygen
delivery to wound beds in the presence of significant
interstitial
edema. The reason is simple. Oxygen and nutrients must
diffuse from the capillaries and then through the
interstital fluid, in
order to reach cells. There is increased metabolic rate in wounds needed for
healing,
including collagen production and cross-linking. Further oxygen is
processed by the body's immune cells to
kill
bacteria by the
oxidative burst method. Furthermore, cell waste products and toxins must be
removed by
diffusion back into the capillary system. Without reduction of
the interstitial edema buildup, bacteria are not
killed and are more likely
to travel into the interstitial fluid planes where they can multiply,
dramatically
increasing the risk of infection.
In summary, reduction of
edema achieves several vital functions related to wound healing:
1) Allows
capillary seal in the wound bed, which speeds healing.
2) Reduces fluid in
wound bed, reducing bacterial colonization and infection rates.
3) Increases
oxygen deliver to speed wound healing.
4) Reduces risk of infection.
5)
Prevents skin macerationof periwound skin.
6) Increases removal rate of
toxins and cellular byproducts, CO2.
Optimal wound care includes:
1.
Wound cleaning. Sterile saline is the preferred agent using gentle pressure. In
simple wounds, a blunt
cannula with syringe can be used. The gentle pressure
of 8-15mm has been demonstrated to reduce
bacterial
load on the
wound bed. In more extreme cases, pulse lavage is needed. Cytotoxic agents such
as hydrogen
peroxide and betadine and most commercial cleansers should be
avoided except in wounds heavily
colonized
with bacteria.
2.
Skin barrier. Since the affected area will be bandaged, a skin barrier needs to
be applied to the limb
to ensure proper skin care. Typical products used
have 2% dimethicone, which prevent skin drying and
chaffing, and also help
prevent maceration. For the periwound skin near draining ulcerations, a more
moistureresistant
barrier dressing is needed, such as one with
high zinc content.
3. Moist wound healing. Wound healing is much improved in
the presence of a moist wound bed. A
properly moistened wound bed
facilitates autolytic debridement, which speeds the bodies own
healing
mechanism. Moistened wound beds are much quicker to epithelize, and
scabs and eschars slow healing
rates
and increase scarring.
Scarred wounds do not have the same skin integrity as properly healed wounds,
and
have some increased likelihood of reulceration. Much of modern wound
care focuses on adequate control of
drainage. For heavily draining wounds,
special dressings need to be used to wisk away the drainage from
the
wound bed and periwound. A good example of such a dressing is
Exudry, which is a dressing made of
similar
design as a diaper.
This is the preferred dressing by many professionals for ulcers draining
lymphedema fluid
(lymphorrhea). For more modrately draining wounds, ABD
(abdominal) pads can be used. For lightly
draining
wounds, gauze
is adequate. For wounds that are not draining, often a telfa dressing is useful
to cover the
topical medicine applied to the wound bed, to prevent drying.
For very dry wound beds, a dressing which
contributes moisture to the wound
bed is needed, such as hydrocolloid dressings. The highest moisture
donor
medication is a hydrogel, which contains over 90% water and
can rehydrate eschar.
4. Appropriate medication selection. Use of
antimicrobial dressing is often desired. Silvadene, used
long for burn care,
is cytotoxic and has no place in wound care outside of burn care. It is still
preferred for
burns due the ability of Sulfamylon to penetrate eschar with
silver ions which are antimicrobial. Preferred
dressings are not cytotoxic,
but wound have antimicrobial properties or facilitate active wound healing.
There
are many hundreds of products and their discussion and
efficacy is out of the scope of this document.
Examples
include
Aquacel Ag, Acticoat, and Silvasorb hydrogel. Needless to say, proper dressing
selection and
application
techniques often makes a significant
difference in the outcome rate of wound healing.
5. Removal of nonviable
tissue. Necrotic and nonviable tissue should be removed from the wound
bed
to stimulate healing. This can sometimes be done through use of
enzymatic debriding agents. For wounds
with
significant slough,
mechanical or sharp debridement is recommended. Use of topical anesthetics such
as
EMLA
cream or 2% lidocaine are sometimes used as topical
numbing agents as needed.
6. Dressings may need to be changed daily. Heavily
draining wounds need to be changed more often.
Adequate use of compression
can greatly reduce drainage levels over time. Often, bandages need to
be
changed daily for wounds with severe lymphorrhea. As compression reduces
the interstitial fluid, dressing
changes can be spaced out less often. Use
of antimicrobial dressings allows less frequent dressing changes.
In
modern wound care clinics, dressing changes once to twice weekly
are possible after interstitial edema is
reduced through proper technique
and dressing selection.
7. Compression bandaging. The gold standard for
lymphedema management is short-stretch bandages.
These bandages have unique
properties that make them ideal for lymphedema management. These
bandages
are usually applied over cotton batting. The number of layers and
technique of application is specialized, and
requires special training. This
requires extensive training, such as is given only in specialized classes
focusing
on
lymphedema treatment. For lower compression,
a
spiral bandage is applied. For more compression, a figure 8
application is used. Often, bandages with less
width are used on the distal
limb, and then wider bandages are used on the more proximal limb. Technique
can
be used to apply the bandage with gradient compression, by
varying the stretch of the bandage and altering
technique and number of
bandage layers.
Multilayer compression wraps or limited reusable garments
such as the FarrowWrap WoundOp(TM) line
are
possible. Completely
nonelastic bandages such as the Unna boot are other options, although they
lose
compression as edema reduces and so are not as ideal as short-stretch
bandages with some elastic
compression.
8. Foam padding. Foam
padding is often necessary for lymphedema patients. There are several
foam
types used in lymphedema management. White foam is softer (lower
inflection load density of approximately
30) and used to pad sensitive areas
such as the ankle bones and tendons over the top of the foot. More
dense
foam with IDL of around 60 is often used to create small pads
with waffle-like configuration. This
configuration
is used over
areas with chronic fibrotic changes due to lymphedema. The foam can help reduce
fibrotic
areas
and restore more normal limb function. Padding is
also necessary between skin folds. In severe
lymphedema,
there
are often large crevices that form between massively swollen limb portions.
These crevices often
become
macerated and are a haven for fungal
infections, ulcerations, and bacterial infections to form. These skin
folds
must
be properly cleaned, appropriate skin barriers or antifungal creams applied,
and then foam wedging
used
to provide gentle compression to the
area to reduce lymphatic swelling.
Gradient Pumps or Manual Lymph Drainage
Pumps During Therapy: Gradient pumps may be
applied during therapy as an
adjunct to treatment. There are newly developed and FDA approved
compression
devices that apply both external compression and manual
lymph drainage mechanically. While mechanical
devices should not take the
place of therapist applied manual therapy, they may be used in addition to
therapist
manual therapy. These devices assist in achieving further
reduction when a patient has reached a plateau, but
requires more reduction
in order adequately treat the lymphedema.
Gradient pumps may be applied for
half an hour to an hour after manual lymph drainage, followed by
the
application of bandaging. Some therapists continue to apply therapy
during application of the gradient pump.
Therapy is applied towards regional
nodes proximal to the affected extremity.
Phase Two – Independent Home
Management Phase:
The independent home management phase occurs after
treatment goals have been accomplished which
includes significant edema
reduction, approximately 30 to 60% depending on the disease stage, and
wounds are
healed. Patients should be supplied with a daytime
compression stocking or garment. Prior to discharge,
each
patient should have a good understanding of proper application
of manual lymph drainage, diaphragmatic
breathing exercises, extremity
exercise, skin care, nutrition and proper application of compression
bandage
systems.
Because compliance during the maintenance phase is
essential, evaluation for long-term external
compression
is
essential. Long-term many patients are not able to be compliant with
bandaging, possibly due to other
physical
limitations such as
arthritis, back injuries, or other conditions that prevent their ability to
properly apply
bandages. Patients report a lack of confidence in their
ability to properly apply bandages, they are not
physically able to apply,
or they simply refuse to wear them because they are time consuming and tedious
to
apply and uncomfortable. In order to adequately address long-term goals,
a realistic approach to disease
management compliance and independence must
be applied with consideration to long-term use of external
compression. This
can be accomplished by evaluating the patient’s physical abilities, system of
support,
lifestyle,
motivation to apply treatment, and the
psychological value in allowing each patient to control their
disease
management tools. A Pre-Discharge Questionnaire assists in
determining what external compression
alternatives
might be most
effective based on the individual patient’s needs.
The “Bandage Only”
approach:
Patient feedback indicates some practitioners have advised patients
that the only way to effectively
manage their disease is by application of
short-stretch bandage. This approach is limiting and not realistic.
Patient
feedback specifically shows a window of application for about two weeks. After
about two weeks,
the
bandaging ceases application by most
patients, therefore, their condition exacerbates. Once the
disease
progresses to a place that is intolerable for the patient, they are
forced to return for therapy. This occurs
repeatedly for years. Patients
must be offered realistic external compression that they are able and
motivated
to
apply daily. Proper evaluation, proper education as to all the external
compression tools available and
patient
choice not only assists
with realistic application, but gives control back to the patient. Most people
are more
compliant with treatment that they choose for themselves. Since
they are the ones who must live with the
disease and the treatment, they
should be the decision maker. The medical practitioner’s job is to
educate
patients on available treatments, the function of each external
compression device, and the proper use of the
external compression device
once the item has been provided. It is then up to the affected individual to
make
the final decision as to what they believe they can live with, and be
compliant with.
Types of External Compression:
The compression
applied externally can apply either resting pressure or working pressure.
Working
pressure refers to pressures that increase with activity. Working
compression is temporary and allows for
superficial vessel refill. This
compression is rigid compression and offers the most resistance against
expanding
muscles. It is most effective when a
patient is walking
or exercising. Examples of working compression are short-stretch bandage, Unna
boot,
rigid
bandages, adhesive bandages, moderate short-stretch
bandages short-stretch compression stockings.
Resting pressure refers to
external compression that pressures increase with rest. This compression
is
constant pressure and involves the use of strong, very elastic bandages.
Since resting compression is
constant, it
does not allow for
superficial vessel refill. Examples of resting compression include, ace wraps,
long-stretch
bandages, and long-stretch stockings.
Pressure Gradient is
essential in the application of external compression. Since one goal in
treating
lymphedema is to restore pressure gradient fluid differentials,
uniform compression can result in pressure
disturbance. Non-gradient
compression can result in compression of proximal vessels and thus, blood
being
trapped in the periphery. This in turn, compromises venous return in
from the distal part of the limb. Because
the venous in-flow increases
lymphatic flow, lymphatic dynamics are reduced. It is much like squeezing a
tube
of toothpaste in the middle. Fluid back up can cause pain, and
exacerbate edema. Because the body
operates
on a pressure
gradient system, treatment should physiologically mimic the body’s system as
close as
possible.
Dr. Smith, Scurr published an article in
Surgery 1990;108:874, in which they discuss the criteria used for
external
compression used in their study. They used Doppler
ultrasonography to review the affects on the veins when
using uniform
compression versus gradient compression. Uniform compression was shown to
collapse the
proximal veins first with the wave of vessel collapse moving in
the distal direction, while gradient
compression
was seen to
collapse the distal veins first with the wave of vessel collapse moving
proximal. Uniform
compression, in collapsing proximal to distal resulted in
a “trapping” of blood in the distal veins, whereas
gradient compression
resulted in a more complete emptying of the distal veins. Patients have
reported
nongradient
compression causes severe paid and
exacerbation of edema. This may be attributed to the distal
trapping of
blood when uniform compression is applied., as it operates against the body’s
natural pressure
gradient system.
Bandaging Alternatives
Overview:
External Compression Devices should be applied by either a trained
therapist, or a certified
compression therapist who has received at least 40
hour of training specific to disease management of
lymphatic
and
vascular disease. Durable medical equipment companies providing these devices
through delivery
personnel or shipping to patients with little or no
instructions can allow for misuse, or placement in spite of
the
existence of contraindications. Because these items are
medically prescribed by a physician, failure to
provide
proper
instructions by trained therapists can lead to serious health complications,
just as providing
prescription
drugs through the mail with little
or no instructions. Trained professionals should always be involved in the
setup
and instructional phase of providing medical equipment and
supplies for lymphedema.
Foam Compression Garments: Foam compression
garments include the Reid Sleeve, Circ-Ai, and Leg
Assist Garments. These
garments work by applying high low pressure points. Foam, when compressed
against
edematous fibrotic tissue works by physiologically by
applying increased pressure, providing a more even
pressure distribution,
helps to provide as foam moves against the skin, it assists in stretching the
skin thereby
stimulating lymph function. When foam is applied with gradient
compression, it assists with the breakdown
and
softening of
hardened fibrotic tissue. This facilitates the elimination of fibrotic tissue
that would not otherwise
eliminate. These devices utilize a system of Velcro
straps and/or an outer spandex type garment that simulate
bandaging.
Patients are much more compliant with these devices as they are easier to apply
and more
comfortable to wear over lengthy periods of time. Foam compression
devices may be worn for nighttime
compression and the devices that are not
accompanied by Velcro straps can be used with gradient pump
therapy. The
compression applied by foam compression garments provide protection for the
superficial
lymphatics, while applying resting compression.
Directional
Flow Garments: Directional Flow garments, such as the Jovi Pak and the Solaris
Tribute
Garment use a similar technology as the multi-density foam
compression garments, but are designed with
seams
that assist in
directing lymphatic flow towards proximal lymph nodes for elimination. Various
foam densities
and the shapes of foam chips enhance lymphatic circulation
and assist fibrotic tissue for elimination. These
garments are used with a
compressive outer garment that assists with increased compression. Bandaging
can be
applied over these devices as can gradient pumps. These
devices provide compression for affected areas of
the
body such
as the face and neck, the genitals, the chest, the hips and abdominal region.
These devices are a
thinner than foam compression garments, and patients
compliance is extremely high because of their ease of
use. These devices
offer technology that assists the body in stretching superficial lymphatics,
thereby
stimulating
lymph flow in the proximal direction for
elimination.
FarrowWrap(TM) Classic Arm-Wraps and Leg-Wraps: This
technology uses short-stretch
compression technology to simulate
short-stretch function in a garment. The garment has similar
compression to
two layers of short-stretch. The garments can be used
to simulate bandaging. The short-stretch function
augments the muscle pump
to augment venous return. The low active compression prevents garment
slippage
and
allows accomodation to limb size. Physiologically, the short-stretch function
is very effective in removing
excess fluid, creating the "pumping" action
that that it is not able to provide on its own. The garment has
been
demonstrated to be easier to don than compression stockings,
and can be used in patients with low
Activities of
Daily Living
(ADL) scores to give them more independence in controlling their swelling. The
FarrowWrap
(TM)
is the only garment in the world with
short-stretch technology.
FarrrowWrap WoundOp (TM) Arm-Wraps and Leg-Wraps:
This line of FarrowWrap products is
designed for Wound care and
post-Operative use. It uses short-stretch technology to provide safer
compression
garments.technology
uses short-stretch compression technology. The WoundOp product line has
slightly
lower
resting compression levels than the Classic
model. The product, however, is breathable and easy to dry, and
more
suitable for use on active wounds. This limited reusable garment has expected
life expectancy of at
least
three months. Since it is reusable,
it is cost-effective over many disposable garments, such as
multilayer
compression wraps, which must be reapplied at least once per week
and in many cases several times per
week.
Circ-Aid Silhouette:
This unit is made using soft foam technology and assists patients with
bandaging.
Foam is applied under bandaging in order to prevent slipping, to
assist with increased local pressure and in
fibrotic tissue breakdown. Many
patients have difficulty bandaging with individual pieces of foam. Holding
the
foam in place while wrapping the bandage around the extremity is
difficult, especially when bandaging the
upper extremity. This device better
facilitates bandaging as it provides the foam in one easy “slide-on”
unit.
This device also reduces the patient’s expense of having to
continually re-purchase new foam.
Circ-Aid Non-Elastic Legging: This
technology non-elastic sustained compression device consists of a
series of
straps that simulate bandaging. With the application of gradient compression,
this device uses
working
pressure to assist in stimulating
venous return and as the patient walks, the superficial lymphatics are
stretched
assisting in increased lymphatic flow. They are easy to
apply and compliance due to ease of use, is very high.
Physiologically, this
device is effective by assisting the body in removing excess fluid, by creating
the
“pumping”
action that it is not able to provide on its
own.
Foam Pads: Reid and Solaris Tribute provide foam pads or crescent
shaped pads that assist with
hardened areas of over large lipomas or fatty
lumps, to assist in break down and elimination. Pads, using
applicable
shape, can be placed around ankles or just under the lipoma and bandages
applied over them in
order to address the edematous and fibrotic tissue.
Lipomas are extremely difficult to bandage and bandages
tend to slip.
Application of foam pads assist in addressing these tough areas by adding soft
high low pressure
directly to the problem area.
Pumps: Pumps in
particular have been widely misapplied, and misrepresented within the
medical
community. These devices can either cause lymphedema to exacerbate
when not applied properly, or when
applied properly they are an invaluable
tool for many affected individuals who have achieved significant
disease
management success over a long period of time. Pumps are not
recommended for everyone, and the
mechanism of compression of some pumps can
cause harm. Due to the lack of education and standard of
care
with these devices, this document seeks to establish a model of
application for sequential pumps when
treating
lymphedema.
There are three different types of
pumps:
1. One chamber intermittent: This pump by applying uniform
compression works against the body’s
natural physiological pressure gradient
system. In doing so, it causes a reflux of fluid in the distal veins,
thereby
increasing
pain upon compression, and increasing edema. This device may reduce edema
initially, however
long
term use can cause further damage to the
lymph system. Patients who use a one cell or one chamber pump
cease use
after a few months due to pain, and as edema becomes worse instead of better.
These devices
are
contraindicated for the treatment of
lymphedema.
2. Sequential non-gradient: This pump applies compression using
three to six chambers. These devices
also in applying uniform compression
sequentially, have shown to cause severe pain upon compression and
increased
edema. Since treatment of lymphedema seeks to restore the pressure gradient
differentials,
application
of compression that works against
pressure gradient differentials are contraindicated for the treatment
of
lymphedema. Short term use may show some reduction, however long-term use
has shown to cause
exacerbation. Compliance becomes an issue as the patient
sees his or her condition exacerbating.
-11-3. Gradient Sequential: Pumps
that apply gradient sequential compression are more closely mimicking
the
body’s pressure gradient system, and more accurately assist in edema reduction,
by helping to restore
pressure gradient differentials. Gradient compression
pumps contain six to twelve chambers, depending on
the
model.
Compression is applied distal to proximal with more pressure distally than
proximal. Gradient
sequential
pumps that apply compression using
a shorter cycle time, more closely mimic venous inflow during walking.
Since
the venous inflow occurs from the planter veins to the femoral vein in
approximately thirty seconds, a
thirty second cycle time is preferred. By
applying compression at the plantar veins, venous inflow is
increased
through the deep venous system. When compression is
applied to the plantar veins, venous out-flow
increases
at a
higher rate of speed. Some medical practitioners believe that this sheer force
against the endothelial cells
releases a natural anti-coagulant into the
blood stream, which prevents or reduces the occurrence of deep
vein
thrombosis. As the gradient pressure continues its sequence
distally the peripheral venous inflow increases,
and
excess edema
causing fluid is pushed back into the vascular system for
elimination.
Peristaltic Wave: Since larger lymphatics have a peristaltic
rhythm, a gradient pump that applies
peristaltic compression is optimal. In
utilizing a gradient compression pump that utilizes the maximum number
of
non-overlapping chambers, as compression is applied sequentially, one chamber
is compressing as
proximal
chambers are releasing compression.
This action results in a slight pulling of the skin as compression
moves
distally, which stretches the superficial lymphatics causing an
increase in lymphatic flow. This technology
more
closely mimics
manual lymph drainage. As the chambers deflate, they allow for capillary
refill. This cycle
compresses distal to proximal every thirty to sixty
seconds during compression pump therapy.
Compression setting: External
compression has shown with the use of a laser Doppler probe,
showed
micocirculatory flow velocity and concentration of moving blood cells reduced
when pressures were
too high. Vascular flow increased upon application of
external compression until 60mmHg, at which time,
microcirculatory flow
began to decrease. Pressure settings between 45 mmHg and 55mmHg, depending
on
patient tolerance are optimal to achieve significant reduction of
edema.
Duration: The duration of gradient compression when used in a clinic
setting should be applied
for about one half hour after the application of
manual lymph drainage. Manual lymph drainage may also be
applied in the
region of drainage during gradient compression therapy. For long-term disease
management
two
hours BID is optimal, as one hour of use only
address “new” fluid, and does not allow time for addressing
“old”
fluid or fibrotic tissue. Once significant edema reduction is
achieved, and wounds are healed if present,
gradient
compression
may be applied as needed to maintain edema reduction and manage
lymphedema.
Gradient Compression Pumps are not recommended when a patient
experience severe renal
failure, active infection, active cancer unless used
for palliative care, deep vein thrombosis, or with
congestive
heart failure. If a patient has a history of congestive
heart failure, has been clear for six months or more and
is
compliant with diuretics, a pump may be applied; however
application may be reduced to one hour BID. A
pump may not be appropriate
for patients who experience limited lymphatics in regional nodes where
drainage
occurs, such as the inguinal region for lower extremity
drainage, or the
back or chest wall, for upper extremity drainage.
Application of a pump may further complicated edema by
pushing fluid to
already affected areas. Some compression devices provide garments that extend
over the
back
and chest wall, and/or over the
hips, waist,
abdomen, and even the female genital region that are appropriate in these
cases, and will
address
edema in these drainage regions,
however, gradient compression should not be applied without extensions
to
address edema in areas affected. Gradient pumps are also not appropriate
for use when male genital edema
is
present, unless the device is
accompanied by an appliance, such as the device that addresses the hips waist
and
abdomen, and when a foam pad is included. These appliances
look more like pants, and allow for
compression
to begin
distally, to just under the chest, addressing affected regions as described
above. Pumps should
always
be used in conjunction with manual
lymph drainage.
Foam Compression for Use with a pump: Foam compression
garments, such as the Reid Optiflow,
Jovi Pak, or the Solaris Tribute
garments may be used with gradient sequential compression devices.
The
application of foam garments with compression therapy assists by
providing addition compression, breaking
down fibrotic tissue that would
otherwise not be eliminated, protecting the superficial lymphatics from
over
compression, and reducing pain. The application of foam with external
compression devices is similar to
bandaging over foam, and because of the
comfort and ease of use, compliance is significantly higher than
the
application of the pump or banding alone.
Compression stockings:
Despite the fact that compression stockings are considered by many as
a
“conservative method of treatment”, compression stockings are not a
“treatment” at all. When used during
early
onset, in conjunction
with manual lymph drainage and exercise, they may assist in effective
disease
management. However, compression stockings do nothing to actually
treat lymphedema. Compression
stockings are a must for use as a daytime
garment to maintain reduction achieved with manual lymph
drainage,
bandaging, and other compression devices. Stockings that
apply 20 to 30 mmHg of graduated compression
should be applied as a part of
the disease management plan in order to continue reduction during daily
activity.
-12-
Miscellaneous treatment overview:
Diuretics:
Diuretics must be used when prescribed by the examining physician, and are
needed to treat
various health conditions, however, when they are used
solely for treating for lymphedema, they can do
more
harm than
good. Diuretics work by removing water from the subcutaneous tissue. In doing
so, they leave
behind proteins and bacteria, now in a higher concentration.
This places the patient at a greater risk of
infection, and long-term use
causes fluid to become hard and fibrotic, making elimination more
difficult.
Furthermore, once the tissue is starved for water, it pulls more
water to the tissue, making the edema worse
long-term. Reduction achieved by
diuretics, unless edema results from causes other than lymphedema, is
shortlived.
Diuretics
further deplete the system of potassium which can cause lower extremity
pain.
Elevation: Elevation assists in edema reduction by eliminating
gravity, and allowing edema causing fluids
to flow towards regional drainage
nodes, however, as soon as elevation ceases, edema returns. This also is
not
a long-term effective method of treatment. It further hinders
the patient’s ability to maintain an active and
productive
lifestyle.
Pool therapy: Pool therapy is an effective adjunct to lymphedema
treatment as the water applies external
compression. External compression
during exercise assists in stretching the lymph vessels improving flow.
Pool
therapy also assists in protecting from muscle strain which can
exacerbate lymphedema, by preventing quick
strenuous movements and allowing
for more slow precise exercise movements. By itself, however, it is not
an
effective long-term disease management tool. When included with
manual lymph drainage and effective
external compression, pool therapy is an
effective exercise technique.
Set-Up Procedures for External
Compression:
External Compression Devices should never be shipped to
patients unless a patient has been properly
trained in its use, and multiple
follow-up visits have been conducted to ensure this is the case. Just as
antibiotics
or any other physician prescribed medical treatment
requires proper use, so does external compression
used to
treat
lymphedema. When used appropriately, these devices can provide an effective
adjunct to disease
management however they can also cause health
complications when not used appropriately. It is
recommended
that external compression devices be provided by a
licensed medical professional with training specific to
treating lymphatic
disease, or a properly trained certified compression therapist.
Each patient
should receive the following with the set-up of home medical supplies or
external
compression devices:
1. Home Set-up
2. Measurements starting
at the ankle or wrist, unless edema involves another area of the
body,
measuring every four centimeters distal to proximal. These
measurements can be entered into various
available
computer
programs in order to determine volume of edema, and reduction.
3. The
patient should be shown how to apply the device, and then allowed to apply the
device
themselves.
4. Have the patient use the device while reviewing
other information, such as:
a. Confidence level in their independent
application of MLD
b. Knowledge of proper exercise technique.
c.
Knowledge of breathing exercises.
d. Knowledge of proper skin care.
e.
Knowledge of proper diet.
f. System of support
g. Confidence level in
their independent application of daytime compression garments.
All
information reviewed above should be reviewed again, when needed, and written
information should
be left
for the patient at their home with external
compression devices.
5. After the device has been applied for no less than
half an hour, measurements should be taken again
and reviewed with the
patient. Problem areas can be addressed that may require special
attention.
6. Review questions and concerns, and refer the patient referrals
to the treating therapist, may be
suggested when there is any question or
lack of confidence in self application at all.
Follow-Up:
Follow-up is
essential for successful long-term disease management. When external
compression is
provided, a seven day phone call should be made to ensure
patient comfort, ability to consistently and
independently apply, and to
address any questions, concerns, or complications they may be
experiencing.
Six to eight week measurements should be taken in order to
monitor continued reduction after external
compression devices have been
provided. In severe cases, three to four subsequent follow-up evaluations
may
be needed. Improvements in edema reduction, skin presentation,
and mobility should be noted and shown to
the patient during each follow-up
visit.
Subsequent six month follow-up visits should be provided to ensure
continued reduction and
maintenance throughout the patient’s lifetime. Any
life changing event or lifestyle change warrants a review of
daily disease
management as these occurrences typically alter a patient motivation and
ability to implement
their
daily disease management regime. A
career change, a divorce, children leaving the home or entering the
home,
loss of a loved one, relocation or other such events can
completely interrupt the daily habits of treatment,
therefore, assisting
patients with re-implementation ensures continued long-term
care.
Conclusion
Lymphedema is a chronic disease, and currently there
was no cure. Technology and treatment exists,
however, that effectively
treats and manages this disease long-term. Disease management failure occurs
when
inexperienced practitioners do not properly apply treatment,
educate patients on self-care, and the proper
longterm
disease
management tools are not provided. Each patient’s needs are unique and
therefore require an
individualized long-term plan of care. Long-term,
successful and independent management can be achieved
when practitioners who
are properly trained, assist those affected in the daily and proper
implementation of
daily management. Improved long-term management increases
mobility, quality of life, and reduces the risk
and
occurrence
of expensive health complications. The optimal standard as outlined in this
document will help to
reduce the overall cost of health care by setting a
national model and standard of care, thus reducing
complications that lead
to hospitalizations and additional medical care. Implementing proper treatment
also
reduces the need for long-term disability and better enables affected
individuals to continue an active and
healthy
lifestyle.
REFERENCES:
1. American Cancer Society
2. National Cancer
Institute
3. The American Society of Lympholgy
4. The United States
Centers for Disease Control – Health and Human Services
5. J. Smith,
LePalliative Care Oxford 2004 Final Chapter 14
6. Solomon, Schmidt, Adragna,
Human Anatomy & Physiology – Second Edition, Harcourt Brace
College
Publishers, 1990
7. M. Foeldi, E. Foeldi, S. Kubic, Textbook of Lymphology,
Urband & Fisher 2003
8. Gardner & Fox, The Return of Blood to the
Heart, John Libbey & Company, LTD. 1989
9. Abu-Own, Shami, Chittenden,
Farrah, Scurr, Colerdige Smith, Microangiopathy of the Skin and
the Effect
of Leg Compression in Patients with Chronic Venous Insufficiency, Journal of
Vascular
Surgery 1994;19:1074-1083
10. Wilson and Bilodeau, Current
Management Concepts for the Patient with Lymphedema,
Journal of
Cardiovascular Nursing 1989: 4(1) 79-88
11. Coleridge-Smith, Sarin, Hasty,
and Scurr, Sequential Gradient Pneumatic Compression
Enhances Venous Ulcer
Healing: A Randomized Trial, Surgery 1990; 108:871-875
12. The Diagnosis
and Treatment of Peripheral Lymphedema, Consensus Document of the
International
Society of Lymphology: Lymphology 36 (2003) 84-91
13.
Individual Vendors listed provided information regarding products
listed.
CONTRIBUTING AUTHORS:
1. Phyliss Tubbs Gingrich, RN, BSN,
CLT – LANA
2. Wade Farrow, MD, CWS, FCCWS
3. Cheryl L. Morgan, PhD
4.
Lawrence L. Tretbar, MD, FACS
5. Benoit Blondeau, MD
Winter
Tips for Lymphers by Tina
Most of us have seen the preventative tips and
heard what we should and should not do regarding our limbs
and
swollen areas. We all must be careful in the summertime about overheating,
sunburn, and warmth along
with humidity. But what about
winter?
Winter is an equally important season in which we must be
careful. After trial and error I have come up with
a list of things
I’d like to share:
1. Be very careful of ice. Remember you can’t always
see ice, it can be what they call black ice, a very fine
coat. Walk
on surfaces very carefully. You don’t want to fall.
2. Dress
appropriately. Keep your limbs comfortably warm but not too warm or too tight.
Remember that
you can swell in wintertime as well. Think of the hot
malls when out shopping and dress appropriately.
3. Always wear
appropriate footware. Make sure you have worn and broken in your boots,
sneakers or
your winterwear before you tread out. Awkward foot gear
can cause falls, and again on ice it’s dangerous.
4. Moisturize!
Remember in wintertime skin can be extremely dry with the furnace air
blowing.
5. Make sure if you happen to get your garments or socks wet,
change them as soon as possible.
Remember we lower lymphers are
prone to fungal infections as well as skin irritations from wet materials.
Waterproofed and insulated boots keep the feet drier than plain rubber
ones.
6. Remember the sensible tips for avoiding illnesss, if you can
get inoculated for flu/pneumonia. Wash your
hands after touching
things someone sick has touched. Try not to have sick people breathe in your
face.
Wearing a scarf helps warm the air for those of us who have
breathing problems as well as keep out germs.
7. Eat a healthy well
balanced diet as usual.
8. Remember that hypothermia and frostbite are
dangerous. Note that wind speeds can make for
dangerously cold
conditions even if the temperature is not below freezing.
9. If you can
wear mittens, they provide more warmth than gloves. Gloves can also become
tight on the
fingers if you swell.
10. Get lots of rest,
drink plenty of fluids, and if you think you are or someone else is
experiencing
hypothermia, avoid caffeine. Warm up slowly with a
blanket and by drinking fluids slowly.
11. Keep a lymphedema and winter
survival kit in your car. Try to carry extra medications, bandages, extra
blanket, batteries, flashlights, etc with you in case you are stranded
somewhere.
12. Keep a list on you in a wallet or purse of emergency
contacts, medications you are on and your doctors
name and
number.
Lymphedema Gardening Tips
Wear gloves that actually
fit, make sure they are not too loose or too tight.
Leather gloves with
a cloth back are a good general purpose glove.
If you plan to work in
wet soil, select rubber gloves with cotton lining
Wear Neoprene gloves
to use when spraying or working with pesticides.
If you are pruning or
trimming shrubbery, wear gloves that have long wrist protectors.
If your
gloves get muddy you can washing the gloves while on your hands!
If you
wear your compression garments under the gloves, make sure you don't
get
them wet, if wet, change immediately.
Avoid direct sunlight, even Spring
sunshine can cause sunburns.
Always wear sunscreen.
Wear
comfortable clothing.
If you get overheated, take a shower in cool
water, not cold, you don't want to cool off too fast.
Make sure you
don't get dehydrated! Drink lots of water and/or gatorade.
Work at a
steady pace with frequent breaks, switch gardening chores often to avoid
repetitive injuries.
Warm up before you garden.
Use as many
ergonomic tools as possible.
Wear shoes that will protect you from
hazards such as nails, sharp objects on the ground.
If you do get
scratched, wash the area right away, apply an antibacterial cream or
zinc.
For any puncture wounds, make sure your tetnus shot is up to date,
wash thoroughly, depending
on how deep they are, clean/bandage, or go to the
emergency room.
Make sure you put tools away when finished to avoid
later injuries.
Some good warm ups: From Tina, who
gardens.
Use hands to squeeze stress balls or balls with seed like
materials in them. Do 10 each hand.
Stretch your hands straight out,
link your fingers and pull lightly to feel a stretch in hands,
elbows and
arms. Do 10 times.
Stretch your hands above your head, again link your
fingers and stretch. Do 10 times.
Bend at the waist downward letting
your arms dangle in a relaxed position, this stretches the
upper
back.
Put your right hand on your left shoulder, turn your body slightly
to the left until you feel a stretch.
Reverse to left hand on right
shoulder, turning right. Switch back and forth, 10 times, so it
will be 5
stretches to each side.
Put your hands on your hips and lean backward,
arch your back, this stretches the ribs. Do 5.
To stretch your low back,
lay down, bend your legs. Put your right foot up to left knee, take a
hold
of your knee and lightly pull to feel a slight stretch. Do the other
side. Do each side 5 times.
Never do exercises until you check with
your doctor.
--------------------------------------------
Skin
Brushing Benefits
Tightens Skin
Helps digestion
Removes
Cellulite
Stimulates Circulation
Increases Cell Renewal
Cleanses
Lymphatic System
Removes Dead Skin Layers
Strengthens Immune
System
Improves Exchange between cells
Stimulates the Glands, thus
helping All of the Body Systems to perform at peak efficiency!!
Easy and
Inexpensive
The Basis for Dry Skin Brushing
The skin is our largest
route of elimination, excreting more than 2 pounds of waste each day, and
taking in
air and sunshine. Our skin breathes! And yet, in most
people, this vital route of detoxification is operating
far below
it's capacity, because it is clogged with dead skin cells and the un-removed
waste excreted
through perspiring.
Dry skin brushing is a simple,
inexpensive way of removing the waste from the skin and breaking down old
toxic deposits through it's unique action on the lymph vessels and
capillaries. Our bodies make a new top
layer of skin every 24 hours
- skin brushing removes the old top layer, allowing the clean new layer to come
to the surface, resulting in softer, smoother skin.
Draining
the Lymph
The lymph is the interstitial fluid that bathes our cells,
bringing them nutrients and removing their waste - all
detoxification occurs first and foremost through the lymph. Our bodies
contain far more lymph than blood,
and yet the lymph is dependent
upon outside forces for it's circulation around the body; the lymph has no
heart to pump it! Consequently, the lymph relies upon exercise and
massage for it's vital circulation, two
things that are lacking in
most people's everyday lives.
For many years, the only way to drain the
lymph was through lymph drain massage or manual lymphatic
drainage,
a powerful massage technique credited to have originated from ancient Chinese
Medicine. Dry
skin brushing prompts the body to release its’ toxic
deposits into the lymph, whilst simultaneously cleansing
the lymph
itself, through it's return to it's two plexuses, or centers, near the
heart.
Because of it's ability to release the skin's detoxification
potential and to cleanse mucoid deposits from the
cells directly
into the colon, dry skin brushing is considered by many (including such
luminaries as Bernard
Jensen and Robert Gray) to be an essential
part of any intestinal cleansing program.
Dry Skin Brushing
Technique
Start with a natural bristle brush
1. Skin Brush before
showering, bathing or sauna
2. Do not wet skin
3. ALWAYS brush towards
heart
4. Begin with the soles of feet, then ankles, calves, and
thighs.
5. Then Brush across abdomen and buttocks. Use
circular
counter-clockwise strokes on the abdomen
6. Now brush your
hands and arms and gently the underarms
7. Reach for that back and
neck
8. Lightly brush the breasts
9. Brush each part of the body
vigorously, completely several times.
10. Wash your brush every few weeks
in water and let it dry.
http://www.racingsmarter.com/skin_brushing.htm
article by doctors on skin brushing, this ones copyrighted
and no
permission granted to use it, sorry gotta go to their site to read
it!
When you brush the pores of your skin clear, your skin is able to
absorb nutrients and eliminate toxins.
Clogged pores are not just a
cosmetic concern. Healthy, breathing skin contributes to overall body
health.
To dry brush, use a soft natural fiber brush (available from health
food stores), a loofah sponge, or a rough
towel. It is important to
use a natural bristle brush, or a loofah sponge, or even a coarse bath glove.
Nylon
and synthetic fiber brushes are too sharp and may damage skin.
Always dry brush before you shower or
bathe because you will want
to wash off the impurities that you scrape up from the brushing
action.
Begin with your feet and brush vigorously in circular motions. Brush
away from your extremities and toward
your heart. Continue brushing
up your legs, then proceed to your hands and arms. Brush your entire back
and abdomen area, shoulders and neck. Do not brush any sensitive,
irritated, infected or damaged areas of
the skin and avoid facial
skin as well.
After brushing, rinse off in the shower. Paavo Airola, author
of Swedish Beauty Secrets, recommends
alternating temperatures in
the shower from hot and cold. This will further invigorate the skin and
stimulate
blood circulation, bringing more blood to the outer
layers of the skin.
Don’t forget to clean your dry skin brush or sponge
regularly, using soap and water. After rinsing, dry your
brush in an
open, sunny spot to prevent mildew from developing
More specific
Instructions:
Dry skin brushing tones the immune and circulatory systems. It
may reduce the duration of infection and
accelerate the clearing of
toxins. It will reduce cellulite, help support the immune system during cancer
and
other chronic illness treatment. Best of all, it feels really
good!
Using your right hand, gently slide the brush along your right jaw
line starting from your earlobe to the
underside of your chin 7
times.
Place the brush at the hairline on your neck and gently pull around
the right side of your neck to the Adam's
apple 7 times.
Hold
the brush with your right hand at the bottom of your neck (where it joins the
top of your back) and
bring it around your neck to the right and
down along your right collar bone and end up between your collar
bones.
Stroke your breastbone in a circular fashion to stimulate the
thymus gland. Carefully brush the breast in a
circular motion. Do
all of Step 1c 7 times. Repeat steps a, b and c on your left side holding the
brush with
your left hand. 2. To stimulate the pituitary gland,
hold the brush on the back of your head near the base of
your neck
and rock the brush up and down, then side to side, both 14 times.
Hold the
brush in your left armpit with your right hand and rotate it counter clockwise
7 items, then
clockwise 7 times. Repeat on your right armpit with
your left hand.
Brush upward 7 times from your upper right thigh to your
right armpit. Repeat process on your left side.
Women may need to
hold their breast out of the way with their free hand.
Brush back and forth
over your belly button and around your waistline 14 times (like passing a
basketball
behind your back).
Brush in a circular motion over
your belly-button, counter-clockwise 7 times then clockwise 7 times. Finish
brushing the front of your body in any direction starting at the bottom
and brushing all the way up 14 times.
Very little pressure needs to
be applied to the genitals and women's breasts because the skin is sensitive
and will redden if irritated.
Brush up and down your spine from
the base of your neck and down as far as you can 14 times Finish your
upper
back by stroking it around toward your 11 sides.
Brush your spine from
tailbone up as high as you can reach 14 times, holding the brush with two hands
or
with the detachable wooden handle. Finish your lower back by
stroking it around toward your sides).
Brush up from right ankle to right
knee and work all the way around your leg, brushing up towards your
heart This improves blood circulation, firms skin and gets rid of
cellulite.
Hold the brush in the right groin with both hands and rotate it 7
times counter-clockwise, then 7 times
clockwise. Repeat with the
left groin.
Brush from right knee to right hip 7 times. Work all the way
around your leg continuing to brush upwards
(towards the
heart).
Brush up from right ankle to right knee and work all the way around
your leg, brushing up towards your
heart (Figure 11). This improves
blood circulation, firms skin and gets rid of cellulite.
Brush around your
right ankle 7 times.
Brush back and forth over the top of your right foot
from toes to ankle.
Brush across your right toes on top and underneath 7
times.
Brush the bottom of your right foot heel to toe 7 times.
Repeat
numbers 11-12 for your left thigh, left leg and foot.
Brushing upward from
right elbow to your armpit and shoulder, cover that entire area 7
times.
Brush from your right wrist to the elbow in the same manner 7
times.
Repeat number 14 for your left arm.
Lightly brush the webbing (or
junction) between your left thumb and index or pointer finger on the palmside
14 times, then on the non-palmside 14 times (Figure 15).
Brush
your left palm from wrist to fingertips and back 7 times. Brush the back of
your left hand the same
way 7 times.
Brush each left hand finger
individually back and forth 7 times on the areas that have not been brushed
yet.
Repeat steps 16-17 for your right hand.
NOTE: YOU CAN DO THE
BRUSHING HEAD TO TOE OR TOE TO HEAD. SOME
THERAPISTS RECOMMEND TOP
TO BOTTOM YET OTHERS PREFER BOTTOM TO TOP.
This article was featured on
Cleansing Waters website which no longer exists, The article is worthwhile and
valuable to lymphedema patients so I chose to keep it up here, it
has been edited by the Lymphland
Editoral Team, 10/08. Before
doing any skin brushing, check with your doctor, we are not medical
professionals and cannot give medical advice. Some lymphedema
therapists recommend brushing, others
do not.
Skin brushing
is one of the better self-help health care methods available to us today. It be
can be
performed on your self while the skin is dry or wet.
Stimulation of the skin activates natural healing
pathways within
your body and it removes toxins from pores and other external surface areas. It
also
stimulates nerve beds within its structure that in turn
activate normal healing pathways and healing processes
throughout
your body. There are no drugs involved, no toxic reactions or contraindications
to be concerned
about, only the commitment to yourself to perform
it on a regular basis. Skin brushing can be used over the
entire
body or just to special local areas to stimulate the body’s normal inflammatory
healing response. The
skin is the largest eliminative organ of the
body and one of the four major intake and eliminations systems.
The
digestive tract, kidneys, and lungs are the other three. Over the course of a
regular inactive day the skin
eliminates over a pound of waste
products mixed in with its sweat. In individuals who are active or in
athletes
who are very active the skin eliminates many times more. Sweat glands are
located through out the
skin's surface and automatically eliminate
unwanted metabolic waste produced. *Never do brushing during
active
cancer, sunburn, or infection.
For maximum lymph drainage both the sequence
and direction of the brushing are important. The area
closest to
the drainage point is treated first. Brush the armpit region before the chest
and both before the
head and neck. The groin region is brushed
before the abdomen. To reduce the resistance of gravity, brush
the
upper body before the lower body. Use 7 brush strokes for each step.
Brush
up the arms from the hands to shoulders.
Armpit: Use 7 circular clockwise
strokes and 7 counterclockwise strokes.
Chest: Brush from the breastbone to
each armpit, 7 times on each side. Women avoid direct brushing to the
breasts,
use curving strokes below the breast. Brush sides upward from the waist to
armpit.
Back: Brush upward and outward from spine, 7 strokes on each side,
starting at the base of the neck. The
upper back and shoulder
blades drain into the armpit.
Neck and throat: Start at the back and brush
outward and upward from the spine, then forward over the
shoulder
to the soft hollow at the base of the throat. Turn head to right when working
on left side and vice
versa. Place brush vertically at the base of
the skull and brush along the jaw line to throat and down over
the
collar bone to the chest.
Lower and mid-back and buttocks: Holding the brush
horizontally with both hands, start at the lower
sacrum, pull brush
upward with firm pressure to the bottom of the shoulder blades. Use 7 strokes
each up
the center, left and right of the back. Buttocks: firm,
upward and outward strokes. Begin at the top, circle
around hip to
groin region. Gradually work down to the gluteal fold where the buttocks join
the thigh, and
then back up to the top.
Leg Region: Brush left
leg first, using firm gliding strokes rush upward 7 times on the inside,
outside, front
and back, front and back, from knee to the top of
the thigh, brush from the ankle upward to the knee.
These instructions
were given to me by my lymphedema therapist who no longer practices. I am not
a
medical professional and cannot give advice, I am only sharing
knowledge in the event it can help another
patient manage
lymphedema. Check with your doctor before you do any skin brushing. Tina
Budde 10/08.
----------------------------------
Remember that the
sun can damage more than the skin.
The eyes are six times more sensitive
to UV rays than the skin. UV radiation increases the likelihood of
cataracts, a condition which clouds vision. If not properly treated, it
can cause blindness. Wearing proper
eye protection can reduce the
likelihood of developing cataracts.
Overexposure to UV radiation can
suppress the immune system. It can cause decreased response to
immunizations, increased light sensitivity and reactions to some
medications.
SUNBURNS...HOW TO TREAT
When, why and how to treat for
sunburn.
Sunburn should be treated before it happens, when it might and
after it does happen. This can be in winter
or in summer, on land
or on water, wherever direct sun or highly reflected light may reach and
therefore
threaten bare skin.
Sunburn should be treated for
the healing of current sunburn pain, skin damage and potential skin cancer as
well as to prevent further sunburn. Here are the several ways we
may do this.
Use Aloe Vera.
Aloe Vera comes from the aloe vera plant
and may be squeezed from its leaves. Purchasing and learning to
care for an Aloe Vera plant through the summer can be a wonderfully
relieving investment. This healthful
moisturizer is frequently used
for sunburn and is applied to the affected areas of the skin as a rub to re-
moisturize the dried and burnt surfaces. You can also purchase aloe
vera creams and ointments that may
include other moisturizers or
treatments for dry or burned skin.
General Moisturizers.
A general
skin moisturizer such as Noxzema can be applied to sun burned areas to cool and
sooth the
painfully itchy malady. Baby oil is a good moisturizer
but don’t use it in the sun or it may help fry you
further.
Anesthetics.
Anesthetics such as the popular skier’s
treatment Cool Blue actually kill the pain of most sunburns for a
time. This is applied to the skin in the form of a spray or gelatinized
rub. It is also frequently mixed with
Aloe Vera as sold. Aspirin
dissolved in water in small doses may be tried directly applied to affected
areas.
Other medications.
Unguentine is used to treat the ache and
itchiness of sunburns. There are other brand name and store brand
treatments you may want to ask your pharmacist about. Mycetracin or
other multiple healing ointments may
help to speed healing though
you will want to ask your pharmacist to be sure.
A hot shower.
A hot
shower immediately after mild sunburn can bring about peeling sooner and rid
you quickly of
discomfort.
Vitamins taken internally or
applied.
Vitamin E, one of the antioxidants, can be taken regularly as part
of a daily vitamin and mineral supplement
or spread as in an
ointment on sunburn. Vitamin C is another antioxidant that will help prevent
severe
damage from sunburn and shorten its effects. Selenium is a
mineral that will help fight sunburn.
Preventing further sunburn while
you heal.
To protect the eyes and the area around the eyes, try placing thin
slices of fresh cucumber over closed
eyelids when lounging in the
sun. The cucumber will absorb all the ultraviolet light and keep the eyes safe
and cool.
Sunscreens cannot be over recommended in my
opinion. Being someone who is sensitive to light and burns
readily
I know that an SPF 8 or greater sunscreen rating is needed if you plan to only
reapply it every two
hours or less often, at least for those who
need to be as concerned as I do.
At any sign of infection, get to a
doctor as soon as possible.
BUG BITES:
Mosquitoes are known to
pass blood-born illnesses from one victim to another. They are a major health
hazard and are responsible for the transmission of yellow fever,
malaria, dengue fever, encephalitis, filariasis,
and many other
serious diseases. ... Ticks can transmit Lyme Disease so you really want to
avoid being
bitten as much as possible
August officially
begins the peak season for bug bites.
Dr. Dirk M. Elston, a
dermatologist with Pennsylvania's Geisinger Health System, offered the
following tips
on prevention and treatment of common summer bug
bites at ACADEMY ‘03, the American Academy of
Dermatology's summer
scientific meeting in Chicago, Ill.
PREVENTION TIPS:
The key to
preventing such things as West Nile Virus and Lyme Disease is protection from
being bitten. Dr.
Elston recommends the following practical
tips:
Wear long-sleeved shirts and pants when outside
Stay indoors at
dawn and dusk (when mosquitoes and other insects are most active)
Remove
standing water in yards and clean out clogged gutters, which are breeding
grounds for mosquitoes
and other bugs
Install or repair window
and door screens so that insects cannot get indoors.
Before going outdoors,
it is important to use insect repellents on the skin and clothing to be
completely
protected against bug bites. The active ingredient in
most commercial agents is either the insecticide
permethrin or the
chemical repellent DEET.
TREATMENT TIPS:
If an insect flies through
your defenses and leaves a bite, Dr. Elston reports the best treatment method
is to
apply ice or products containing camphor or menthol to the
affected area in order to reduce itch. The
average insect bite is
harmless and may leave a small red mark or bump that will disappear within a
week.
Persistent itch can also be treated with
prescription-strength cortisone products.
"If your bug bite lingers and
a rash develops, or if you experience a fever, headache, episodes of joint
pain,
dizziness or fatigue following an arthropod bite, it is
important to consult a dermatologist or other
appropriately trained
physician immediately in order to rule out a potentially serious condition,"
said Elston.
See also ants, spiders, poison ivy page.
This comes from
another great article that is no longer available on the internet. The
original author was a
Dr. Elston, but we do not have any
credentials for the doctor. Please check with your doctor to see if the
tips provided here are right for you, this is not meant to replace any
medical advice from your doctor. We
are not medical professionals
but are only sharing information on our site in order to help others with
lymphedema.
This page was edited by Lymphland editorial team
2/07.
---------------------------------------------------
BEES
Bees
and wasps inject venom with their stingers. (Only honey bees leave a stinger
behind. The poison sacs
are still attached to the stinger, and
continue to pump venom into the skin after the bee departs.) There will
be stinging, swelling, and redness at the sting site. Usually, the
symptoms subside after 20 to 30 minutes
Allergy to insect stings can be
deadly. Symptoms of allergy can include faintness, dizziness, general itching,
shortness of breath, or swelling in places away from the sting
site.
A second type of allergy is much less serious. This is allergic
swelling around the sting area. It usually starts
the next day, and
can persist for up to 5 days. The area is red, raised, hot, itchy and
tender.
Infection is also possible. Infection is common with honey bee
stings (because of the stinger "foreign body"),
but is rare with
wasps. Beesting infection usually appears as red streaks.
Immediate
care:
If a stinger is present (honey bee sting), remove it. Drag a sharp
object gently across the skin, so it catches
the stinger and drags
it out.
Don't press hard -- this turns the blade into a "shaver" so it cuts
the stinger off at the skin line, leaving part of
it in the skin. If
you have splinter forceps, steady hands, and good eyes, you can grab the SHAFT
(not the
top) of the stinger and pluck it out.
Insect Sting
Relief pads contain alcohol and benzocaine. Benzocaine is a topical anesthetic.
The pads can
relieve the pain of a fresh insect sting. Cold packs
can limit swelling. Elevate the sting area. Take an
antihistamine
such as diphenhydramine to reduce swelling and reaction at the sting
site.
See the doctor if you: become short of breath or wheezy, develop a
severe throbbing headache, get hives,
general redness, or
widespread itching
or become faint or lightheaded
Ongoing
care:
Continue antihistamines until all swelling is gone.
Local
swelling:
The day after a beesting, you may see severe local swelling. If
it's itchy, hardens gradually to a central
"pimple" at the site of
the sting, is surrounded by a thin border of whitened skin, is not particularly
tender,
tends to go DOWN the extremity as much as (or more than) it
goes up, and is NOT accompanied by fever
or body aches, it's
probably a local allergic reaction. This reaction tends to last about 5
days.
Watch for:
See the doctor if there is increasing tender red
swelling around the wound, red streaks, drainage, fever,
tender
bumps in the groin or armpit upsteam from the sting, or an unexplained increase
in pain or tenderness
An insect repellant containing DEET will keep
mosquitos at bay. For determined the horse flies, you may
have to
spray your clothing, because they can bite through it.
Mosquitos, black
flies, horse flies, and deer flies inject saliva containing an anticoagulant
before they start
sucking your blood. You have an allergic reaction
to the saliva. (Although if you get bitten enough,
eventually the
reaction is less severe -- kind of like allergy shots.) There are two types of
reaction:
immediate edema (watery swelling) caused by antibodies,
and delayed cell-mediated hypersensitivity
caused by your immune
cells.
The immediate reaction usually goes away in about an hour, but some
people have itching that persists for a
couple of days. The delayed
hypersensitivity comes later -- often the next day -- and persists for several
days.
Concerns:
Severe (life-threatening) allergy to insect
bites is rare. Symptoms of systemic allergy can include faintness,
dizziness, general itching, shortness of breath, or swelling in places
away from the site of the bite.
The second type of allergy is annoying, but
not dangerous. This is allergic swelling around the area of the
bite. It usually starts the next day, and can persist for up to 5 days.
The area is red, raised, hot, itchy and
tender.
Immediate
care:
If you come home itching, take an antihistamine such as
diphenhydramine (sample brand Benadryl). An
adult can use 50 mg (2
over-the-counter caps) every four hours. If you're prone to prolonged itching,
scrub
the bite well with soap and water, let it dry, then rub
hydrocortisone 1% cream into the bite
Put another dab of hydrocortisone
right on top of the bump, then cover it with a bandaid. The bandaid
drives the medicine into the skin -- and it keeps your fingernails
away
For the delayed hypersensitivity, antihistamines alone won't cure the
underlying problem. Take an anti-
inflammatory medicine, such as
ibuprofen 600 mg four times daily. Apply warm packs, 20 minutes every
two
hours. If it's itching, add diphenhydramine 50 mg every four hours. Rub
hydrocortisone 1% cream over
the bite site three times daily. If
the reaction is particularly severe, you may need to see the doctor for
steroid pills (such as prednisone or Medrol).
Watch for:
See the
doctor if there is increasingly painful red swelling around the wound, red
streaks, drainage, fever,
tender bumps in the groin or armpit
upsteam from the bite, or an unexplained increase in pain or
tenderness
NASTY SPIDERS
Black Widows hang out in the
darkness.
Description:
You'll always feel a black widow bite. It feels
like a sharp pinprick. Looking closely at the skin, you may
see a
couple of tiny red fangmarks about 2 mm apart. Within minutes, the area around
the bite becomes
vaguely reddened, to a diameter of about an inch
or two. The area begins to tingle. In a half-hour or so,
painful
muscle cramps develop upstream from the bite. (If the bite is on the leg, the
thigh then the abdomen
will begin to cramp and hurt. If the bite is
on the arm, the venom affects the upper arm and shoulder, then
the
chest.) As the poisoning progresses, there's shortness of breath, chest pain,
and generalized muscle
pains.
Concerns:
While a black widow
bite is very painful, it rarely kills a grown adult. But children and elderly
victims can
die.
Immediate care:
Get to the hospital. You may
require IV medication (calcium, muscle relaxers like diazepam, and narcotic
pain medication). For life-threatening bites, antivenin may be
required.
The brown recluse (fiddleback spider) has tiny fangs. The bite is
almost never felt. Because this spider is
reclusive, it usually
isn't seen either. The bite starts as a blister, which then becomes bloody. The
blister
pops, leaving an ulcerated hole in the skin that gradually
enlarges over many days.
Immediate care:
Relax. First of all, that funny
bump on your skin almost certainly ISN'T a brown recluse bite. Second, we
don't do much about them. We just bandage the hole up and watch for
infection. Most other therapies, such
as cutting the bite area out,
using steroids, etc, are controversial. If you do develop an enlarging skin
sore,
go see your doctor
garden spiders do the most biting. But
the bite isn't dangerous. You may develop some local swelling and
pain at the site of the bite. The local reaction can persist for
several days, and often looks like an infection.
(It rarely IS
infection, but if you go to the doctor, he'll probably treat it as infection
just to be safe.)
ANTS
Fire Ants:
1. Remove all ants from the body
to prevent further stinging.
2. Elevate the extremity where the person
was bit.
3. Apply a topical steroid cream, such as hydrocortisone,
with a concentration of at least 0.25 percent.
4. Administer oral
antihistamines.
5. Monitor carefully for severe allergic reactions.
6. Monitor carefully for infection.
POISON IVY
Poison ivy
causes misery for thousands of people each year. Its sticky resin causes
symptoms such as
swelling, a red itchy rash, blisters and oozing
which may appear as soon as a few hours after exposure to as
long
as two weeks later. The more sensitive someone is to poison ivy, the sooner the
symptoms will appear.
And if they have had a reaction to poison ivy
before, they will be even more sensitive to it the next time they
are exposed. It is important for these people to avoid the plant
carefully.
Poison ivy usually appears on the body in the areas where the
skin is the thinnest. The arms, the legs
(especially the shins),
and the face are affected most often. The rash will break out in a straight
line of
blisters that itch intensely, or in patches of red, bumpy
skin. About five days later, the blisters crack open
and release a
watery discharge. It takes at least a week to two weeks for the irritation to
heal. Most people
can treat themselves at home, with no need to see
a doctor.
Here are some things to do if you have been exposed to poison
ivy:
1. Wash the exposed area as quickly as you can. If you don't have quick
access to a shower, a water hose
will do. You want to remove as
much of the resin as possible, as soon as possible. Sometimes thorough
washing is enough to prevent the rash from developing.
2. Change
clothes and wash the clothing as soon as you can. Any sticky resin on the
clothing will remain
until the items are washed. Simply coming into
contact with the resin can cause irritation. Any items that
can't
be washed should be isolated and stored in a well ventilated area for at least
three weeks. This
includes shoes and boots.
3. If you do develop
a rash, you can help relieve the itching by sponging the affected areas with
alcohol,
applying a paste of baking soda, using calamine lotion, or
soaking in a tub of warm water with a handful of
baking soda thrown
in.
4. Take an antihistamine like Benadryl. This will help the itching and
the swelling. If the itching becomes
unbearable, ask your physician
to recommend something.
Some people are highly allergic to poison ivy and
experience extreme reactions. In severe cases, the
person's eyes
may swell shut, they may develop a fever and intense pain, swollen lymph nodes
in the neck,
armpits or groin, and have difficulty breathing. If any
these symptoms occur, it is important to seek a
doctor's help
immediately. An infection this severe will have to be treated with an
antibiotic.
A poison ivy irritation is extremely uncomfortable and far too
easy to develop, but you don't have to be a
victim. Here are a few
things to keep in mind when you're in an area infested with poison
ivy:
Learn what the plant looks like and avoid it! An old expression goes
like this: ‘Leaves of three, let it be!'
The plant's appearance
varies in different areas of the country. Find out what the species in your
area looks
like and memorize its appearance.
When walking in
wooded areas, wear long sleeves and gloves. Tuck pants legs into boots or
socks. Don't
wear shorts or sleeveless shirts!
Don't let your
dogs or cats run loose through the area. Poison ivy resin will stick to their
fur and you can
come into contact with it simply by petting the
animals. Bathe your pets as soon as possible if you think
they've
been near poison ivy.
Don't burn the poison ivy plants. This may sound like
strange advice, but the oil from the plants can be
inhaled through
the smoke and cause lung irritation.
And don't be fooled into thinking that
you are immune to poison ivy. Just because you've never been
affected before is no guarantee that the next time you come in contact
with it you won't break out into itchy
blisters. Take the necessary
precautions to protect yourself from this potent
plant.
---------------------------------------------
ICD 10
Codes
I 97.2 Lymphoedema arm, axillary lymph flow
area
I 89.0 Lymphoedema leg, inguinal lymph flow area
(primary or secondary)
I 89.9 Other diseases of lymph
vessels
R 60.0 Oedema without specification
R
60.0 Oedema with CVI (chronic venous insufficiency -
Ed!)
R 60.1 Cyclic Idiopathic Syndrome
R 60.9
Lipoedema and E 88.2
----
http://www.medscape.com/viewarticle/703674?src=mp&spon=17&uac=91492PV
From Medscape
Business of Medicine
Best Ways to Deal With Noncompliant Patients
Mark
Crane, BA
Authors and Disclosures
Published:
06/05/2009
Once you've figured out what's ailing your patient, the
real challenge is convincing him or her to follow your
advice. Only
half of all chronically ill patients take medicines as directed, and many don't
even bother to get
the prescription filled, according to a 2003
World Health Organization study.
Beyond that, many patients refuse to make
recommended lifestyle changes that can improve their health.
Noncompliance
is dangerous for the patient and frustrating for the physician. As more
insurers and Centers
for Medicare & Medicaid Services (CMS)
promote pay-for-performance programs, physicians will
potentially
be scored and reimbursed on the basis of patient outcomes -- meaning that
noncompliant
patients could drag down doctors' scores.
Patient
refusal to follow a treatment regimen also affects the nation's healthcare
system. "The cost of patient
noncompliance is easily in the tens of
billions of dollars a year in needless complications and
hospitalizations," says David B. Nash, MD, MBA, an Internist and
Chairman of the Department of Health
Policy at Jefferson Medical
College in Philadelphia, Pennsylvania. "If we could improve compliance, we'd
be well on our way to fixing the healthcare system regardless of
what reforms are ultimately passed."
Up to 11% of hospital admissions, 40%
of nursing home admissions, and about 125,000 deaths a year are
due
to noncompliance with prescribed medication regimens, according to the American
Pharmacists
Association. As former US Surgeon General C. Everett
Koop once lamented, "Drugs don't work in
patients who don't take
them."
Economic Woes Increase Noncompliance
Today's tough economy has
created new reasons why more patients are noncompliant. Patients don't take
medications if they can't afford them. Many patients who have lost
their jobs and health insurance are
forgoing prescription drugs or
office visits.
"People who have lost jobs are putting off preventive care
and canceling routine visits," says Rick
Kellerman, Chair of the
Department of Family and Community Medicine at Kansas University School of
Medicine in Wichita, Kansas, and past president of the American Academy
of Family Physicians (AAFP).
"That creates long-term potential for
conditions to develop into more serious illnesses."
On the basis of
widespread money problems, physicians should take the time to ask about a
patient's
financial circumstances that can affect
compliance.
"Patients are often reluctant to tell physicians that they've
lost a job and can't afford medicine," says
Kellerman. "Perhaps it
should be part of a standard history to inquire about whether they might have
trouble
filling prescriptions or returning for follow-up
care."
It's especially important to counsel patients about dosage when money
is tight because some patients split
pills to make them last
longer. Physicians can also provide free samples, substitute generics whenever
appropriate, and refer patients to pharmaceutical company or
government assistance programs.
Section 1 of 6
Best Ways to Boost
Patient Compliance
Physicians face 2 chief noncompliance challenges:
patients who can't comply due to financial reasons, and
those who
don't want to make the effort to lose weight, test their blood sugar, or say no
to harmful lifestyle
choices.
For doctors, it's vitally
important to take time to tell patients why the treatment is necessary.
"As
many as 1 in 5 patients don't fill the original prescription because the doctor
didn't convince them that
they really needed it," says Kellerman.
"It takes time to sit down with the patient and make sure they have
all the information they need, but currently, the reimbursement system
and shortage of primary care doctors
doesn't make that
easy."
"There are multiple reasons for noncompliance," adds Donald J.
Palmisano, MD, JD, a vascular
surgeon/attorney in Metairie,
Louisiana, and former president of the American Medical Association
(AMA). "Patients may not understand what you told them. I typically ask
the patient to repeat back to me
what it is he's supposed to do.
It's important to explain that if the patient doesn't take the medicine, he's
at
increased risk for stroke or some other illness.
"If I suspect
the patient is unclear, we give written instructions and may follow up with
phone calls. It's
important to know if the patient is able to read.
I've been amazed over my career at how many patients
cannot," says
Dr. Palmisano.
Patients need to know what the drug is and how it works in
terms that are understandable to them. How
and when should they
take the drug? For how long? What side effects can be expected? What are the
consequences of stopping the medication? If doctors can answer these
questions, it's far more likely that
your patients will follow your
advice.
Depending on your practice workflow, it may be useful for a medical
assistant or nurse to discuss the
prescription with the patient. He
or she can stress the importance of the prescription and make sure the
patient understands what is expected.
Section 2 of
6
Technology Can Help Promote Patient Compliance
Type the words
"patient compliance" into Google and you'll get 3.7 million hits, mostly from
vendors eager
to sell you programs to encourage patient compliance.
Some of them can be helpful.
The solutions take the form of patient
education, reminders, and ongoing monitoring, including call centers,
email
reminder programs, computer programs, high-tech packaging, and other tools to
remind patients of
dosages and refills.
As electronic health
records and e-prescribing grow, these technologies help physicians and health
plans
determine whether patients are taking their medications.
Horizon Blue Cross Blue Shield of New Jersey, for
example, is
working with Merck & Co., Inc. to send text messages to physicians,
informing them of patients
not filling their prescriptions. Another
program, supported by Pfizer Inc., provides automatic voice mail
reminders to patients, replacing mailed notices.
Electronic alerts
have proven helpful and effective in encouraging patients to get screening and
treatment for
dyslipidemia. A report published in the January 2008
issue of Circulation described a randomized
controlled trial in
which investigators from The Netherlands found that 65% of patients who
received
electronic alerts were screened vs 35% of patients who had
inquired by themselves.[1]
Numerous new high-tech devices can help patients
remember when to take their pills. Some offer
subscribers a
reminder service via a pager or other wireless device. MedivoxRx Technologies
Inc., in
Pittsford, New York, has a talking pill vial that reminds
blind, visually impaired, and illiterate patients to take
their
medicines.
The Med-eMonitor System, developed by Rockville, Maryland-based
InforMedix, Inc., combines
compliance and disease management on the
basis of the patient's care plan. The system includes a portable
drug storage device that uses chimes to prompt the patient to take the
medicine. It also asks patients
whether they have taken the meds,
monitors their health status by asking other questions, and records the
time and date of all interactions.
The system automatically uploads
the patients' information to a central database. If there is cause for
concern, it triggers an outbound email, page, or cell phone text message
sent to the patient's physician.
Section 3 of 6
Companies Help
With Nurse Coaches and Teaching Aids
Some manufacturers are using nurse
coaches to promote compliance, especially with high-cost specialty
drugs. For example, McKesson Specialty, a provider of reimbursement,
distribution, and clinical services
for specialty drugs, runs
nurse-coach programs through partnerships with manufacturers and health plans.
For drugs that require self-injection, McKesson's nurses teach
patients how to inject the drug, conduct
monthly phone-ins, and
coordinate care.
Some pharmaceutical companies are providing physicians with
practicing counseling tools to help patients.
For example, a portable
teaching aid from teriparatide (Forteo®), an osteoporosis drug, demonstrates to
patients how bone strength and density can improve from treatment.
The teaching aid is a 3-dimensional
model that replicates
before-and-after treatment bone biopsies from the hip of a clinical-trial
patient of the
drug.
A program for tazarotene (Tazorac®) is
designed to encourage teens to regularly apply the acne medicine.
Messages are delivered through text messages received on teens' cell
phones from a mobile "buddy" who
they've selected. The program
offers patients a series of incentives and rewards, such as wallpapers and
ringtones, the magazine reports.
David Nash comments, "All of the
new methods are helpful, but there's no magic bullet and nothing
substitutes for the basics: taking the time to explain to the patient
why you're prescribing the medication."
Section 4 of 6
Should You
Dismiss Noncompliant Patients?
At times, you'll encounter patients who
complain endlessly about their conditions but stubbornly refuse to
follow the recommended treatment.
"We doctors tend to blame, but
perhaps I could have done a better job of communicating," says Kellerman.
"If I have trouble communicating with a patient, I try to look at
myself first. It's rare to discharge a patient
unless he's
disruptive or abusive to the staff."
Patients who repeatedly break
appointments or don't show up for scheduled procedures may be
discharged from a practice, however.
"I had a patient scheduled to
have his colostomy closed," says Dr. Palmisano. "He never showed up. We
had a hard time locating him. We finally did and reschedule, but he
didn't show up again. He came to the
ER [emergency room] a few
nights later, drunk and creating a disturbance, cussing out the staff.
"I
told him I couldn't continue to treat him and that it was in his best interest
to find another doctor. I gave
him a referral to a clinic and told
him I'd be available in case of an emergency. It's rare to discharge patients,
but sometimes you have to. It gives them a reality check that they
cannot keep acting the same way."
Some pay-for-performance programs could
lead to unintended consequences, including pressuring
physicians to
discharge noncompliant patients who might undermine their performance
scores.
"I worry about 'cherry picking' and 'lemon dropping' in poorly
designed pay-for performance programs,"
says Kellerman. "If I'm paid
based on patient outcomes over which I don't have ultimate control if the
patient is noncompliant, I could be penalized financially. That could
be an incentive to drop patients who
need my help the
most."
"Every doctor has an obligation to do the best he can for patients,"
says Dr. Palmisano. "So doctors may
get an extra percent or two of
reimbursement if they follow certain guidelines under these programs. We
have to remember that patients are individuals, and we can't let
managed care or government policies
dictate the ethical practice of
medicine."
"All physicians can do is make sure patients have the information
they need to make a rational decision,"
says Kellerman. "It's
ultimately the patient's choice whether to accept our advice."
Section 5
of 6
How to Dismiss a Noncompliant Patient
Discharging a patient
should be a last resort only after repeated attempts to find out why the
patient is
disruptive or won't comply with your
advice.
Physicians should personally speak with the patient to ask about any
specific complaints, say malpractice
risk managers. You may learn
that the patient is unhappy with your treatment or office staff. These
situations
could potentially be corrected.
It's important to end
the doctor-patient relationship carefully to avoid getting sued for abandonment
or
discrimination. Most liability insurers have protocols and sample
letters that doctors can use to reduce their
risk for a lawsuit
when they discharge a patient.
It's wise to warn patients first that they'll
be discharged unless their behavior changes. Document any
noncompliance in the patient's chart. You should also document that you
informed the patient of the specific
potential consequences of
failing to follow medical advice, says Dr. Palmisano, who also heads Intrepid
Resources, a risk management firm in Metairie.
Send a
termination letter by certified mail, return receipt requested, and keep the
receipt in the patient's file.
Give the patient sufficient notice
that you will stop treating him or her. A month is usually adequate, but
check with your insurer or state medical society for
guidance.
Inform the patient that you'll continue to treat him or her until
the termination date and for any emergencies
that occur up to then.
Refer the patient to the local medical society or hospital to obtain a list of
physicians.
Offer to transfer the patient's records promptly once
you receive a written authorization.
Section 6 of
6
-------------------------
Frequently-Asked Questions
What is
Lymph Drainage Therapy?
For the past thirty years the benefits of Lymph
Drainage Therapy have been scientifically documented and
medically
prescribed throughout Europe. Now it is rapidly gaining recognition in the U.S.
by health care
providers. Trained in Dr. Chikly's unique technique,
therapists use precise, gentle, wave-like hand
movements to feel
the rhythm, depth and direction of the flow of the body's lymph fluid, to
detect
obstructions, and to map that flow. This enables the
therapist to redirect the lymph to the pathway that is
most
effective for drainage - with far-reaching benefits.
As noted by Dr. Bruno
Chikly:
The lymphatic system belongs to the circulatory apparatus which
provides one way for the blood to leave
the heart, the arterial
system, and two ways for it to return: the venous and lymphatic pathways. The
lymphatic system is therefore another pathway back to the heart,
parallel to the venous system.
The main functions of the lymph system
are:
stimulation of the immune system
stimulation of the
parasympathetic nervous system
stimulation of body fluid
circulation
recovery of crucial substances that have escaped from the
blood
The lymphatic system drains the interstitial fluid. Stress, disease,
injuries, environmental toxins cause the
lymphatic system to
stagnate or be obstructed, leading to the accumulation of excess fluid,
metabolic waste,
cells and toxins, foreign bodies and pathogens,
and proteins in the interstitial environment, compromising
optimum
cellular function. This leads to disease and premature aging. Once the
interstitial fluid enters the
lymph vessels, it is called lymph.
Lymph is then transported to the lymph nodes, purification centers, where
it is filtered and processed for elimination through the
kidneys.
What are some of its benefits?
Stimulates the functions
of the immune system (promotes healing and general well being)
Stimulates
the parasympathetic nervous system while depressing the sympathetic nervous
system (aids
insomnia, depression, stress, digestion)
Relieves
muscle pain and hyper tonus
Reduces edema (swelling)
Alleviates heavy
metal, pesticide and metabolic waste TOXICITY
Reduces pain (fibromyalgia,
chronic fatigue syndrome)
Helps tissue regeneration (pre- and post-surgical,
burns, injuries, reduces scar formation)
Diminishes the effects of
aging
Reduces inflammation
Improves circulation
What are some of its
applications?
Surgical: pre- and post-surgical tissue regeneration
and reduction of edema
Sport injuries: sprains, strains, fractures,
inflammation, chronic pain, whiplash, sciatica
Pediatrics
Ear, Nose and
Throat: sinus, asthma, allergies, ear and throat infections, vertigo,
tinnitus
Neurological: migraines, headaches, stroke, facial paralysis, MS,
Parkinson's disease, myopathy
Gastroenterological: celiac disease, irritable
bowel disease, chronic constipation, weight problems
Dermatological: scars,
burns, wrinkles
Gynecological: infertility, menstruation, PMS, swollen legs,
varicose veins
Metabolic: stress, Chronic Fatigue Syndrome, chronic pain,
cellulite, insomnia, toxicity
Dentistry: inflammation, periodontitis, tooth
extractions, TMJ pain
Geriatrics: promotes tissue regeneration and
oxygenation, improves circulation, relieves muscles soreness
Ophthalmology:
chronic edema of eyelids, cataracts, macular degeneration, reduced visual
acuity
Orthopedics: trauma, sublaxations, sprains, fractures
Osteopathic:
whiplash, back pain, sciatica
Rheumatology: scleroderma, lupus,
fibromyalgia, gout, rheumatoid arthritis, nocturnal paresthetic
brachialgia
Veterinary: Lymph Drainage Therapy can be applied to
animals
What are the contraindications?
Acute
infection/inflammation/fever
Serious circulatory problems
Major cardiac
problems
Hemorrhage
Acute anuresis (absence of urination)
Active
cancer not under medical control, undiagnosed lump
What are the known
effects of Lymph Drainage Therapy?
Manual Lymphatic Drainage is
effective for a wide range of conditions and can be safely applied to
everyone
from children to the elderly, if the basic precautions and contraindications
are respected. Here are
a few of the known effects of Lymphatic
Drainage therapy.
CIRCULATION of lymph, blood capillaries, veins
interstitial liquids and cerebrospinal and synovial fluids
(indirectly) is ACTIVATED. This action helps to reroute stagnant fluid
in the body (i.e., edema, primary
and secondary lymphedema) mucosa,
muscles, viscera, joints, cranial sutures, periosteum, chambers of the
eyes and cochlea.
TOXINS and METABOLIC WASTE PRODUCTS are
removed, making lymphatic drainage especially
effective in TISSUE
REGENERATION. Scars, stretch marks, wrinkles, bruising and fracture or surgical
incision sites are improved. LDT is used as part of DETOXIFICATION
and ANTI-AGING regimens.
MACROMOLECULES (PROTEINS) are drained which
helps to ELIMINATE PROTEIN-RICH
FLUIDS from the extracellular
tissues and aid in the REABSORPTION OF EDEMA.
FATS are EVACUATED through
the lymphatic vessels. These VESSELS ARE located in virtually every
area of the body WHERE FATS MAY ACCUMULATE.
FUNCTION OF THE
IMMUNE SYSTEM is STIMULATED through increased lymph flow. The
additional flow carries more antigens to the lymph nodes, thereby
INCREASING
ANTIBODY/ANTIGEN contact. This has been found to HELP
with chronic or subacute
INFLAMMATORY PROCESSES - chronic fatigue
syndrome, autoimmune diseases, bronchitis, sinusitis,
amygdalitis,
tonsilitis, laryngitis, arthritis, acne and eczema.
FUNCTIONING OF THE
PARASYMPATHETIC system is BOLSTERED, and SYMPATHETIC is
DIMINISHED
with stimulation of the lymphatics. This can be very helpful in dealing with
STRESS,
DEPRESSION, SLEEPING and DIGESTIVE
DISORDERS.
EFFECTS OF PARASYMPATHETIC STIMULATION
Conserves
and restores ENERGY
Helps regenerate injured tissue
Generally most active
during sleep, deep relaxation states
Stimulates immune
functions
Decreases heart rate
Decreases respiratory rate
Decreases
blood pressure
Increases blood flow to skin
Increases blood sugar
level
Increases gastrointestinal motility and kidney function
Increases
secretion of lachrymal glands
Increases secretion of salivary
glands
Increases secretion of digestive glands
Increases secretion of
bronchial glands
Constricts bronchioles
Relaxes sphincters and
spasms
Contracts pupils (miosis)
Contracts ciliary muscles
(accommodations)
Contracts urinary bladder
Stimulates erection
CHRONIC
PAIN is REDUCED as the drainage alleviates tissue-fluid stagnation and possibly
inhibits
nociceptors (pain receptors). TRIGGER POINTS and FASCIA
PULLS can be RELEASED.
VOLUNTARY and INVOLUNTARY MUSCLE SPASMS are
REDUCED, proving helpful in cases of
CONSTIPATION and other
muscle-related maladies.
DRAINAGE of the lobes of the LIVER is
invaluable for releasing most of the post-treatment effects.
As with any
technique, there are conditions under which lymphatic drainage should NOT be
used. These
include ACUTE INFLAMMATION OR INFECTION (especially any
condition with FEVER), MAJOR
CIRCULATORY and CARDIAC problems,
ACUTE BLEEDING and MALIGNANCY NOT UNDER
MEDICAL CONTROL, ACUTE
ANURESIS (ABSENCE OF URINATION).
http://home.earthlink.net/~lymph-drainage-therapy/faq.html
do you treat Lymphedema?The gold standard treatment is a form of medical
massage that can be
called:Manual Lymph Drainage (MLD)Lymph Drainage
Therapy (LDT)Complete/Complex Decongestive
Therapy (CDT)The goal of
therapy is to activate fluid circulation, to drain stagnant areas, stimulate
the
immune system, reduce pain, and keep muscle spasms to a
minimum.To perform Lymphedema therapy,
one must be certified and
properly trained, look for your therapists credentials.Therapy feels like a
massage
only lighter. Your therapist will work on your body,
usually head to toe. He/she will drain the nodes which
again, feels
like a massage. The main nodes are the waterwheel (behind earlobe), clavicle
(near collarbone),
axilla (under arms) and the iliac/inguinal nodes
which are in the abdomen. A good deal of time is spent going
back
and forth to the main nodes to ensure good movement of fluids. Extra time will
be spent on areas of
swelling. Before you are worked on, the
therapist will take your medical history and measure your areas of
swelling. This is done so they can keep a record of how you progress to
a smaller level.You will be taught
to perform self bodywork, how to
care for your skin, possibly skin brushing, do's and don'ts, special
exercises
to promote lymph flow, and how to wrap yourself. You usually are wrapped after
each session.
After you maintain the same size for a period of
time, you will be ordered compression garments (sleeve,
stockings)
to wear instead of wraps.When NOT to go to or schedule therapy: You should not
schedule or
go to an appointment if: You have active or acute
infectionsYou have a fever or inflammed red skin and
possible
infectionThrombosis (serious circulatory problems)Major heart problems
(bodywork increases the
cardiac load)BleedingYou are unable to
urinateAlso if you have any unexplained lumps or possible
malignancies, you need to check in with your doctor and therapist. NEVER
forget to tell your therapist
about any problems you are having,
and ALWAYS have your therapist update your health records to any
new medications or problems.You should always have a current
prescription for bodywork. Most
therapist will not treat you
without a referral.ALWAYS check your therapists credentials before you have
bodywork done.
This is a must read:
A systematic review of the evidence for complete
decongestive therapy in the treatment of lymphedema from 2004 to
2011.
http://www.ncbi.nlm.nih.gov/pubmed/22920313
DIURETICS - HOW EFFECTIVE ARE THEY?Reputable
health authorities advise against using diuretics
in the treatment
of lymphedema pointing out that the therapy is generally not effective and can
be damaging
when used over a long period of time. The Canadian
Medical Association Journal, Clinical practice
guidelines for the
care and treatment of breast cancer: 11. Lymphedema (CMAJ 2001;164(2):191-9)
released in January of 2001 by Susan R. Harris, Maria R. Hugi, Ivo
A. Olivotto, Mark Levine, for the
Steering Committee for Clinical
Practice Guidelines for the Care and Treatment of Breast Cancer notes:
Diuretics,
which have been recommended in the past, may temporarily mobilize water, but
the increased
interstitial oncotic pressure exerted by the high
protein concentration of lymph fluid will cause rapid
recurrence of
edema. The diuretic effect in the rest of the body may cause adverse side
effects, such as
hypotension, dehydration and electrolyte
imbalance.The National Cancer Institute (NCI) points out that,
" Diuretics encourage vascular fluid depletion, but do nothing
for excess protein deposits and could
hasten connective tissue
fibrosis. Therefore, diuretics should be used with caution and only for
treatment of
excess vascular fluid due to other causes (1998).The
1995 consensus document of the International Society
of Lymphology
Executive Committee reports that although diuretics may be occasionally be
useful during
the initial phase of physiotherapy or in certain
unique medical situations, their use on a long term basis is not
generally effective. &Long-term administration of diuretics is
discouraged as being of marginal benefit and
potentially
complicated by fluid and electolyte disturbances.Managing your lymphedema takes
time and
practice. You're therapist will teach you how to properly
bandage or wear compressions combined with
self massage. Practice
makes perfect so have patience.Although there is no cure and lymphedema is
usually
progressive, we can hope for research and studies to arise
in the future to help those with the condition and
also measure to
prevent others from ever having it.Therapist HygieneIf you have open wounds or
leaking
fluid, your therapist may wear gloves. Gloves protect
contact with fluids, substances, and chemicals. If
working in the
mouth to drain nodes, a therapist will wear gloves. Be sure if you have any
known allergy to
latex you inform your therapist BEFORE bodywork
with gloves
Managing LymphedemaAt a GlanceYour doctor and nurse
are more likely to take your symptoms seriously
and be attentive to
your progress if they regularly measure the circumference of your arm and
compare it
with your unaffected arm, documenting the measurements
over time. You can usually control lymphedema
by practicing good
care and following basic guidelines.The health care professionals who
specialize in the
management of arm lymphedema are physical medicine
doctors (physiatrists), physical therapists, and
occupational
therapists. But don't assume that anyone in these specialties is an expert in
treating
lymphedema. Ask about experience and references before you
let anyone work on your edema problem.
Most metropolitan areas have
occupational or physical therapists with practices dedicated to managing the
physical, psychological, and activity-related side effects of
breast cancer treatment. If you can't find a
therapist who
specializes in breast cancer, look for a general occupational or physical
therapist in a
rehabilitation center or department who has
experience taking care of women with breast cancer
Title: Early
Intervention and Treatment Intervention for LymphedemaAuthors: Gergich N,1
Washington F,2
Pfalzer3 L, Soballe P1 and McGarvey C4Affiliations:
1. Breast Care Center, National Naval Medical
Center, Bethesda,
MD.2. University of Maryland School of Medicine, Baltimore, MD.3. University of
Michigan-Flint, Flint, MI.4.National Institutes of Health,
Bethesda, MD, Physical Therapy Dept.,Abstract:
DESIGN: This
observational (case-control) outcome study investigated the frequencyand
severity of
morbidities in a population of approximately 165
patients diagnosed withbreast cancer before and after
medical and
surgical treatment.METHODS: A subset analysis of a cohort of women of women
diagnosed
with subclinicallymphedema (LE) was conducted.
Pre-operative and follow-up arm volumemeasurements
taken at 80% of
limb length measured from ulnar styloid to tip ofacromion at 1, 3, 6, 9, 12 and
18 months
by optoelectronic volumeter
(Perometer®) from2001-2006. Quantitative girth measurements
were collected over this period using anoptoelectric limb
volumeter. The device is an framed infrared
scanning
system(Perometer, Pero-system MeBgerate GmbH, Wuppertal, Germany). This
instrument
wasdesigned specifically to measure girth (cm) and
volume (ml) of the upper or lowerextremities and has
been validated
for use in a clinical environment by Stanton1 andothers.ANALYSIS: 2-way
Repeated
ANOVA with Time and Limb as factors and mean
valuescalculated for Affected and Unaffected Arms.
RESULTS: 43 women
34-82 years old (mean =55.3 + SD 12.1) reported symptoms ofLE including
heaviness or increased limb volume. Intervention was introduced if
thevolume change equated to
approximately 100 ml or 3% volume change
compared to preopmeasure. At intervention the volume
increase in
the affected arm was significant (83.0ml + 118.8 [2.1 % + 5.2] p=0.001).
Baseline to onset of
lymphedema and interventionaveraged 7.6 mos.
Average time to follow up was 5.0 months, during which
time
thecohort demonstrated a significant (p=0.0000) mean volume decrease of 119.9
ml [8.6%]in their
affected arm by using the sleeve.CONCLUSIONS:
Pre-operative assessment, prospective surveillance and
earlyintervention may have prevented the onset of irreversible LE in
this small cohort.The garment
significantly reduced affected limb
volume to nearly that of the unaffectedlimb and therefore provides
effective treatment when sub-clinical LE can be detected.Further
research is warranted to confirm the long
term effectiveness and
costeffectiveness of this preventive model compared to a traditional impairment
based model.1. Stanton AW, Northfied JW, Holroyd B, Mortimer PS,
and Levick, JR. Validation of
anoptoelectronic limb volumeter
(Perometer). Lymphology. 1997 vol:30 (2): pp:77 -97
This page is a
mix of content from Lymphology magazine in the last article, exerpts from
Dr.Chikly
------------------------------------------------------------------------------------------------
MLD
can be used for other things too, to speed healing after surgery.
Hi
Charissa,
The answer is YES MLD is very successful for acne. I have
done many cases here, they are all very
pleased with the results.
Some of them are closed to 95% clear and 1 had 100% clear skin now. Most
will experience at least a 50% reduction of appearance of acne. I only
have 1 resistant case due to prolong
(12 years) antibiotics
consumption, I realise we have to do full detox to make things work but in
general
everyone else responded. 99% success rate from my
experience. :) Do your treatment regularly and use
gentle pH
balance skin care products. Harsh products will make things worse.
hugs,
veronica yap
Vodder MLD Lymphoedema Therapist
I am really interested
in feedback
about how successful the mld was for
acne.
Charissa
--------------------------------------------
Alternative
Systems of Medical Practice
Overview
Worldwide, only an estimated 10 to
30 percent of human healthcare is delivered by conventional,
biomedically oriented practitioners. The remaining 70 to 90 percent
ranges from self-care, according to folk
principles, to care given
in an organized healthcare system based on an alternative tradition or
practice.
Popular healthcare is the kind most people practice and receive at
home, such as giving herbal tea to
someone who has a cold.
Community-based healthcare, which reflects the health needs, beliefs, and
natural
environments of those who use it, refers to the
nonprofessionalized but specialized healthcare practices of
many
rural and urban people. Professionalized healthcare is more formalized;
practitioners undergo more
standardized training and work in
established locations.
Professionalized Healthcare Systems
The
professionalized healthcare practitioners often have conducted scientific
studies about the causes of
illness and explanations and results of
treatment. Each of the major professionalized systems has certain
characteristics: a theory of health and disease; an educational scheme
to teach its concepts; a delivery
system involving practitioners; a
material support system to produce medicines and therapeutic devices; a
legal and economic mandate to regulate its practice; cultural
expectations about the medical system's role;
and a means to confer
professional status on approved providers. These professionalized medical
systems
include traditional oriental medicine, acupuncture,
ayurvedic medicine, homeopathy, anthroposophy,
naturopathy, and
environmental medicine.
Traditional Oriental Medicine
Traditional
oriental medicine is a sophisticated set of many systematic techniques and
methods, including
acupuncture, herbal medicine, acupressure, qi
gong, and oriental massage. The most striking characteristic
of
oriental medicine is its emphasis on diagnosing disturbances of qi, or vital
energy, in health and disease.
Diagnosis in oriental medicine
involves the classical procedures of observation, listening, questioning, and
palpation, including feeling pulse quality and sensitivity of body
parts.
The professionalization of oriental medicine has taken diverse paths
in both East Asia and the United States.
Currently, the model in
the People's Republic of China, which was established after the 1949
revolution,
involves the organized training of practitioners in
schools of traditional Chinese medicine. The curriculum of
these
schools includes acupuncture, oriental massage, herbal medicine, and
pharmacology, though the
clinical style of making a diagnosis and
then designing a treatment plan is the one traditionally associated
with herbal medicine. The graduates of these colleges are generally
certified in one of the four specialty
areas at a training level
roughly equivalent to that of a Western country's bachelor's degree.
In the
United States, the professional practitioner base for oriental medicine is
organized around
acupuncture and oriental massage. There are about
6,500 acupuncturist practitioners in the United States.
The
American Oriental Body Work Therapy Association has approximately 1,600 members
representing
practitioners of tuina, shiatsu, and related
techniques. Many American schools of acupuncture are evolving
into
"colleges of oriental medicine" by adding courses in oriental massage, herbal
medicine, and dietary
interventions. They also are offering
diplomas, master's degrees, and doctor's degrees in oriental medicine.
The legal sanctioning of oriental medical practice is most extensive in
New Mexico, where the acupuncture
community has established an
exclusive profession of oriental medicine. Their legal scope of practice is
currently similar to that of primary care M.D.s and D.O.s (doctors of
osteopathy), and their State statute
restricts other licensed New
Mexico health professionals' ability to advertise or bill for oriental medicine
or
acupuncture services.
Extensive research has been done in
China through the institutions of traditional Chinese medicine, but only
in the past quarter century have biomedical scientists in China
characterized and identified active agents in
much of traditional
medical formulary. The use of traditional oriental herbal medicines and
formulas in China
and Japan has been studied for therapeutic value
in the following areas: chronic hepatitis; rheumatoid
arthritis;
hypertension; atopic eczema; various immunologic disorders, including acquired
immunodefiency
syndrome (AIDS); and certain cancers. It would be
useful to repeat these studies in the United States,
assessing U.S.
clinical populations according to high-quality research
criteria.
Acupuncture
Acupuncture involves stimulating specific anatomic
points in the body for theerapeutic purposes. Puncturin
the skin
with a needle is the usual method, but practitioners also use heat, pressure,
friction, suction, or
impulses of electromagnetic energy to
stimulate the points. In the past 40 years, acupuncture has become a
well-known,
reasonably-available treatment in developed and developing countries.
Acupuncture is used to
regulate or correct the flow of qi to
restore health.
Modern theories of acupuncture are based on laboratory
research conducted in the past 40 years.
Acupuncture points have
certain electrical properties, and stimulating these points alters chemical
neurotransmitters in the body. The physiological effects of acupuncture
stimulation in experimental animals
have been well documented, and
in the past 20 years acupuncture has become an increasingly established
healthcare practice. An estimated 3,000 conventionally trained U.S.
physicians have taken courses to
incorporate acupuncture in their
medical practices.
Acupuncture is one of the most thoroughly researched and
documented of the so-called alternative medical
practices. A series
of controlled studies has shown evidence for the efficacy of acupuncture in the
treatment
of a variety of conditions, including osteoarthritis,
chemotherapy-induced nausea, asthma, back pain, painful
menstrual
cycles, bladder instability, and migraine headaches. Studies on acupuncture
also have shown
positive results in the areas of chronic pain
management and in the management of drug addition, two areas
where
conventional Western medicine has had only a modicum of
success.
Ayurveda
Ayurveda is India's traditional, natural system of
medicine that has been practiced for more than 5,000
years.
Ayurveda provides an integrated approach to preventing and treating illness
through lifestyle states
that all disease begins with an imbalance
or stress in the individual's consciousness. Lifestyle interventions
are
a major ayurvedic preventive and therapeutic approach. There are ten ayurveda
clinics in North
America, including one hospital-based clinic that
has served 25,000 patients since 1985.
In India, ayurvedic practitioners
receive state-recognized, institutionalized training in parallel to their
physician counterparts in India's state-supported systems for
conventional Western biomedicine and
homeopathic medicine. The
research base is growing concerning the physiological effects of meditative
techniques and yoga postures in Indian medical literature and Western
psychological literature. Published
studies have documented
reductions in cardiovascular disease risk factors, including blood pressure,
cholesterol, and reaction to stress, in individuals who practice
Ayurvedic methods.
Laboratory and clinical studies on ayurvedic herbal
preparations and other therapies have shown them to
have a range of
potentially beneficial effects for preventing and treating certain cancers,
treating infectious
disease, promoting health, and treating aging.
Mechanisms underlying these effects may include free-radical
scavenging effects, immune system modulation, brain neurotransmitter
modulation, and hormonal effects.
Homeopathic Medicine
Homeopathic
medicine is practiced worldwide, especially in Europe, Latin America, and Asia.
However,
even in the United States the homeopathic drug market is a
multimillion-dollar industry. Homeopathic
remedies, which are made
from naturally occurring plant, animal, or mineral substances, are recognized
and
regulated by the Food and Drug Administration (FDA) and are
manufactured by established pharmaceutical
companies under strict
guidelines. Homeopathy is used to treat acute and chronic health problems as
well as
for disease prevention and health promotion. Recent clinical
trials suggest that homeopathic medicines have
a positive effect on
allergic rhinitis, fibrositis, and influenza.
Basic research in homeopathy
has involved investigations into the chemical and biological activity of highly
diluted substances. Some homeopathic medicines are diluted to
concentrations as low as 10-30 to 10-
20,000. This particular aspect
of homeopathic theory and practice has caused many modern scientists to
reject homeopathic medicine. Critics of homeopathy contend that such
extreme dilutions of the medicines
are beyond the point at which
any active molecules of the medicine can theoretically still be found in the
solution. On the other hand, scientists who accept the potential
benefits of homeopathic theory suggest
several theories to explain
how highly diluted homeopathic medicines may act. Using recent developments in
quantum physics, they have proposed that electromagnetic energy in
the medicines may interact with the
body on some level. Researchers
in physical chemistry have proposed the "memory of water" theory,
whereby the structure of the water-alcohol solution is altered by the
medicine during the process of dilution
and retains this structure
even after none of the actual substance remains.
Anthroposophically Extended
Medicine
Anthroposophically extended medicine is an extension of Western
biomedicine and also incorporates
approaches and therapeutics from
two alternative medicine movements: naturopathy and homeopathy.
Anthroposophically extended medicine is most prominent in Europe, but
there are an estimated 30 to 100
M.D.s in the United States who
practice it also. Hundreds of uniquely formulated medications are used in
anthroposophical practice, each seeking to match the key dynamic forces
in plants, animals, and minerals
with disease processes in humans
to stimulate healing. Much research in anthroposophically extended
medicine has been connected with attempts to understand the nature of
disease, assess treatments
qualitatively, and understand how the
essential properties of the objects under investigation could be applied
in therapy.
Naturopathic Medicine
Naturopathic medicine, as a
distinct American healthcare profession, is almost 100 years old. It was
founded as a formal healthcare system at the turn of the century by
medical practitioners from various
natural therapeutic disciplines.
By the early 1900s, more than 20 naturopathic medical schools existed, and
naturopathic physicians were licensed in most States. Today there are
more than 1,000 licensed
naturopathic doctors in the United
States.
As practiced today, naturopathic medicine integrates traditional
natural therapeutics - including botanical
medicine, clinical
nutrition, homeopathy, acupuncture, traditional oriental medicine,
hydrotherapy, and
naturopathic manipulative therapy - with modern
scientific medical diagnostic science and standards of care.
The
medical research base of naturopathic practice consists of empirical
documentation of treatments using
case history observations, medical
records, and summaries of practitioners' clinical experiences.
At present,
the two accredited naturopathic medical schools in the United States have
active research
departments. Naturopathic researchers have
investigated the pharmacology and physiological effects of
nutritional and natural therapeutic agents, and naturopathic physicians
have been active in the investigation of
new homeopathic remedies
and in the natural treatment of women's health problems. The most recently
completed naturopathic study in women's health tested the clinical and
endocrine effects of a botanical
formula as an alternative to
estrogen replacement therapy.
Environmental Medicine
Environmental
medicine, like anthroposophically extended medicine, also can be viewed as an
extension of
modern biomedicine. Environmental medicine traces its
roots to the practice of allergy treatment and the
work of Dr.
Theron Randolph, in the 1940s, who identified a variety of common foods and
chemicals that
were able to trigger the onset of acute and chronic
illness even when exposure was at relatively low levels.
Environmental
medicine recognizes that illness in individuals can be caused by a broad range
of incitant
substances, including foods, chemicals found at home
and in the workplace, and chemicals in the air, water,
and food.
Today there are 3,000 physicians worldwide practicing environmental medicine,
and there are
several environmental control units in the United
States and one in Canada, where patients' sensitivities are
unmasked
through fasting and complete avoidance of potentially incitant
chemicals.
Research, in this field, has been directed at clinical treatment
of patients and at evaluation of the diagnostic
and treatment
techniques used by practitioners. Other studies have supported the use of the
approaches of
environmental medicine in treating arthritis, asthma,
chemical sensitivity, colitis, depression, eczema, fatigue,
and
hyperactivity.
The belief that humans can get sick from cumulative low-level
environmental exposure to certain incitants is
not well accepted by
the conventional medical community. However, because "sick building syndrome"
and
other chronic conditions that cannot be explained by other
phenomena are being seen with greater
frequency, environmental
medicine offers a theoretical groundwork for dealing with such phenomena.
Indeed, environmental medicine is in a position to be a leading force
in the investigation of ways to reduce
the incidence of these and
other disorders.
Community-Based Healthcare Practices
Community-based
healthcare practices are varied and are found throughout the United States.
Like other
healthcare specialists, community-based healers may
emphasize naturalistic, personalistic, energetic
explanatory models
or a combination. Traditional midwives and herbalists and, at the present time,
pragmatic weight loss specialists are probably the best known of
community-based practitioners who follow
the naturalistic model. In
addition, the Native American medicine man or medicine woman is a community-
based traditional healer with primarily naturalistic skills, that is,
the skills of an herbalist in particular. Some
medicine people are
also shamans, in which case they are often distinguished as holy men and
women.
In contrast to professionalized practitioners, community-based
healers often do not have set locations
such as offices or clinics for
delivering care but do so in homes, at ceremonial sites, or even right where
they
stand. Community-based healing of the personalistic variety
can also be "distant," that is, it does not require
that
practitioner and patient be in each other's presence. Prayers or shamanic
journeys, for example, can be
requested and "administered" at any
time, and charm cures are sometimes delivered by telephone.
Meanwhile,
community-based systems also thrive in urban areas. These systems include the
popular weight
loss programs and other 12-step programs. Often the
practitioners rent office space and emphasize contact
between
client and practitioner, and they may charge considerable fees. Since these
practitioners depend on
their healing practice for their
livelihood, they advertise and so may be easier to identify and contact for
study purposes.
Native American
Native American Indian
community-based medical systems have a number of rituals and practices:
sweating
and purging, usually done in a "sweat lodge"; the use of
herbal remedies gathered from the surrounding
environment and
sometimes traded over long distances; and shamanic healing involving
naturalistic or
personalistic healing. Tribes such as the Lakota and
Dineh (Navajo) also use practices such as the medicine
wheel,
sacred hoop, and the "sing," which is a healing ceremony rite that lasts from
two to nine days and
nights and is guided by a highly skilled
specialist called a "singer."
Formal research into the healing ceremonies
and herbal medicines conducted and used by bona fide Native
American Indian healers or holy people is almost nonexistent, even
though Native American Indians believe
they positively cure both the
mind and body. Ailments and diseases such as heart disease, diabetes, thyroid
conditions, cancer, skin rashes, and asthma reportedly have been
cured by Native American Indian doctors
who are knowledgeable about
the complex ceremonies.
Latin American
Latin American community-based
practices include curanderismo, which is a folk system of medicine that
includes two distinct components: a humoral model for classifying
activity, food, drugs, and illness; and a
series of folk
illnesses.
In the humoral component of curanderismo, things could be
classified as having qualitative (not literal)
characteristics of
hot or cold, dry or moist. According to this theory, good health is preserved
by
maintaining a balance of hot and cold. Thus, a good meal will
contain both hot and cold foods, and a person
with a hot disease
must be given cold remedies and vice versa. Again, a person who is exposed to
cold
when excessively hot may "take cold" and become ill.
The
second component, the folk illnesses, is actively in use in much of Mexico and
among less educated
Hispanic U.S. citizens. Studies have found that
as many as 96 percent of Mexican-American households
(more frequent
in the less Americanized communities) treated members for Hispanic folk
illnesses. Similarly,
high use patterns among Mexican migrant
workers have been found in Florida and Mexico.
Although no formal
effectiveness studies seem to have been done on this system, its wide
popularity and the
research suggesting the relevance of the folk
diagnoses, for biomedical practice, indicate the need for further
demographic and effectiveness studies.
Alcoholics
Anonymous
Alcoholics Anonymous (AA) is an example of an urban
community-based healing system for helping
people, whose lives are
damaged by the consumption of alcohol, to stop drinking. Founded in 1935 by
Bob Smith, M.D. and Bill Wilson, two alcoholics, it is a
patient-centered self-help fellowship of men and
women. AA has
burgeoned and today is widely considered the most successful existing method
for
supporting sobriety.
In contrast to most community-based
systems, a very large literature exists analyzing AA. Several models
attempt
to explain its success. One popular psychometric model interprets AA as a
"cult" and the
achievement of sobriety as a "conversion experience."
Another model, however, asserts that members
recover by integrating
their own experiences with alcohol with those of others in the group and by
learning
and practicing some new ways to behave. Through these new
ways, AA members feel as if they are living
apart from the urban
materialist norm; that the cause of alcoholism is not at issue; that people
should share,
not compete; and that the individual need not rise
above the rest (spiritual anonymity).
Studies have concluded that active AA
membership allows up to 68 percent of alcoholics to drink less or
not at all for up to a year, and 40 to 50 percent to achieve sobriety
for many years. More active or
dedicated members (those who attend
meetings more often) remain sober longer.
Bioelectromagnetic
Applications
Electromagnetic Fields
Bioeletromagnetics (BEM) is an
emerging science that studies how living organisms interact with
electromagnetic (EM) fields. Electrical phenomena are found in all
living organisms, and electrical currents in
the body can produce
magnetic fields that extend outside the body. Those that extend outside the
body can
be influenced by external magnetic and EM fields. Changes
in the body's natural fields may produce
physical and behavioral
changes.
Endogenous (internal) fields are distinguished from exogenous
(external) fields. The latter can be natural,
such as the earth's
geomagnetic field, or artificial, such as power lines, transformers,
appliances, radio
transmitters, or medical devices. Oscillating
nonionizing EM fields in the extremely low frequency (ELF)
range
can have vigorous biological effects that may be beneficial. Changes in the
field configuration and
exposure pattern of low-level EM fields can
produce specific biological responses, and certain frequencies
have
specific effects on body tissues.
Electromagnetic Research &
Studies
The mechanism by which EM fields produce biological effects is under
increasing study. At the cutting edge
of BEM research is the
question of how endogenous EM fields change with consciousness. Nonionizing
BEM medical applications are classified according to whether they are
thermal or nonthermal in biological
tissue. Thermal applications of
nonionizing radiation include radio frequency (RF) hyperthermia, laser and
RF surgery, and RF diathermy.
The most important BEM modalities in
alternative medicine are nonthermal applications of nonionizing
radiation. Major new applications of nonthermal, nonionizing EM fields
are bone repair, nerve stimulation,
wound healing, treatment of
osteoarthritis, electroacupuncture, tissue regeneration, and immune system
stimulation.
In the study of other alternative medical treatments,
BEM offers a unified conceptual framework that may
help explain how
diagnostic and therapeutic techniques such as acupuncture and homeopathy may
produce
results that are hard to understand from a more
conventional viewpoint.
Diet, Nutrition, Lifestyle Changes
Preventing
& Treating Chronic Disease
Throughout evolution, human beings adapted to
a wide range of naturally occurring foods, but the types of
food
and the mix of nutrients (in terms of carbohydrates, fats, and proteins)
remained relatively constant.
Food supplies were often precarious,
and the threat of death from starvation was a constant preoccupation
for
most early humans.
However, about 10,000 years ago the agricultural
revolution began making profound dietary changes in
many human
populations. The ability to produce and store large quantities of dried foods
led to preferential
cultivation of some foods, such as grains, which
constituted new challenges to the human digestive system.
Then,
about 200 years ago, the Industrial Revolution introduced advances in food
production, processing,
storage, and distribution. Recent
technological innovations, along with increased material well-being and
lifestyles that have allowed people more freedom in deciding what and
when they wish to eat, have led to
even further major dietary
changes in developed countries. Because changes in the dietary patterns of the
more technologically developed countries, such as the United
States, have been so dramatic and rapid, the
people consuming these
affluent diets have had little time to adapt biologically to the types and
quantities of
food that are available to them today. The longer
term adverse health effects of the diet prevailing in these
countries - characterized by an excess of energy-dense foods rich in
animal fat, partially hydrogenated
vegetable oils, and refined
carbohydrates but lacking in whole grains, fruits, and vegetables - have become
apparent only in recent decades.
Because of the recent, rapid rise in chronic illness related directly or indirectly to diet, the focus of nutrition
research has shifted away from eliminating nutritional
deficiency to dealing with chronic diseases caused by
nutritional
excess. Another concern among nutrition researchers is the accumulation of
evidence indicating
that a less-than-adequate intake of some
micronutrients, over a long period, may increase the risks of
developing coronary heart disease, cancers, cataracts, and birth
defects. In recent decades, the data on the
relationship between
certain dietary habits and nutritional intake have been growing exponentially.
Designing
interventions based on this wealth of research has become
increasingly more difficult and complex.
Dietary Supplements
The Federal
Government's approach to dietary intervention, formulated by boards composed of
nutrition
scientist, generally does not recommend supplementing the
typical American diet with vitamins or nutrients
beyond the
recommended daily allowances (RDAs), nor does it suggest that some foods never
be eaten. In
contrast, many alternative dietary approaches contend
that no amount of manipulation of the typical
American diet is
enough to promote optimum health or prevent eventual chronic illness. These
alternative
approaches represent a continuum of philosophies ranging
from the concept that supplementing the typical
American diet
somewhat beyond the RDAs is necessary to promote optimum health, to the idea
that
supplementation well beyond the RDAs is often required to
reverse the effects of long-term deficiencies.
Other approaches
advocate drastic dietary modification, either eliminating or adding certain
types of foods
or macronutrients, to treat specific types of
conditions such as cancer and cardiovascular disease. Finally,
there is the view that certain major staples of typical American diet,
such as meat and dairy products, are
basically unhealthy and should
be generally avoided.
There is a growing body of data supporting the notion
that the RDAs for mineral, such as calcium and
magnesium, may be
too low and that supplementation may be necessary to prevent the onset of
chronic
diseases. In addition, the RDAs for a number of vitamins
and micronutrients, such as vitamin C, vitamin D,
vitamin E, folate,
and beta-carotene, may not be adequate to prevent chronic illness. For example,
recent
studies have found that the RDA for folate may need to be
doubled for women as well as men.
Orthomolecular Medicine
Orthomolecular
medicine-the therapeutic use of high-dose vitamins to treat chronic
disease-promotes
improving health and treating disease by using the
optimum concentration of substances normally present in
the body.
Increasing the intake of such nutrients to levels well above those usually
associated with
preventing overt deficiency disease may have health
benefits for some people. There is at least preliminary
evidence
that orthomolecular remedies may be effective in treating AIDS; brochial
asthma; cancer;
cardiovascular disease, heart attacks, and stroke;
lymphedema; and mental and neurological disorders.
Alternative Diets
A
variety of alternative diets are offered for treating cancer, cardiovascular
disease, and food allergies.
Virtually all of these interventions
focus on eating more fresh and freshly prepared vegetables, fruits, whole
grains, and legumes. Allergy to food has become a major area of
research. Food intolerance is being
studied as a causal or
contributing factor in rheumatoid arthritis, and there is evidence that
food-elimination
diets may help many hyperactive children.
Some
alternate dietary lifestyles are believed to offer a greater resistance to
illness. These include several
variations of the vegetarian diet,
such as those consumed by Seventh-Day Adventists and proponents of the
macrobiotic diet. Studies have found a significant lowering of risk
factors for heart disease and certain forms
of cancer in these two
groups. Recent studies have also reported that certain cultural eating styles,
such as
the Asian and Mediterranean diets, appear to lower risk
factors for heart disease and certain forms of
cancer as well.
Although there have been few controlled studies of the benefits of many
traditional diets,
such as those originally consumed by Native
American Indians, diseases such as diabetes and cancer were
not a
problem for these populations until their diets became more Western, or
affluent.
Because dietary and nutritional therapy interventions affect an
array of biochemical and physiological
processes in the body,
evaluating their effectiveness may require equally complex methods.
Furthermore,
developing a comprehensive healthcare policy that
incorporates diet and nutritional interventions may
require taking
into account Federal feeding programs and dissemination strategies that might
present
barriers to the effective propagation of adequate
nutritional knowledge.
Herbal Medicine
Folk Medicine Traditions
All
cultures have long folk medicine traditions that include the use of plants and
plant products. Even in
ancient cultures, people methodically
collected information on herbs and developed well-defined herbal
pharmacopoeias. Indeed, well into the twentieth century, much of the
pharmacopoeia of scientific medicine
was derived from the herbal
lore of native peoples. Many drugs commonly used today are of herbal origin.
Indeed, about one-quarter of the prescription drugs dispensed by
community pharmacies in the United
States contain at least one
active ingredient derived from plant material.
The World Health Organization
(WHO) estimates that 4 billion people, 80 percent of the world population,
presently use herbal medicine for some aspect of primary healthcare.
Herbal medicine is a major
component in all indigenous peoples'
traditional medicine and a common element in Ayurvedic,
homeopathic,
naturopathic, traditional oriental, and Native American Indian
medicine.
Drug Regulation
Although, the discovery of useful therapeutics
from plants has changed the face of medicine and the course
of
civilization, many people, especially some in the Federal Government, evaluate
herbal remedies as though
they were either worthless or dangerous.
Today in the United States, herbal products can be marketed only
as
food supplements. An herb manufacturer or distributor can make no specific
health claims without FDA
approval. A growing number of Americans
are interested in herbal preparations.
Two features of European drug
regulation make that market more hospitable to natural remedies. First, it
costs less and takes less time in Europe to approve medicines as safe
and effective. This is especially true of
substances that have a
long use history and can be approved under the "doctrine of reasonable
certainty."
European guidelines for the assessment of herbal
remedies follow up on WHO's Guidelines for the
Assessment of Herbal
Medicines, which state that a substance's historical use is a valid way to
document
safety and efficacy in the absence of scientific evidence
to the contrary.
France, where traditional medicines can be sold with
labeling based on traditional use, requires licensing by
the French
Licensing Committee and approval by the French Pharmacopoeia Committee. Germany
considers whole herbal products one active ingredient; this makes
it simpler to define and approve the
product. The German Federal
Health Office regulates products such as ginkgo and milk thistle extracts so
that potency and manufacturing processes are standardized. England
generally follows the rule of prior use;
that is, years of use with
apparent positive effects and no evidence of detrimental side effects
constitute
enough evidence - in lieu of other scientific data -
that the product is safe.
In Japan, China, and India, patent herbal remedies
composed of dried and powdered whole herbs or herb
extracts, often
in tablet form, are the rule. Traditional herbals are the backbone of China's
medicine. Japan's
traditional medicine, kampo, is similar to and
historically derived from Chinese medicine but includes
traditional
medicines from Japanese folklore. Herbal medicines are the staple of medical
treatment in many
developing countries and are used for many types
of ailments.
European Phytomedicines
European phytomedicines are among
the world's best studied medicines, researched in leading European
universities and hospitals. Some have been in clinical use, under
medical supervision, for more than ten
years, with tens of millions
of documented cases. This form of botanical medicine most closely resembles
American medicine. In Europe there have been credible research studies
reporting positive effects on a
variety of chronic illnesses for
herbs such as Silybum marianum (milk thistle), Ginkgo biloba (ginkgo)
Vaccinium
myrtillus (bilberry extract), and Ilex guayusa. Many herbs in China have been
studied extensively
by methods that are acceptable from the Western
perspective; among these herbs are ginseng, fresh ginger
rhizome,
Chinese foxglove root, baical skullcap root, wild chrysanthemum flower, and
licorice root. A
number of Ayurvedic herbs also have recently been
studied in India under modern scientific conditions,
including
Eclipta alba, Indian gooseberry, neem, turmeric, and trikatu.
Reports of
positive effects of herbal preparations in developing countries and Native
American Indian herbs
are primarily anecdotal. However, since much
modern-day medicine is directly or indirectly derived from
such
folklore sources, it seems illogical to conclude that there are no more
significant treatments or cures for
major diseases to be found, in
the world, from plant sources.
Manual Healing
Overview
Touch and
manipulation, with the hands, have been in use in health and medical practice
since the beginning
of medical care. Physicians' hands were once
their most important diagnostic and therapeutic tool. Today,
however, many medical and health practitioners tend to retreat from
physical contact with the patient,
distanced by diagnostic
equipment and legal and time constraints.
Manual healing methods are based
on the understanding that dysfunction of a part of the body often affects
secondarily the function of other discreet, not necessarily directly
connected, body parts. Consequently,
theories and processes have
been developed for correcting secondary dysfunctions by manipulating soft
tissues or realigning body parts. Overcoming misalignments and
manipulating soft tissues bring the parts
back to optimal function,
and the body returns to health.
Osteopathic Medicine
One of the earliest
U.S. healthcare systems to use manual healing methods was osteopathic medicine.
In
1993 more than 32,000 American-educated and -licensed D.O.s were
practicing in the United States.
More than 60 percent of
osteopathic physicians are involved in primary care - family medicine,
pediatrics,
internal medicine, and obstetrics-gynecology. An
extensive body of work supports the use of osteopathic
techniques
for musculoskeletal and nonmusculoskeletal problems. Nearly all osteopathically
oriented
research has been funded from the private
sector.
Chiropractic Science
Chiropractic science is concerned with
investigating the relationship between structure (primarily of the
spine) and function (primarily of the nervous system) of the human body
to restore and preserve health.
Chiropractic medicine applies such
knowledge to diagnosing and treating structural dysfunctions that can
affect
the nervous system. Chiropractic physicians use manual procedures and
interventions, not surgical or
chemotherapeutic ones. In 1993, more
than 45,000 licensed chiropractors were practicing in the United
States.
Chiropractic specialty areas are extremely pertinent to other
medical specialties, such as radiology,
orthopedics, neurology, and
sports medicine. Current chiropractic research interests include back and other
pain, somatovisceral disorders, and reliability studies.
Massage
Therapy
Massage therapy, one of the oldest methods in healthcare practice,
is the scientific manipulation of the soft
body tissues to return
those tissues to their normal state. Massage consists of a group of manual
techniques
that include applying fixed or movable pressure and
holding and causing the body to move. Primarily the
hands are used,
but sometimes forearms, elbows, and feet are used also. These techniques can
affect the
musculoskeletal, circulatory-lymphatic, and nervous
systems. Massage therapy encompasses the concept of
vis medicatrix
naturae - helping the body heal itself - and is aimed at achieving or
increasing health and well-
being. Touch is the fundamental medium of
massage therapy.
Massage therapists are licensed by 25 States, the District
of Columbia, and several localities. Most States
require 500 or
more hours of education from a recognized school program and a licensing
examination.
Massage therapy techniques include Swedish massage,
deep-tissue massage, sports massage,
neuromuscular massage, and
manual lymph drainage. Other physical healing methods include reflexology,
zone therapy, tuina, acupressure, Rolfing, Trager, Feldenkrais method
and Alexander technique.
Biofield Therapeutics
Biofield therapeutics -
laying on of hands - is also a very old form of healing. The earliest Eastern
references
are in the Huang Ti Nei Ching Su Wen (The Yellow
Emperor's Classic of Internal Medicine), dated
between 2,500 and
5,000 years ago. The underlying rationales cluster around two views: first,
that the
healing force comes from a source other than the
practitioner - God, the cosmos, or another supernatural
entity -
and second, that a human biofield directed, modified, or amplified in some way
by the practitioner is
the operative mechanism.
During biofield
treatment, the practitioner places hands directly on or near the patient's body
to improve
general health or treat a specific dysfunction.
Treatment sessions may take from 20 minutes to an hour or
more; a
series of sessions is often needed to treat some disorders. There is consensus
among practitioners
that the biofield permeates the physical body
and extends outward for several inches. Extension of the
external
biofield depends on the person's emotional state and health. Biofield
practitioners have a holistic
focus. About 50,000 practitioners
provide 18 million sessions annually in the United States.
At least three
forms of biofield therapeutics are used in medical care inpatient and
outpatient settings: healing
touch, therapeutic touch, and SHEN
therapy. No generally accepted theory accounts for the effect of these
therapies.
Mind-Body Control
Overview
Most traditional medical
systems make use of the interconnectedness of mind and body and the power of
each to affect the other. During the past 30 years there has been a
growing scientific movement to explore
the mind's capacity to
affect the body. The clinical aspect of this enterprise is called mind-body
medicine.
Mind and body are so integrally related that it makes
little sense to refer to therapies as having impact just
on the
mind or the body.
Mind-body interventions often help patients experience and
express their illness in new, clearer ways.
Distinctions between
curing and healing have little place in contemporary medical practice but are
important
to patients. Perceived meaning has direct consequences to
health. The placebo response is one of the most
widely known
examples of mind-body interactions in contemporary, scientific medicine, yet it
is also one of
the most undervalued, neglected assets in medical
practice. That the placebo response relies heavily on the
relationship between doctor and patient says a great deal about the
importance of the doctor-patient
relationship and the need to
provide further medical training on understanding and using this relationship.
The therapeutic potential of spirituality, as well as religion, also
has been neglected in the teaching and
practice of
medicine.
Interest in the mind's role in the cause and course of cancer has
been substantially stimulated by the
discovery of the complex
interactions between the mind and the neurological and immune systems, the
subject of the rapidly expanding discipline of psychoneuroimmunology.
The profound differences in the
psychological stances taken by
people who survive cancer suggest that there is extreme variation both
among cultures and within cultures.
Specific mind-body interventions
include psychotherapy, support groups, meditation, imagery, hypnosis,
biofeedback,
yoga, dance therapy, music therapy, art therapy, and prayer and mental
healing.
Psychotherapy
Psychotherapy directly addresses a person's
emotional and mental health, which is, in turn, closely
interwoven
with his or her physical health. It encompasses a wide range of specific
treatments from
combining medication with discussion, to simply
listening to the concerns of a patient, to using more active
behavioral and emotive approaches. It also should be understood more
generally as the matrix of interaction
in which all the helping
professions operate. Conventional psychotherapy is conducted primarily by means
of psychologic methods such as suggestion, persuasion,
psychoanalysis, and reeducation. It can be divided
into general
categories. All of the therapies can be undertaken either individually or in
groups.
Research indicates that psychotherapeutic treatment can hasten a
recovery from a medical crisis and is in
some cases the best
treatment for it. Psychotherapy also appears to be valuable in the treatment of
somatic
illnesses in which physical symptoms appear to have no
medical cause. These symptoms are often improved
markedly with
psychotherapy. In addition, psychotherapy has been shown to speed patients'
recovery time
from illness. This, in turn, leads to smaller medical
bills and fewer return visits to medical practitioners.
Support
Groups
Support groups, as the research literature demonstrates, can have a
powerful positive effect in a wide
variety of physical illnesses,
from heart disease to cancer, from asthma to strokes. Indeed, one study found
that women with breast cancer who took part in a support group lived
an average of 18 months longer (a
doubling of the survival time
following diagnosis) than those who did not participate. In addition, all the
long-
term survivors belonged to the therapy group.
Support groups
have two other major benefits:
they help members form bonds with each other,
an experience that may empower the rest of their lives; and
they are
low cost or even "no cost" (for example, Alcoholics
Anonymous).
Meditation
Mediation is a self-directed practice for
relaxing the body and calming the mind. Most meditative techniques
have come to the West from Eastern religious practices, particularly
India, China, and Japan, but can be
found in all cultures of the
world. Until recently, the primary purpose of meditation has been religious,
although its health benefits have long been recognized. During the
past 15 years, it has been explored as a
way of reducing stress on
both mind and body. It is often recommend it as a way of reducing high blood
pressure.
Some studies have found that regular meditation can
reduce healthcare use; increases longevity and quality
of life;
reduces chronic pain; reduces anxiety; reduces high blood pressure; reduces
serum cholesterol level;
reduces substance abuse; increases
intelligence-related measures; reduces post-traumatic stress syndrome
in
Vietnam veterans; reduces blood pressure; and lowers blood cortisol levels
initially brought on by stress.
Imagery
Imagery is both a mental process
(as in imagining) and a wide variety of procedures used in therapy to
encourage
changes in attitudes, behavior, or physiological reactions. As a mental
process, it is often defined
as "any thought representing a sensory
quality." It includes, as well as the visual, all the senses - aural,
tactile,
olfactory, proprioceptive, and kinesthetic.
Imagery has been successfully
tested as a strategy for alleviating nausea and vomiting associated with
chemotherapy in cancer patients, to relieve stress, and to facilitate
weight gain in cancer patients. It has been
successfully used and
tested for pain control in a variety of settings; as adjunctive therapy for
several
diseases, including diabetes; and with geriatric patients
to enhance immunity.
Imagery is usually combined with other behavioral
approaches. It is best known in the treatment of cancer
as a means
to help patients mobilize their immune systems, but it also is used as part of
a multidisciplinary
approach to cardiac rehabilitation and in many
settings that specialize in treating chronic pain.
Hypnosis
Hypnosis and
hypnotic suggestion have been a part of healing from ancient times. The
induction of trance
states and the use of therapeutic suggestion
were a central feature of the early Greek healing temples, and
variations of these techniques were practiced throughout the ancient
world.
Modern hypnosis began in the eighteenth century with Franz Anton
Mesmer, who used what he called
"magnetic healing" to treat a
variety of psychological and psychophysiological disorders, such as hysterical
blindness, paralysis, headaches, and joint pains. Since then, the
fortunes of hypnosis have ebbed and
flowed. Freud, at first, found
it extremely effective in treating hysteria and then, troubled by the sudden
emergence of powerful emotions in his patients and his own
difficulty with its use, abandoned it.
In the past 50 years, however,
hypnosis has experienced a resurgence, first with physicians and dentists and
more recently with psychologists and other mental health
professionals. Today, it is widely used for
addictions, such as
smoking and drug use, for pain controls, and for phobias, such as the fear of
flying.
One of the most dramatic uses of hypnosis is the treatment of
congenital ichthyosis (fish skin disease), a
genetic skin disorder
that covers the surface of the skin with grotesque hard, wartlike, layered
crust.
Hypnosis is, however, most frequently used in more common
ailments, either independently or in concert
with other treatment,
including the management of pain in a variety of settings, reduction of
bleeding in
hemophiliacs, stabilization of blood sugar in
diabetics, reduction in severity of attacks of hay fever and
asthma, increased breast size, the cure of warts, the production of
skin blisters and bruises, and control of
reaction to allergies
such as poison ivy and certain foods.
Biofeedback
Biofeedback is a
treatment method that uses monitoring instruments to feed back to patients
physiological
information of which they are normally unaware. By
watching the monitoring device, patients can learn, by
trial and
error, to adjust their thinking and other mental processes in order to control
bodily processes
heretofore thought to be involuntary--such as blood
pressure, temperature, gastrointestinal functioning, and
brain wave
activity.
Biofeedback is used to treat a very wide variety of conditions and
diseases, ranging from stress, alcohol and
other addictions, sleep
disorders, epilepsy, respiratory problems, and fecal and urinary incontinence
to
muscle spasms, partial paralysis, or muscle dysfunction caused
by injury, migraine headaches, hypertension,
and a variety of
vascular disorders. More applications are being developed
yearly.
Yoga
Yoga is a way of life that includes ethical precepts,
dietary prescriptions, and physical exercise. Its
practitioners have
long known that their discipline has the capacity to alter mental and bodily
responses
normally thought to be far beyond a person's ability to
modulate them. During the past 80 years, health
professionals in
India and the West have begun to investigate the therapeutic potential of yoga.
To date,
thousands of research studies have been undertaken and
have shown that with the practice of yoga a
person can, indeed,
learn to control such physiologic parameters as blood pressure, heart rate,
respiratory
function, metabolic rate, skin resistance, brain waves,
body temperature, and many other bodily functions.
Regular yogic meditation
also has been shown to reduce anxiety levels; cause the heart to work more
efficiently and decrease respiratory rate; lower blood pressure and
alter brain waves; increase
communication between the right and left
brain; reduce cholesterol levels (when used with diet and
exercise); help people stop smoking; and successfully treat
arthritis.
Dance Therapy
Dance therapy began formally in the United
States in 1942, and in 1956 dance therapists from across the
country
founded the American Dance Therapy Association, which has now grown to over
1,100 members.
It publishes a journal, the American Journal of
Dance Therapy, fosters research, monitors standards for
professional practice, and develops guidelines for graduate
education.
Dance/movement therapy has been demonstrated to be clinically
effective in the following: developing body
image, improving
self-concept and increasing self-esteem; facilitating attention; ameliorating
depression,
decreasing fears and anxieties, expressing anger;
decreasing isolation, increasing communication skills and
fostering
solidarity; decreasing bodily tension, reducing chronic pain, and enhancing
circulatory and
respiratory functions; reducing suicidal ideas,
increasing feelings of well-being, and promoting healing; and
increasing verbalization.
Music Therapy
Music therapy is used in
psychiatric hospitals, rehabilitation facilities, general hospitals, outpatient
clinics,
day-care treatment centers, residences for people with
developmental disabilities, community mental health
centers, drug
and alcohol programs, senior centers, nursing homes, hospice programs,
correctional facilities,
halfway houses, schools, and private
practice.
Studies have found music therapy effective as an analgesic, as a
relaxant and anxiety reducer for infants and
children, and as an
adjunctive treatment with burn patients, cancer patients, cerebral palsy
patients, and
stroke, brain injury, or Parkinson's disease
patients.
Art Therapy
Art therapy is a means for the patient to reconcile
emotional conflicts, foster self-awareness, and express
unspoken
and frequently unconscious concerns about his/her disease. In addition to its
use in treatment, it
can be used to assess individuals, couples,
families, and groups. It is particularly valuable with children who
often cannot talk about their real concerns.
Research on art therapy
has been conducted in clinical, educational, physiological, forensic, and
sociological
arenas. Studies on art therapy have been conducted in
many areas including with burn recovery in
adolescent and young
patients, with eating disorders; with emotional impairment in young children,
with
reading performance, with chemical addiction, and with sexual
abuse in adolescents.
Prayer and Mental Healing
Prayer and mental healing
techniques fall into two main types. In Type I healing, the healer enters a
prayerful, altered state of consciousness in which he views himself and
the patient as a single entity. There
need be no physical contact
and there is no attempt to "do anything" or "give something" to the person in
need, only the desire to unite and "become one" with him or her and
with the Universe, God, or Cosmos.
Type II healers, on the other
hand, do touch the healee and describe some "flow of energy" through their
hands to the patient's areas of pathology. Feelings of heat are common
in both healer and healee. These
healing techniques are offered
only as generalities. Some healers use both methodologies, even in the same
healing session, and other healing methods could be described.
Many
published reports exist, of experiments, in which persons apparently were able
to influence a variety
of cellular and other biological systems
through mental means. The target systems for these investigations
have included bacteria, yeast, fungi, mobile algae, plants, protozoa,
larvae, insects, chicks, mice, rats,
gerbils, cats, and dogs, as
well as cellular preparations (blood cells, neurons, cancer cells) and enzyme
activities. In human "target persons," eye movements, muscular
movements, electrodermal activity,
plethysmographic activity,
respiration, and brain rhythms have been apparently affected through direct
mental influence.
These studies assess the ability of humans to
affect physiological functions of a variety of living systems at a
distance, including studies where the "receiver" or "target" is unaware
that such an effort is being made. The
fact that these studies
commonly involve nonhuman targets is important; lower organisms are presumably
not subject to suggestion and placebo effects, a frequent criticism
when human subjects are involved.
Many of these studies do not describe the
psychological strategy of the influencer as actual "prayer," in
which one directs entreaties to a Supreme Being, a Universal Power, or
God. But almost all of them involve
a state of prayerfulness - a
feeling of genuine caring, compassion, love, or empathy with the target system,
or a feeling that the influencer is "one" with the
target.
Conclusion
In addition to preventing or curing illnesses, these
therapies by and large provide people the chance to be
involved in
their own care, to make vital decisions about their own health, to be touched
emotionally, and to
be changed psychologically in the process. Many
patients today believe their The mind-body approach is
potentially
a corrective to this tendency, a reminder of the importance of human connection
that opens up
the power of patients acting on their own
behalf.
More work needs to be done, but there is already a growing amount of
evidence that many of the mind-
body therapies discussed in this
report, if appropriately selected and wisely applied, can be clinically as well
as economically cost-effective, that they work, and that they are
safe.
Pharmacological and Biological Treatments
Pharmacological and
biological treatments are an assortment of drugs and vaccines not yet accepted
by
mainstream medicine. A sampling of biological and
pharmacological treatments currently being offered by
alternative
and medical practitioners includes the following:
Antineoplastons
Peptide
fractions originally derived from normal human blood and urine, presently being
used to treat certain
kinds of tumors as well as AIDS.
Cartilage
Products
Derived from cattle, sheep, sharks, and chickens, which are being
used to treat cancer and arthritis.
Ethylene Diamine Tetraacetic Acid (EDTA)
Chelation Therapy
Used to treat heart disease, circulatory problems, and
rheumatoid arthritis and to prevent cancer.
Immunoaugmentive Therapy
An
experimental form of cancer immunotherapy consisting of daily injections of
processed blood products.
714-X
A nitrogen-providing compound injected
into the lymph system near the abdomen to treat cancer and AIDS.
Coley's
Toxins
A mixture of killed cultures of bacteria from Streptococcus pyogenes
and Serratia marcescens, used for
treating cancer.
MTH-68
A
vaccine that uses an attenuated strain of the Newcastle disease virus of
chickens (paramyxovirus), which
may interfere with cancer-related
viruses.
Neural Therapy
A therapy that involves injecting local
anesthetics into nerve cell bodies, peripheral nerves, scars, and
elsewhere to treat chronic pain.
Apitherapy
The medicinal use of
various products of the common honeybee to treat a variety of diseases:
rheumatic
diseases such as arthritis; neurological diseases such as
multiple sclerosis, low back pain, and migraine;
dermatological
conditions (for example, eczema, psoriasis, herpesvirus infections); chronic
pain; and cancer.
Iscador
A liquid extract from mistletoe plants used to
treat tumors.
Biologically Guided Chemotherapy
A major impediment to full
investigation of alternative pharmacological and biological treatments is the
high
expense of conducting the trials. Most alternative treatments
lack sponsors and funding for clinical trials of
safety and
effectiveness. Many potentially useful alternative drugs or vaccines are
supported by data
indicating they may be useful in treating cancer,
AIDS, heart disease, hepatitis, and other major health
problems.
Source: National Center for Complementary &
Alternative Medicine
For More Information
Visit the National Center for
Complementary & Alternative Medicine
Visit the U.S. Food and Drug
Administration
------------------------------------------
COMPLIMENTARY
HOLISTIC REMEDIES FOR LYMPHEDEMA TREATMENT
by Diana Brady, Holistic
Nutritionist
Ultimate Health Center, Asheville, N.C.
1/06
Please note that the following article discusses holistic
nutritional supplementation that may be useful in
supporting a
patient's daily regime of self-care. This is not an endorsement by the NLN, nor
do we promise
results from the use of any of these items listed
below. We are committed to presenting all avenues of
possibility
for improvement of the condition and quality of life for all lymphedema
patients. Any and all
claims or opinions expressed in this article
are solely of the author. Ed.
--------------------------------------------------------------------------------
There
are many holistic remedies that can support and enhance CDP and manual lymph
drainage therapy.
Some of these therapies have been around for a
dozen or so years, with much clinical research to back
them. Others
are just now being reviewed in scientific journals, while still others are
being used in clinical
practice based upon empirical results alone.
All of the remedies are non-prescription and consist of
enzymes,
vitamins, herbs and homeopathic compounds. They are best used in conjunction
with the patient's
treatment regime and will vary from person to
person. I will briefly describe a few of the more popular
remedies and reference the clinical research. Suppliers and their phone
numbers will be provided at the end
of the article.
INFLAMZYME FORTE
From American Biologics, Chula Vista, CA
This product is a specific combination of digestive enzymes, antioxidants
and co-factors designed to reduce
the accumulation of protein and
fats in the lymphatic system and connective tissue. It has similar effect to
benzopyrenes without the side effects.
It contains:
pancreatin, bromelain, papain, trypsin, chymotrypsin, lipase, amalyse, rutin,
zinc, superoxide
dismutase, catalase and l-cysteine. It must be
taken on an empty stomach, with the dosage of three to six
tablets
three times a day. It is recommended for use before, during and after
treatments; until the limb or
affected area is close to normal
size. At that point, the inflammation and proteins, fats, etc., causing it will
be
under control.
Inflamzyme Forte was created by and for the
American Biologics Medical Center in Tiajuana, Mexico. It
has been
used there very successfully for the past ten to twelve years. Clinical
research has been performed
by the Bradford Research Institute,
Chula Vista, CA.
LYMPHOTEND
From American Biologics, Chula Vista,
CA
This is a homeopathic remedy designed to relieve lymphatic congestion.
It works well in combination with
inflamzyne forte. Lympotend is a
specific combination of classic homeopathic remedies manufactured
according to the process defined by Dr. Samuel Hahnemann. Although each
of the component ingredients
has been used since the 19th century,
this particular combination is fairly new. Lymphotend has been used
in clinical practice worldwide for the past year and a half with
excellent results. This product should also be
used before, during,
and after treatments until the inflammation is reduced. The Bradford Research
Institute,
Chula Vista, CA is currently accumulating research data.
HORSECHESTNUT HERB
In a recent study of chronic diseases of the
veins, the herb, horsechestnut, was found to be very effective.
Horsechestnut was compared to that of compression stockings in 240
patients with chronic venous
insufficiency. Patients were randomly
assigned to receive either compression treatment, horse chestnut
(providing 50 mg of active component escini twice daily), or a placebo
for twelve weeks. Horsechestnut
was found to be as effective as
compression treatment, as determined by the reduction in swelling in the
legs. Both treatments were significantly more effective than the
placebo.
Research was conducted by C. Diehm, and reported in the Lancet,
1996; 347:292-294. This remedy is
currently being used in clinical
practice. More information will be provided at a later time.
DANDELION
LEAF EXTRACT
From Herbalist & Alchemist, Inc.
Herbalist all over
the world have considered dandelion a valuable herb for centuries. It has a
long folk use
throughout the world for a variety of ailments.
Dandelion root (Taraxacum officinale) is regarded as one of
the
finest liver remedies, both as food and as a medicine. The dandelion contains
much more nutritional
value than many other vegetables, being
particularly high in vitamins, minerals, protein, choline, inulin and
pectins.
Dandelion leaf has been used historically as a natural diuretic aiding in
excess fluid loss. Due to its
high content of potassium and other
electrolytes, there is little, if any side effects to the use of this natural
diuretic.
Recommended dosage is 30-60 drops, two or three
times per day either before or after meals. This can be
used
indefinitely, but should be used for several months, stopped for a week or so
and then started again. It
is more effective this way, as the body
does get used to the herb and it loses its potency.
BURDOCK/RED ROOT
COMPOUND
From Herbalist & Alchemist, Inc.
This is a special
formula designed to thin the lymphatic fluid, allowing it to flow more easily,
as well as
cleansing the lymphatic system itself. It is useful for
many conditions of stagnation in the body including
congested
lymphatics, swollen lymph nodes and low resistance to infections. It contains
burdock root
(Arcticum lappa), red root (Ceanothus spp.), figwort
herb (Scrophularia nodosa), violet herb (Viola
odorata), red clover
blossoms (Trifolium pratense) and echinacea root (Echinacea angustifolia).
Recommended dosage 10-30 drops daily for up to a year or two depending
upon the severity of the
condition. Breaks should be taken from
this compound periodically to ensure effectiveness
VITAMINS, MINERALS,
ANTI-OXIDANTS
It is important to ensure the use of a good multiple vitamin
along with potent anti-oxidants like pycnogenol
for an indefinite
period of time. There are many good products on the market. Some of the
manufacturers
that we prefer are: Phyto Pharmacia, Enzymatic
Therapies, AMNI, Solgar, Twin Labs, etc.
SUPPLIERS
American
Biologics, Chula Vista, CA
Consumers..............................800-227-4473
Health Care
Professionals...800-332-9345
Phyto Pharmacia, Green Bay, WI
800-553-2370
Herbalist and Alchemist, Inc. N.J.
800-611-8235
AMNI, CA 800-356-4791
Ultimate Health Center, N.C.
800-268-6905
PATIENTS with light to moderate lymphedema may use this
supplement program starting several weeks
before treatment and then
continue it through treatment, says lymphedema expert, Peter Glasser,
L.M.T.
Before Treatment:
Flor Essence tea (2 oz twice daily, 30
minutes before meals); for gentle detoxification when there is a
history of infections.
Harmony Multi Herbal Cleanse (1-6 capsules
twice daily, 60 minutes before rneals; increase water intake
to 4 -
12 glasses daily); for colon and body cleansing when there is no history of
infections. Add two
teaspoons of colloidal silver twice daily to
prevent an infection. *
Colon Formula (1-6 capsules twice daily, 30 minutes
before meals): use if you're not having one bowel
motion daily;
when once-daily regularity begins, then switch to Harmony Multi Herbal
Cleanse.
Basic Preventive (two capsules three times daily, at meals); a
well-rounded multivitamin with minerals.
PCO Phytosome (one capsule twice
daily, at meals); grape seed extract as an antioxidant.
Dandelion leaf/root
extract (30 drops three times daily, at meals); increases urination (works as a
diuretic).
Garlic extract, colloidal silver, echinacea (per directions);
natural antibiotics in cases of infection.
At Start of
Treatment:
Infla-Zyme Forte (3-5 capsules three times daily, 30 minutes
before meals on empty stomach): enzymes to
break up fat and protein
deposits in the lymph and tissues.
Lymphotend (ten drops three times daily,
on tongue, taken just before Infla-Zyrne Forte); homeopathic
remedy
to cleanse the lymph.
Burdock/red root herbal extract (10-40 drops three
times daily; start at ten drops, then increase); to
cleanse the
blood and lymph.
Garlicin Pro (one capsule twice daily); an internal
disinfectant.
Lymphatic System Cleanse (10-30 drops three times daily, at
meals; take for six days, omit seventh day,
then resume); contains
cleansing herbs.
Horse chestnut seed capsules (one capsule twice daily with
meals); to reduce swelling and strengthen lymph
vessel walls.
Vitamin C with bioflavonoids (1,350 mg, at meals); strengthens vascular
system.
Rutin (500 mg twice daily); to be taken with horse chestnut seed; a
bioflavonoid or vitamin C helper, helps
reduce swelling and
strengthens lymph vessel walls.
Optional: Flaxseed oil (1,000 mg daily, with
a meal); reduces inflammation.
Optional: Echinacea,/red root herbal extract
(30-40 drops three times daily); cleanses blood and lymph.
Optional:
CurcuMax (three capsules three times daily, 30 minutes before meals); contains
enzymes, herbs,
vitamins, and minerals to reduce
inflammation.
Optional: GingerMax (two capsules twice daily, before meals);
improves blood circulation.
* Using Harmony cleanse can sometimes trigger an
infection in lymphedema patients by moving toxins faster
than the
sluggish lymphatic system can eliminate them, says Glasser. For that reason, he
always includes a
course of colloidal silver to be used with
it.
------------------------------------------------
http://www.cancer.org/docroot/NWS/content/NWS_3_1x_Coumarin_and_Lymphedema.asp
Coumarin and
Lymphedema
Study Determines Coumarin Does Not Reduce
Lymphedema
Article date: 1999/03/04
The drug coumarin is not
effective therapy for women who develop arm lymphedema after being treated for
breast cancer, according to a study reported in the February 4,
1999, issue of The New England Journal of
Medicine. Lymphedema can
be a serious consequence of therapy for breast cancer, and coumarin has been
reported to be effective in treating lymphedema.
In this latest
study, researchers studied 140 women with chronic lymphedema in order to
confirm results of
a previous study, which showed that coumarin
reduced lymphedema.
"In our study we found coumarin did not alleviate
lymphedema, and coumarin-related hepatoxic effects
[liver toxicity]
were more common than has been previously reported," the authors wrote, adding
they
cannot explain the differences in the results of the two
studies.
All of the women studied had lymphedema after treatment for
breast cancer and characteristics of the
women in both studies were
similar. Standards for the study were arm and hand measurements and women’
s perceptions about their symptoms.
Although coumarin is marketed
in several foreign countries, the Food and Drug Administration (FDA) has
not approved its medical use in the US, said Charles L. Loprinzi, MD, of
the Mayo Clinic and one of the
researchers in the study, though he
said women have been able to get the drug through pharmacies
formulating it locally as well as from other countries. Dr. Loprinzi
also noted during his study coumarin was
removed from the market in
at least two countries because of death from liver toxicity.
The new
study should reassure women who are frustrated because coumarin is not
available here that they
aren’t missing out on an important therapy,
said Debbie Saslow, PhD, director of breast and cervical
cancer for
the American Cancer Society.
In the study, women in both groups gave
similar responses when asked about their symptoms of arm
swelling,
pressure, tightness, heaviness, loss of mobility, and the frequency of
infections.
Women who have lymphedema should see a doctor who recognizes
the condition and who is educated
about it, Dr. Saslow said. Other
recommendations from Dr. Saslow: For mild lymphedema, visit a trained
physical
or occupational therapist. For the early stages, compression sleeves are
suggested, but
compression pumps are controversial. For more severe
lymphedema there are trained people in this country
who can provide
more elaborate treatment.
Recommendations
The most important
thing for women who are at risk – women who have had radiation therapy or had
any
of their lymph nodes removed – is to be aware there is a risk
for lymphedema and to follow some of the
recommendations below, Dr.
Saslow said.
The recommended preventative measures are suggestions from
women who have had lymphedema.
Avoid infection by keeping the arm
clean, avoiding cuticle cuts and using gloves for washing dishes and
gardening.
Avoid
extreme temperatures from activities such as taking a sauna or putting hands in
ice.
Avoid carrying anything heavy such as a heavy purse with a shoulder
strap.
Never have blood pressure taken or have blood drawn from the arm at
risk.
Avoid anything constrictive such as a tight wristband or tight jewelry
on the arm at risk.
Avoid heavy lifting including heavy repetitive weight
lifting.
Dr. Saslow said some women associate the onset of lymphedema with
the change in pressure linked with
air travel, and women should
wear a compression sleeve when traveling by air. Another suggestion is to
examine the arm frequently for any redness, swelling, warmth,
heaviness, or bloatedness. The key, Dr.
Saslow said, is to catch
lymphedema early
Coumarin is a dietary supplement that has been studied as a
treatment for
lymphedema. In the United States, dietary supplements are
regulated as foods
not drugs. Supplements are not required to be approved
by the Food and Drug
Administration (FDA) before being put on the market.
Because there are no
standards for manufacturing consistency, dose, or
purity, there may be
considerable difference from one lot of dietary
supplements to the next.
Coumarin was once used in some foods and
medications in the United States. It
was found to cause liver damage, and
its use in foods and medications in the
United States has been banned since
the 1950s. Coumarin is available in
several countries, but has not been
approved for use in the United States or
Canada.
http://www.cancer.org/docroot/NWS/content/NWS_3_1x_Coumarin_and_Lymphedema.asp
-----------------------------------------------------------
Horsechestnut
Herb in the Treatment of Lymphedema
by Diana Brady, Holistic
Nutritionist
Please note that the following article discusses holistic
nutritional supplementation that may be useful in
supporting a
patient's daily regime of self-care. This is not an endorsement by the NLN, nor
do we promise
results from the use of any of these items listed
below. We are committed to presenting all avenues of
possibility
for improvement of the condition and quality of life for all lymphedema
patients. Any and all
claims or opinions expressed in this article
are solely of the author. Ed
--------------------------------------------------------------------------------
The
swelling and edema characteristic of lymphedema is the result of damaged lymph
nodes/vessels, often
combined with radiation in the case of
secondary lymphedema (secondary), or as a result of inborn missing
lymphatics or partially functioning lymphatics (primary) which leads
into protein accumulation in the
interstitial tissue, causing
swelling. This manifests itself in various parts of the body, most commonly the
arms
and legs.
Bandaging and compression garments are used
successfully to reduce and control edema through pressure.
Plant
compounds that improve tissue integrity are also used to treat edema, but work
in a different manner.
One particular herb, horsechestnut seed,
contains a plant compound (escin) that strengthens the tissues of
the lymph vessels, capillaries and veins. When these tissues are
strengthened, there is less leakage of fluid
into the surrounding
tissue. Edema is therefore reduced at its source.
A recent study at the
Department of Internal Medicine in Germany proved the efficacy of this herb in
clinical
testing. Results were published in the February 1996 issue
of the Lancet, by D. Diehm (vol. 347, pp.292-
4). The effectiveness
of horsechestnut seed extract was compared to that of compression stockings in
240
patients with chronic venous insufficiency. Patients were
randomly assigned to receive compression
treatment, horsechestnut
extract (containing 50 mg. of escin twice daily) or placebo for twelve weeks.
Horsechestnut seed was found to be as effective as compression
treatment, determined by the reduction in
swelling in the legs of
the patients. Both treatments were significantly more effective than the
placebo.
Based upon this study, Peter Glasser, LMT, MLDT, ICMT, began
incorporating horsechestnut into his
treatment program with
encouraging results. His patients were at different stages of treatment when
the
horsechestnut was introduced, and results have varied from
patient to patient. Here are a few of the results
reported by just
a few of his patients:
The first patient to include horsechestnut in her
regime was a 69 year old woman with secondary
lymphedema of the
left arm. She had 11 CDP/Manual Lymphatic Drainage treatments nine months ago,
along with Mr. Glasser's complete program of herbs, vitamins and
enzymes. She also had one maintenance
treatment every two weeks for
five months before starting the horsechestnut herb. In addition, she was
bandaging nightly or using CircAid garment, and wearing a Juzo
compression sleeve with custom hand
piece.
By this time her
affected arm was measuring the same and even less in some areas than her
affected arm.
After a few days of taking 10 drops of horsechestnut
once a day, she stopped bandaging, using CircAid
and the
compression garment. When she came in for her next bi-monthly treatment, there
was very little
increase in swelling from her last visit (0.1 cm to
0.4 cm).
The patient continued this routine for over three months, but
the dosage was increased to 10 drops twice a
day. Each time she
came in for a treatment, her arm measurements were the same or slightly higher
with the
increase ranging from 0.1 cm to 0.4 cm. There was only one
time when she overexerted herself and her
measurements increased
between 0.1 cm to 1.3 cm. Her dosage was increased to 30 drops two times daily
to try and compensate for her active lifestyle. This appears to be
the appropriate dosage for her. When she
overexerts herself now,
she simply relaxes for a while and allows the swelling to reduce itself without
compression garments. The only time she uses the compression
garment and CircAid is when she flies. She
is extremely happy with
these results.
A patient with secondary lymphedema of both legs and into
the abdominal area began treatment seven
months ago. At this time
she came in only for maintenance treatments but was enthusiastic about trying a
holistic protocol. Along with this, she was treated in the clinic
once or twice a month for two months, and
then once a month. At
that time she was put on 10 drops of horsechestnut twice a day. It took two
weeks
for any noticeable improvement in the edema, but after two
weeks, the edema began to decrease and she
was able to stop wearing
her compression garments. However, when the weather became warm, the
edema
increased. Her dosage was increased to 30 drops twice a day and that controlled
the swelling. She
reported feeling much better on the increased
dosage and is very happy with the results.
Three months ago, a gentleman
with primary lymphedema of the left leg started on five drops of
horsechestnut twice a day. At the time he was wearing a full thigh
stocking with a knee-high stocking over
this for better compression.
His work requires him to be on his feet all day. With the addition of the
horsechestnut, his leg does not get as hard at the end of the day as it
did before the herb was added. He
reports that the tissue is soft
and supple, even after a long day on his feet. His dosage has been increased to
10 drops twice a day in an attempt to achieve the same results
without having to wear the extra knee high
stocking.
Other
patients who have tried the horsechestnut herb have all reported that they feel
better, that their edema
is reduced and is maintaining. It does
take some time to ascertain the correct amount of horsechestnut herb
for
each individual. However, it is well worth the effort, according to patient
reports thus far, as well as
physical measurements. Mr. Glasser is
currently experimenting with a topical ointment containing aloe vera
gel
and horsechestnut herb.
The type of horsechestnut used by Mr. Glasser is
manufactured by GAIA herbs. It is important to get the
highest
quality product on the market. GAIA can be purchased at many health food stores
or can be
ordered directly from the manufacturer at:
1-800-831-7780. Emerson Ecologics also distributes the herb.
They
can be reached at: 1-800-654-4432.
http://www.uhealth.net/article6.htm
Life Extension
Magazine March 2005
PROFILE features people who exemplify the Life
Extension Foundation way of life: a commitment to
enhanced health
and nutrition, as well as an abiding respect for body and mind.
Individualized care best for lymphedema patients
Posted On: August 10, 2012 - 3:30pm
COLUMBIA, Mo. – Millions of American cancer survivors
experience chronic discomfort as a result of lymphedema, a common side effect of
surgery and radiation therapy in which affected areas swell due to protein-rich
fluid buildup. After reviewing published literature on lymphedema treatments, a
University of Missouri researcher says emphasizing patients' quality of life
rather than focusing solely on reducing swelling is critical to effectively
managing the condition.
Jane Armer, professor in the MU Sinclair School of Nursing
and director of nursing research at Ellis Fischel Cancer Center, said many
insurance providers and health care professionals assess whether lymphedema
patients need treatment based solely on how swollen their limbs are. However,
several studies have shown that the volume of fluid doesn't necessarily
correspond with patients' discomfort.
"Practitioners need to treat the swelling while considering
patients' distress. We don't want to burden them with unnecessary or ineffective
treatments," Armer said. "Health care providers should focus on managing
symptoms and choose carefully among various treatments to provide individualized
care plans that comfort patients, which may require modifying existing
protocols."
In their literature review, Armer and her colleagues found
that Complete Decongestive Therapy (CDT), a comprehensive approach for treating
lymphedema involving skin care, exercise, manual lymphatic drainage and
compression of the swollen limbs, may be the best form of specialized lymphedema
management.
"Patients have different medical needs and come from
culturally diverse backgrounds. They have different goals, support systems, pain
levels and treatment tolerances. All these factors influence patients' responses
to care, which affects their well-being," said Marcia Beck, a review co-author
and an MU graduate who now works at Truman Medical Centers in Kansas City,
Mo.
"Caring for lymphedema patients should be flexible and
adjusted to maintain patients' quality of life," said Ausanee Wanchai, another
co-author who received her doctorate at MU and now teaches at Boromarajonani
College of Nursing in Buddhachinnaraj, Thailand.
In a separate literature review, the researchers found that
Intermittent Pneumatic Compression (IPC) therapy, in which sequential inflatable
devices surrounding swollen limbs are used to increase lymphatic circulation, is
beneficial as an adjunct therapy for chronic lymphedema patients who have
limited or no access to medical care; patients can use the compression devices
in their homes.
Armer said further research is needed to demonstrate the
usefulness of various lymphedema treatments, such as CDT and IPC. The literature
reviews were the third and fourth in a series of 12 to be published in
conjunction with the American Lymphedema Framework Project (ALFP). As director
of the ALFP, Armer works alongside clinical experts and investigators to
increase awareness of lymphedema and related disorders. The ALFP was founded in
2008 and is headquartered at the MU Center for Lymphedema Research, Practice and
Health Policy. Its steering committee and staff currently are partnering with
the International Lymphedema Framework (ILF) in producing an updated edition of
the ILF Best Practice Document from 200
Developing a Successful Treatment for Lymphedema
By Paul
Gains
PROFILE: PETER GLASSER
"Lymphedema causes massive
swelling, usually in the arms and legs.
left untreated, it can lead to
hypertension and stroke."
Millions of Americans suffer from lymphedema,
a debilitating condition in which lymphatic fluid accumulates
in
the interstitial tissues. Lymphedema causes massive swelling, usually in the
arms and legs. Left untreated,
it can lead to hypertension and
stroke.
Lymphedema sufferers are often sent home and told to apply
bandages and compression garments to the
extremities. Although this
helps to squeeze fluids out and reduce the swelling, it is a temporary fix at
best.
Fortunately, a holistic treatment pioneered by Peter Glasser, a North
Carolina-based massage therapist, is
proving successful with
lymphedema patients from across the continent. The treatment involves the
administration of supplements and herbs, most notably horse chestnut
(Aesculus hippocastanum), in
combination with a specific massage
technique called manual lymph drainage.
An Accidental
Discovery
In 1995, Glasser moved to Asheville, NC, where he opened a
practice called the Ultimate Health Center
(www.uhealth.net) with
his wife, Diana Brady, a holistic nutritionist. A New Jersey native, Glasser
learned
about lymphedema while studying massage, and became
intrigued by the lack of information about the
condition.
"I saw
a news broadcast one evening on lymphedema and they mentioned massage as part
of the treatment
program. It's called manual lymph drainage and it
piqued my interest," Glasser recalls. "I called and asked
what
lymphedema was and what they knew about it. I went for an interview and then
for two weeks of
training to be certified in the treatment of
lymphedema."
Glasser, a licensed massage therapist, has established
himself as something of an authority on lymphedema,
which has a
variety of origins. It can be caused by a genetic condition, though some people
develop
secondary lymphedema because of surgery, radiation
treatment, or injury. In many cases, it is directly
related to
cancer surgery.
A lot of women get it when they have breast cancer and
their lymph nodes are removed," Glasser explains.
"With radiation
treatment, there's more stress on your lymphatic system. You see it with
hysterectomies,
which can cause lymphedema in the legs. In men,
prostate surgery can cause it in the legs. These are the
main
causes of secondary lymphedema."
While treatment centers have sprung up
around the country in recent years, Glasser believes his is the only
facility
that specializes in the holistic treatment of lymphedema. He criticizes the
mainstream medical
establishment for failing, through either
ignorance or complacency, to warn patients that surgery might cause
the condition.
"It's a case of the lesser of two evils." Glasser
says. "Many patients complain that their doctors never tell
them
there is a possibility they will develop lymphedema. When they come back and
complain to their
doctors, they're told, 'you're still alive,
aren't you?' "The doctors should be up front and tell patients that
there is that possibility, but a lot of doctors don't know much about
lymphedema. There is very little training
on the lymphatic system
in medical school, so a lot of doctors don't know what to do for the
swelling.
People will go out and get a pump or get compression garments,
and they're told to wait and it will get
better." As Glasser's
hands-on experience in treating lymphedema has grown, so has his practice. In
addition to his wife, the Ultimate Health Center now employs
several other massage therapists, a
physiotherapist, a physician's
assistant, and a medical doctor who doubles as the center's medical director.
"I was always interested in finding a better way for patients,"
Glasser recalls. "I would hear a lot of
complaints from patients on
the amount of bandaging they had to do every night on their arms and legs.
They didn't want to do it for the rest of their lives.
"I
started reading more about herbs and came across an article in The Lancet about
horse chestnut being
used in Germany and Austria for varicose veins
and hemorrhoids. I thought that if it could improve blood
vessels,
then it could help lymphatic vessels. So I started experimenting with horse
chestnut extract, which
was then still hard to find in this
country.
Soon I found that my patients' conditions were improving." Life
Extension products figure prominently in
Glasser's
practice.
He recommends that his patients take two capsules of Venotone
(horse chestnut) with a quarter teaspoon
of Life Extension's Rutin
Powder twice a day. This strengthens their lymphatic vessels and helps reduce
the
edema.
"We also recommend Life Extension's two-per-day
multi-vitamin and Super Digestive Enzymes, which help
reduce
fibrotic tissue and edema," says Glasser.
Patients' Lives
Transformed
The Ultimate Health Center's reputation has spread quickly
throughout the US. Although most of the
center's patients are from
North Carolina and bordering states, Glasser has treated lymphedema sufferers
from as far away as California and Canada.
"I had lymphedema
for almost 20 years, but the doctors couldn't tell what it was," says
52-year-old Susan
Philips, one of the center's long-time patients.
"Finally in 1999, I went to a major teaching hospital in
Winston-Salem, NC. They started working on me and could get the liquids
squeezed out of my legs, but
my legs would fill right back up. I
had gotten to the point where I could hardly walk. My calves were larger
than my waist." Philips was referred to the hospital's occupational
therapy department, whose staff was well
aware of Glasser and his treatment
protocol. But getting an appointment at the Ultimate Health Center
proved difficult, as Glasser was taking on more patients.
"He
had a long waiting list, so I originally saw him in July 1999 but didn't start
manual lymph drainage
treatment until that October," says Philips.
"I did begin taking horse chestnut in July. I had already lost
inches of swelling off my legs by the time I saw him in October, just
from taking the supplements." Like
many of his other patients,
Philips is now on what Glasser calls a maintenance program, which involves
taking horse chestnut daily. She also applies it to her skin each day.
While she originally took treatments at
the center six times a
week, those have been scaled back to twice a month.
Over the years,
Philips has lost most about 150 pounds. Glasser believes from that this has
extended her life.
Philips says that while her legs have returned to normal
size, they are still deformed from enduring 20 years
of lymphedema.
Doctors now almost believe her condition is hereditary, since her younger
brother and
sister also suffer from lymphedema.
Another
long-time patient, 69, year-old Vicki Stokes, developed lymphedema after a
radical hysterectomy.
Doctors discovered she had cervical cancer,
thus necessitating the surgery. According to Stokes, however,
the
doctors went too far.
"My oncologist was not familiar with the lymphatic
system at all," Stokes explains. "I diagnosed myself. He
removed an
unreasonable amount of lymph nodes from each side, saying that he was trying to
prevent a
recurrence.
"So I got on the Internet and found
out about lymphedema.
"I belong to an online support group with people
from Israel, India, South America, and all over the world.
That's
where we share information. The doctors remove lymph nodes. Mine were all
healthy. That causes
lymphedema."
Twice a year, she makes
the journey to Asheville from her home in San Diego for a weeklong maintenance
treatment, and she showers praise on Glasser and his
team.
Despite his success to date, Glasser continually seeks ways to
improve his treatments. Although he tells
patients to follow his
protocol for six months to a year, he often sees them improve much more
quickly. He
ascribes that rapid improvement to the quality of the
horse chestnut and other supplements he prescribes.
"I started using
Rutin Powder along with the horse chestnut," Glasser explains. "Rutin is a
bioflavonoid that
works well in combination with horse
chestnut.
When I first started, horse chestnut was an extract. I would
tell patients to take 30 drops with a little bit of
water, twice a
day. Then it started coming in capsules, so I started advising patients to take
one capsule,
twice a day, and I found that it works better."
Because horse chestnut is a powerful herb that can cause
nausea and
other gastrointestinal problems, Glasser advises his patients to take it with
meals.
Glasser recommends that patients who are already on blood
thinners to forego horse chestnut. He also
advises pregnant women
not to use horse chestnut.
As Glasser and his staff continue to treat
lymphedema patients, they are learning more about its prognosis
and
adjusting their treatment protocols accordingly.
Glasser believes there
are millions of people with lymphedema who can be treated with horse chestnut
and
relieved of this crippling condition. While his patients have
Glasser to thank for regaining their health, he is
quick to share
the credit.
"The way my wife and I see it, Life Extension is the leader
in the philosophy that aging and disease can be
prevented or
corrected," Glasser says. "That's a philosophy that I happen to
share."
Medline:
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-horsechestnut.html.
Horse
chestnut appears to be fairly safe, as long as it is standardized and
does
not contain significant levels of esculin (constituent of horse
chestnut
that is toxic except at low or moderate doses). The same caution
is sounded
by James A. Duke, a leading world authority on herbs, in his
book The Green
Pharmacy.
http://healthlibrary.epnet.com/GetContent.aspx?token=e0498803-7f62-4563-8d47-
5fe33da65dd4&chunkiid=21758
Safety Issues
Whole horse
chestnut is classified as an unsafe herb by the FDA. Eating the nuts or
drinking a tea made
from the leaves can cause horse chestnut
poisoning, the symptoms of which include nausea, vomiting,
diarrhea, salivation, headache, breakdown of red blood cells,
convulsions, and circulatory and respiratory
failure possibly
leading to death.19 However, manufacturers of the typical European
standardized extract
formulations remove the most toxic constituent
(esculin) and standardize the quantity of aescin. To prevent
stomach irritation caused by another ingredient of horse chestnut, the
extract is supplied in a controlled-
release product, which reduces
the incidence of irritation to below 1%, even at higher doses.20
Properly prepared horse chestnut products appear to be quite safe.21
After decades of wide usage in
Germany, there have been no reports
of serious harmful effects, and even mild reported reactions have
been few in number.
In animal studies, horse chestnut and its
principal ingredient aescin have shown a low degree of toxicity,
producing no measurable effects when taken at dosages seven times higher
than normal.21,22 Dogs and
rats have been treated for 34 weeks
with this herb without harmful effects.
Individuals with severe kidney
problems should avoid horse chestnut.23-25 In addition, injectable forms
of horse chestnut can be toxic to the liver.26 The safety of horse
chestnut in young children and pregnant
or nursing women has not
been established. However, 13 pregnant women were given horse chestnut in a
controlled study without noticeable harm.29 Furthermore, studies in
pregnant rats and rabbits found no
injury to embryos at doses up to
10 times the human dose, and changes of questionable significance at 30
times the dose.21
Horse chestnut should not be combined with
anticoagulant, or blood-thinning, drugs, as it may amplify their
effect.27,28
--------------------------------------------------------------------------------
Interactions
You Should Know About
If you are taking aspirin, clopidogrel (Plavix),
ticlopidine (Ticlid), pentoxifylline (Trental), or anticoagulant
drugs such as warfarin (Coumadin) or heparin: Do not use horse chestnut
except under medical
supervision.
----------------------------------
Self-Care:
Massage
Introduction
Living Well With Lymphedema
Performing
self-massage is an important role that you play in managing your
lymphedema!
The primary purpose of self-massage, also known as lymphatic
massage, is to improve the flow and
drainage of lymph by
stimulating the lymphatic vessels. Your lymphedema therapist will instruct you
in a
program of daily self-massage. Since this is an important and
your should perform self-massage regularly as
directed by your
therapist. [1]
Self-Massage Basics
If you have an infection, or any
indication that you are developing an infection, you may need to modify or
skip your self-massage until the infection is under
control.
Self-massage is a gentle technique that should never hurt or make
the skin red.
Self-massage is not the same as conventional muscle massage.
Do not allow anyone, other than a trained
lymphedema therapist, to
instruct you in how to perform massage using deep strokes on lymphedema
affected tissues.
Self-Massage is best performed first thing in the
morning before bandaging or exercising, and at other times
as
specified by your therapist.
Self-massage should be performed in a time and
place where you can be relaxed and will not be disturbed.
The time
devoted to self-massage varies depending on your condition and the instructions
of your
lymphedema therapist.
Most self-massage strokes use very
little pressure and the hands do not slide over the skin. Instead they
move and stretch the skin to stimulate the lymphatic capillaries
located just under the skin. Therefore, oils
and lotions that make
the skin slippery are not used during self massage.
Self-massage movements
are repeated from five-to-seven times in the same position. This matches the
subtle pumping motion of the lymphatic vessels in a rhythm of
five-to-seven pulsations per minute.
Self-massage begins at the terminus.
This clears the terminus so that lymph flowing upward from other parts
of the body can move freely into the terminus where it will rejoin the
circulatory
system.
------------------------------------------
Aloe
The
gel extracted from aloe (Aloe vera) leaves is a cost-effective, natural way to
treat a variety of seasonal
ailments: it can be used topically for
the treatment of windburn, skin irritations or inflammation, and rashes.
Look for a whole, living plant at your local garden store, cut open the
leaf and apply the gel generously as
needed. Or, choose a lotion
(look for those with a high percentage of aloe gel) or a gel product. Although
aloe is great for minor heat burns, you should always contact
trained medical personnel to treat burns with
significant
blistering.
--------------------------------------------
avoid
deep massage strokes on pregnant womens legs, also lymphedema
There
is truth to this, the really deep pressure can damage nodes on someone with
lymphedema or
pregnant, keep in mind alot of people do get deep
tissue massage on their limbs and legs BUT they are not
people with
lymphedema, those are more sports oriented. Deep cross fiber friction work,
speading and
other techniques are good to break up scar tissue,
relax spasmed muscle which do block lymph flow are
good techniques
BUT only done by a knowledgeable, qualified person, they have to be done the
right away.
Avoid Deep Massage Strokes on Pregnant Women's
Legs!
A Spa Site Guest Article by Elaine Stillerman, LMT, the author of
"MotherMassage: A Handbook For
Relieving the Discomforts of
Pregnancy" and "The Encyclopedia of Bodywork" and the developer and
instructor of the professional certificate program MotherMassage:
Massage During Pregnancy, taught at
massage schools and spas across
the country.
Contact
Elaine Stillerman, L.M.T.
Massage
Therapist
108 E. 16 Street
Suite 401
New York, NY 10003
Tel: (212)
533-3188
Fax: (212) 533-3148
http://mothermassage.net/
Related
Resources
• Elaine Stillerman's NY Massage Practice
• MotherMassage®:
Massage During Pregnancy Professional Certification Course Description
•
Breech Presentation, a Spa Site Guest Article by Elaine Stillerman, L.M.T.
•
Spas that Offer Maternity Treatments
Related
Books
MotherMassage
The Encyclopedia of
Bodywork
Several weeks ago, I got a frantic call from a colleague
and former student. She was distressed about a
pregnant client she
had just massaged.The client wanted her to massage her sore legs deeply, but my
colleague explained to her that she couldn't because of several
physiological changes in her circulation. The
disgruntled client
then called me up to complain. I assured her that her massage was administered
correctly.
"Well," she said in a huff, "I don't care what you
think, I'm going to find someone who will work deeply on
my legs."
I told her that anyone who would do so probably didn't understand the changes
in her body and if
she did, would be acting
irresponsibly.
During pregnancy, several physiological changes in her
circulatory system caution the use of deep massage
work. As a way
to prevent hemorrhaging during labor, her body increases her coagulating
activity (the
creation of fibrin) 4-5 times. The potential of
developing blood clots is 5-6 times greater than when she is
not
pregnant. In some cases, these thrombi cause pain, heat, muscle spasms and are
symptomatic.
However, sometimes the presence of thrombi is
asymptomatic: there is no over-riding pain or discomfort.
These
clots are generally found where the blood is most stagnant - the iliac, femoral
and saphenous veins of
the legs. Deep massage strokes, ischemic
compression (i.e. acupressure, shiatsu), deep vibration,
tapotement
or friction could dislodge these clots are send them coursing through the
circulatory system. The
result could be a stroke, or coronary or
pulmonary thrombosis.
Another equally important consideration is the
increase in interstitial fluid. By the third trimester, the fluid
within her tissues can increase as much as 40%. It is no wonder, then,
that her legs are tired and sore. But
the only way to effectively
increase removal of the fluid is through lymphatic drainage technique. This
massage technique is light to enhance the lymphatic drainage of the
superficial lymph vessels. The direction
of this light pressure is
always towards the heart and the massage starts at the proximal portion of the
leg
(knee to hip) to open the channels and then continues from
ankle to knee to hip and finally from the feet
(distal) up the leg
to the hip.
Traditional Swedish massage strokes, or any other deep
technique, can actually inhibit lymphatic drainage.
These strokes
(i.e. deep effleurage) cause an increase in arterial blood flow. You can see
this when the skin
turns red after an area has been massaged
(hyperemia). This increase of arterial blood flow causes an
increase
in blood capillary pressure and subsequent increase in ultra filtration of
water. Therefore, more
water accumulates within the tissues causing
an increase in lymph load and lymphedema. Another reason to
avoid
deep Swedish massage strokes on pregnant women's legs is that the superficial
lymphatics are
vulnerable to external pressure and damage can be
done to the anchoring filaments and endothelial lining of
the lymph
vessels.
As a spa director or massage practitioner, you want to do what is
right and best for the client. When a
pregnant client tells you her
legs bother her, the best way to treat them is to address the cause of the
problem: fatigue and soreness from swelling. Even if her legs aren't
swollen, it is still important to massage
them following lymphatic
protocol to avoid dislodging potential blood clots: lightly. The fact that the
lymph
load is decreasing from this safe and appropriate care will
provide her with much needed and welcomed
relief."
Elaine
Stillerman, LMT is the author of MotherMassage: A Handbook For Relieving the
Discomforts of
Pregnancy (Dell, 1992) and The Encyclopedia of
Bodywork (Facts On File, 1996). She is the developer
and instructor
of the professional certificate program MotherMassage: Massage During
Pregnancy, taught
at massage schools and spas across the country.
-----------------------------------------
Instructions to drain
the face:
start at forehead middle, drain both sides towards the
temple
keep going down and over as indicated by arrows. You want to
drain
all areas. After each arrow set, drain the waterwheel
(nodes behind the
ears) and clavicle (collarbone area nodes) and
axilla (underarm) nodes. Do
each area with 20 strokes (each
line). When you finish, make sure to drain
the thoracic duct
sides of the body, iliac nodes and inguinal nodes. the
thoracic duct is
the sternum area between your breasts. Iliac nodes are
each
side of the bellybutton and inguinals are groin, crease of the
leg
nodes.
---------------------------------------------
THE IMPORTANCE
OF BODY AND LYMPHATIC DETOXIFICATION
IN THE TREATMENT OF LYMPHEDEMA
by
Diana Brady, M.A., Holistic Nutritionist
Please note that the following
article discusses holistic approaches and/or alternative nutritional/herbal
supplementation that may be useful in supporting a patient's daily
regime of self-care. This is not an
endorsement by the NLN, nor do
we promise results from the use of any of these items listed below. We
are committed, and at request of our members, to presenting all avenues
of possibility for improvement of
the condition and quality of life
for all lymphedema patients. Any and all claims or opinions expressed in this
article are solely of the author. Ed.
--------------------------------------------------------------------------------
"Every
tissue in the body is fed by the blood, which is supplied by the intestines.
When the intestines are
dirty, the blood is dirty and so are the
organs and tissues. It is the intestinal system that must be cared for
first before any effective healing can take place," according to Dr.
Bernard Jensen, D.C., Ph.D. This
thought was echoed by Joseph D.
Beasley, M.D. and Jerry Swift, M.A. authors of the 1989 Kellogg
Report, "In today's conditions, most adult patients have to be
detoxified and nutritionally restored before
specific diagnosis can
be formulated" 1.
Today's conditions refer to the amount of external
and internal toxins bombarding us every day. External
toxins were
quantified in 1989 by U.S. Environmental Protection Agency, Office of Toxic
Substances 2 to
be the following:
* 551,034,696 pounds
of industrial chemicals
were dumped into public sewage storage.
*
1,180,831,181 pounds of chemicals were
released into the ground,
threatening our natural aquifers.
* 188,953,884 pounds of chemicals
were
discharged into surface waters.
* The total amount of air
emissions pumped
into the atmosphere was 2,427,061,906 pounds.
*
A grand total of 5,705,670,380 pounds of
chemical pollutants were released
into the environment in 1989.
Toxic chemicals easily find their way
into our body through the air we breath, the food we eat and the water
we drink. Obviously these toxins must be eliminated before they can
disrupt normal metabolic systems and
processes. Yet, although the
body is designed to eliminate toxins, it cannot always handle the overload
present in today's environment. In addition to external toxins, our own
bodies produce internal toxins
through normal metabolic processes
such as digestion, muscle movement and cellular activity.
Consequently, annual and bi-annual detoxification is routinely
recommended by many health care
professionals regardless of health
status. However, healthy detoxification takes on an even more important
role in a disease, lymphedema, characterized by a breakdown in the
detoxification mechanism itself.
Lymphedema is characterized by edema
and blockage of the lymphatic system. The lymphatics have three
very important functions, according to Dr. Gerald M. Lemole, Chief of
the Department of Thoratic and
Cardiovascular Surgery, Deborah
Heart and Lung Center, Browns Mills, New Jersey:
"First of all, the
lymphatics return protein to the bloodstream. As much as 50 percent of our
serum protein
can leak out of our bloodstream during a 24-hour
period, and it is the job of lymphatics to return this
protein to
the blood. Second, the lymphatics clear the spaces between our cells and carry
away toxins and
foreign particles such as bacteria, large proteins,
cholesterol, and viruses. We were taught that the liver and
kidneys
clear away toxins, but it is actually the lymphatics that clear away the fluid
that bathes each cell of
our body. Third, the lymphatics are an
integral part of our immune system. The white cells, called
lymphocytes, circulate in and out of the lymphatics and help destroy
foreign particles like bacteria, viruses
and parasites.
"The
trouble begins when the lymphatic system becomes blocked or the flow of lymph
slows down
appreciably. It's like the kitchen sink: if the drain is
clogged but you leave the water running, the water will
eventually
run all over the floor." Not only is the lymphatic fluid blocked, but so are
all the toxins, bacteria
and viruses that the lymphatic fluid
normally drains from the body. It is no surprise that lymphedema patients
suffer from other varied health ailments. The stagnant lymph fluid is a
breeding ground for bacteria, parasites
and viruses; and a cesspool
of toxic waste.
Peter Glasser, MLDT, LMT, ICMT of Ultimate Health
Center, Asheville, N.C. uses herbal cleanses as an
integral part of
his treatment for lymphedema. The results show improvement, not only in the
lymphedema,
but also in the overall health and well being of the
patient. Peter has also found that when an herbal cleanse
is
initiated before treatment begins, treatment time itself is shortened and
results improved. His typical
treatment period is between two to
four weeks, with 90% of his patients requiring only two weeks of one
treatment
per day.
It is critical to undertake an herbal cleanse under the care
and scrutiny of a qualified health care practitioner.
Each
individual may react different to the cleansing process itself, and to the
herbs contained within the
cleanse. A cleansing program needs to be
established for the circumstances and needs of the individual
patient, and closely monitored for any adverse reactions.
The
herbal cleanses remove some of the toxins in the blocked lymphatic fluid and
start the process of
lymphatic drainage. Patients have reported a
decrease in swelling of affected limbs and a softening of
hardened
tissue before treatment even begins. Some patients chose to use an herbal
cleanse after their CDP
treatments, and still noticed improvements
in their lymphedema and overall health.
The herbal cleanses preferred by
Mr. Glasser include both a commercial tablet and a specially prepared
liquid
formula. The commercial tablet is available in most health food stores as
Nature's Secret A.M./P.M.
Multi-Cleanse. The liquid formula is
specifically created for Mr. Glasser by Herbalist and Alchemist of New
Jersey and GAIA herbs.
The A.M./P.M. herbal cleanse contains:
alfalfa leaf, black cohosh root, burdock root, cayenne fruit,
cascara sagdrada bark, chickweed herb, dandelion root, echinacea
angustifolia leaf extract, fennel seed,
fenugreek seed, ginger root,
guar gum, hawthorn berries, horsetail herb, marshmallow root, milk thistle
extract, mullien leaf, papaya leaf, peppermint leaf, plantain root,
psyllium seed, red clover leaf, safflower oil,
slippery elm bark,
yarrow flower and yellow dock root 4. The herbal cleanse works by cleansing the
body ,
blood and lymphatics. Waste is eliminated by stimulating
additional bowel movements. The amount and
type of bowel movements
needs to be monitored so that they do not exceed two to three per day, and do
not become too watery. Additionally, because toxins and bacteria
are being mobilized, some symptoms of
detoxification should be
expected . They include: flu like symptoms, fatigue, flatulence and in some
cases, a
slight rash.
Mr. Glasser normally recommends going
very slowly with the cleanse, monitoring progress and including
what is considered a "natural antibiotic," such as colloidal silver, in
the regime. The "natural antibiotic" is to
ensure that as the
bacteria are mobilized from the system, they are destroyed before they can
multiply. Also,
included in the regime is a good multi-vitamin,
pycnogenol and dandelion root/leaf. The multi-vitamin
provides
necessary vitamins and minerals to strengthen and revitalize the body,
pycnogenol combats free
radical production in the blood and lymph
system, and dandelion helps the liver and kidneys deal with the
elimination of toxins while also aiding in edema reduction.
The
custom liquid formula contains herbs historically used to cleanse the lymphatic
system 3: echinacea,
cleavers, golden seal and poke root. This
formula is taken three times a day with the usual starting dose of
between 10 to 30 drops. To date, no side effects have been reported
using the liquid formula.
Either one or both of the herbal cleanses is
and excellent way to start the process of lymphatic drainage.
The
benefits obtained can shorten the treatment time and help the patient achieve a
greater level of overall
health and well being.
REFERENCES
1. Beasley JD, Swift JJ. The Kellogg Report. Institute of Health
Policy and Practice, The Bard College
Center. 1989;Ch 4:171.
2. U.S. Environmental Protection Agency, 1991. Toxics in the Community:
National and Local
Perspectives. The 1989 Toxics Release Inventory
National Report. Office of Toxic Substances,
Washington, D.C.
3. Hoffman, David. The Holistic Herbal. Element Books, Inc. Rockport,
1995; 32.
4. Herbal Research Publications. Naturopathics Handbook of
Herbal Formulas. Herbal Research
Publications, Inc., Ayer,
Massachusetts. 1996;
133-15
-------------------------------------------------
TIPS FOR
HEALTHY EATING WHILE TRAVELING:
Bring your own sandwiches and fresh
fruit in a cooler or picnic basket.
Keep an assortment of dried fruit
handy for snacking, it will satisfy your sweet tough while providing disease
fighting antioxidants. Better yet make your own trail mix with
dried fruit, mixed nuts, sunflower seeds.
Pack single servings of precut
baby carrots, celery, or bell peppers in resealable bags to snack on. Use
small plastic containers to pick dips such as low fat ranch dressing,
peanut butter or hummus.
Freeze grapes the night before so they are
chilled for your trip. They make great bite sized snacks and taste
great with small cubes of low fat cheese.
For convenience, pick
up prepackaged fruit slices or vegetables at the grocery store. Some even come
in
their own containers with utensils and dipping sauces. You can
also buy peanut butter in a squeezable
tube. It tastes great on
apple slices or granola bars.
Many fast food restaurants offer fruit and
vegetable options instead of fries. You can also usually request a
fruit cup or side salad for an additional service of fruits or
vegetables. *Note McDonalds now has a fruit
and nut
salad!.
Switch from soda to low fat milk or water or experiment with
various flavors of herbal teas.
As an appetizer, order a salad with low
fat dressing or oil and vinegar.
Opt for tomato juice, vegetable juice
or water on the airplane.
Order a small fruit smoothie at the juice
bar.
Don't necessarily skip your favorite dessert or fried foods. Eat
smaller portions of these and make them
treats, not regular menu
items.
Watch portion sizes. Share an appetizer or antree or choose two
appetizers instead of an entree.
Prepare half of your meal yourself and
snack on fruits and vegetables
Diet Reading
With so many diet
programs and pills on the market today you may be asking yourself which dieting
plan
you should consider purchasing. Our goal is to provide you
with the most unbiased diet reviews for both the
good diet programs
as well as the bad diet programs on the web.
Celebrity film stars are
different from people around, with cooks, fitness trainers and continual other
people
to assist them, they lead a life which is completely
different. So the Celebrity Diets aught to be different too!
To the
celebrities their million-dollar image is so important that the Celebrity Diets
can go to any extent, no
matter how bad the diet is, to sustain
that Star look. Celebrity Diets can be very strict and can even extend
to long fasts, which otherwise can be harmful to the common
workingman.
Looking curiously at some of the secret Celebrity Diets, one
very popular one is Hampton diet. It's a plan
designed by Dr. Fred
Pescatore (M.D) and is basically a low carbohydrate eating plan centered upon
whole and organic foods and good fats such as macadamia oil. Every
famous celebrity is associated with a
book, a DVD, infomercial, and
other publicized diet plans. And others keep appreciating the Atkins and the
Hampton diet.
One thing should be very clear. Celebrities
can advice about acting maybe and its also acceptable, but
advice
about a diet plan should come from a health care professional such as a
registered dietician. Most
Celebrity Diets are faked and as per the
reputation of the so-called Celebrities to promote. The words
might
appear harsh, but they are very true. Following a celebrity diet just out of
mere appreciation for the
Star can cause detrimental results. Also,
Celebrity Diets promote very quick programmes, which are hard
to
follow, and ballyhoo all types of ideas in the diet plan. And if people who are
not technically trained to do
so design these so called Celebrity
Diets, then the results can be really detrimental.
Again, Celebrities
are paid huge cash in order have that good look and can thus meet the expense
of hiring
personal chefs, masseur and other people to do whatever
they wish. Ordinary people, or common men,
must seek help of a diet
plan that is affordable, practical and also includes food that are
available.
There is no need to feel awful and depressed because one has
to cut out upon the Celebrity Diets, its simply
because the
Celebrity Diets are not worth following. The Celebrity Diets, just like their
celebrities, are good
to look at and lucrative from far away, what
remains inside these Celebrity Diets and their celebrities is an
abysmal mystery, otherwise why do they are always on the get to a
simple lifestyle at every opportunity.
Celebrity Diets, be happy
where you are among the
Stars!
-----------------------------------
Non-Surgical
Weight Loss
ST. LOUIS (Ivanhoe Newswire) -- For the first time in this
country, doctors are performing a weight loss
procedure without a
single incision. It's a new experimental option for obese patients who want to
drop the
pounds without having major surgery.
A nine pound
weight loss in two weeks amazes Carrie Williamson. The 30-year old has been
overweight
since she was a child.
"I had done Meridia,
Weight Watchers," Williamson recalled to Ivanhoe. "You name it, I did
it."
That's why she volunteered to be the first American patient to
undergo a new form of stomach stapling
surgery without incisions.
It's called transoral gastroplasty, or TOGA.
"The thing that's unique
about this is that it's all done through the mouth," J. Christopher Eagon,
M.D., an
assistant professor of surgery at Washington University
School of Medicine in St. Louis, told Ivanhoe.
Washington University
surgeons 'stapled' Williamson's stomach by passing flexible instruments down
her
esophagus, to the stomach where a restrictive pouch was
created.
"The jaws open up, pull a portion of the stomach into the jaws,
and then close it down and fire the stapler
and that creates that
tubular type of anatomy," Dr. Eagon explained.
The pouch collects food
as it enters the stomach, giving the patient a feeling of fullness after a
small meal.
"Because you take in so little food, you have to make sure
you take enough protein -- enough nutrients,"
Williamson
said.
In the pilot study, patients on average lost 40 percent of excess
body fat within a year of the procedure.
Doctors say that's
slightly less than gastric bypass, but patients recovered quickly and had a low
risk of
complications.
Williamson is blogging about her
experience in the TOGA study. She writes: "I did the bike for 30 minutes
… more than I ever thought I could do!"
"I had surgery on
Wednesday and went back to work on Monday," Williamson said.
A
schedule-friendly procedure that has many of the weight loss surgery benefits
without a single incision.
Researchers in Mexico and Belgium
successfully tested TOGA weight loss over the past year. TOGA
patients stayed overnight in a hospital after the procedure, but
doctors believe it will eventually be
performed on an outpatient
basis. The TOGA study is investigating 275 cases across the United States.
Volunteers who want to enroll must be 18 to 60 years old and be at
least 100 pounds overweight.
FOR MORE INFORMATION, PLEASE
CONTACT:
Toga Clinical Study
http://www.togaclinicalstudy.com
------------------------------------------------------------
The
Fat Flush Diet can be subdivided into three phases. In the ultimate phase the
Fat Flush Diet
recommends 40 percent carbohydrates, 30 percent
protein and 30 percent fat, a ratio that is best suited
when most
toxins are out of the human body. However in the incipient stages, first two
stages, there remain
a lot of restrictions to achieve proper
functioning of the Fat Flush Diet plan. Discussing the phases one by
one,
beginning with the toughest and the strictest...the first phase.This first
phase of the Fat Flush Diet is like
a purification phase, cleansing
the liver and nourishing it in the proper way to achieve effective weight loss.
Restrictions include strictly upon not using herbs or spices except
for the fat flushing herbs and spices
outlined in The Fat Flush
Plan, margarine, alcohol and sugar too are restricted. Leaving aside flaxseed
oil,
all oils and fats are restricted too. Even vegetables like
grains, bread, cereal or starchy vegetables such as
beans,
potatoes, corn, parsnips, carrots, peas, and pumpkins are removed from the
first phase of the Fat
Flush Diet. Neither dairy product is spared
in the plan.
Coming down to the second phase of the Fat Flush Diet, it
incorporates more food preferences, including
the option of adding
some small amount of carbohydrates. Finally coming round to the third phase of
the
Fat Flush Diet, some dairy products as well as starch
containing vegetables are included along with some
grains too. This
is the final phase of the Fat Flush Diet plan where the human body is
effectively trained for
the Fat Flush process enhancing weight
control and keeping healthy in the same time. The Fat Flush Diet is
a progressing diet plan that continues from a very strict plan onto a
trained and later conventional diet in its
final phases. However
people following this Fat Flush Diet plan reportedly have had a lot of health
benefits
and this assures the success of the Fat Flush Diet.
Anyways, the diet remains to be popular among people
irrespective
of its strictness thereby proving that discipline is the foundation of a
healthy empire named LIFE!
The grapefruit diet promises that you can
lose up to 50 pounds in as little as two and a hald months time.
Are you kidding? Not only is this type of weight loss very unhealthy,
but is also nearly impossible without
totally depriving your body of
nutrients.The grapefruit diet consists of eating four meals throughout each
day. Meal 1 would consist of a half grapefruit, 3 eggs(any style), and
two slices of bacon! Healthy? I don't
think so. Meal 2 would consist
of another half grapefruit, any piece of meat you want, and a salad with any
type of dressing. Is salad dressing healthy? No. Meal 3 consists of
the exact same thing as meal 2, but add
1 cup of coffee into your
meal. Finally Meal 4 consists of either 1 eight ounce glass of tomatoe juice or
1
eight ounce glass of skim milk. This is one of those diets that
many of you may have tried in the past and
found that it didn't
work. Although the grapefruit diet seems very easy, it doesn't produce results
and is far
from a healthy and permanent way of dieting.
The
reason why the Mediterranean Diets are being so popular is because research
reveals that the people
of the Mediterranean live the longest of
lives! Starting from Italy, Crete, Spain to France. The imperative
portions of the Mediterranean Diets are perhaps the spectral blend of a
variety of component foods like
lofty quantities of cereals, olive
oils, dry fruits, garlic, herbs and also sea food. Poultry is also included in
the
Mediterranean Diet more often than red meat; also Wine is
moderate component of the Mediterranean
Diet. In total the
Mediterranean Diet is a different mixture of nutrient foods. The Mediterranean
Region
covers 3 continents with above 17 countries and for years
all these countries have had their influences upon
the
Mediterranean Diet whose age old recipes are a stupendous mingle of all the
cultures of these countries.
From Turkey, Portugal, Spain, Egypt
and Arabia all with different ways of living and thinking have
contributed to the making of this great Mediterranean Diet that
outshines all other diets in it's diversity. The
Arabs brought the
richness of spices to the Mediterranean Diet. They also added the Mediterranean
Diet
with nuts, saffron, rice and fruits. Taking a closer look at
the Mediterranean Diet, it can be observed that
this diet is a
perfect and wholesome natural diet without the dependency upon manufactured
foods.
The followers of the Mediterranean Diet, on principle, take
reduced amounts of saturated fats and whatever
fats the
Mediterranean Diet provides the body with are monounsaturated in nature that
primarily does not
elevate cholesterol levels in the blood. Thus
Mediterranean Diets have the miracle of reducing the rates of
heart
diseases and subsequent death rates. The credit to this can be partially
admitted to the Mediterranean
Diet without dispute. The consumption
of the so called monounsaturated fats, fruits, dry fruits and high
quantities of cereals makes the Mediterranean Diet a good plan to
supply the human body with essential
nutrients, vitamins and no foul
components and thereby the Mediterranean Diet prevents diseases very
efficiently.
However not enough is known whether these goods are only due to the
Mediterranean Diet or
due to the climatic factors and lifestyles of
the Mediterranean Countries too, and to what extent. Thus the
Mediterranean Diet is not officially suggested very often as much of
the research still lays ahead, however
there no denying that the
Mediterranean Diet does have some good effects. Hence the Mediterranean Diet
remains to enthrall people around the world with the wonders it can
do to the human race.
The name Subway Diet seems a bit puzzling to the
common reader, but it is certainly a twister in it's own
way! Also
Subway Diets have a great story behind them. It's a popular story about a
college student named
Jared Fogle, who weighed around 410 pounds.
He, Jared Fogle, one day noticed an advertisement in
Subway about
low fat subs. He followed the idea and the meals really helped him
drastically.
This was the story about Subway diet. Now looking at the
facts about Subway diets. The key idea is a
good selection of
low-calorie subs that can comprise a person's lunch, frequent snacks during
even weight
loss plans in order to reduce junk food intake and
dinner. However only the subs are not sufficient. People
need to
include vegetables and fruits, for instance, to supplement the Subway diet and
make it complete.
The only fact that proved it is that Subway diets
are not properly planned and are the least scientific of all
diets.
Neither does the Subway diet plan follow any calorie-measured path. Thus it is
an intuition-based
program that can cause a lot of problems with
people with diseases such as heart problems and diabetes,
which
really need a specialized and properly planned diet and not just Subway diet.
Subway diets are good
to follow casually, but if followed seriously
them they should be properly supplemented with other foods to
provide the correct calorific intake a human body requires. Otherwise
the Subway diet instead of helping
weight loss plan would cause a
person to lose strength and energy. Hence no fruitful results would come out
of the Subway diets in any way.
The most active ingredients
in Trim Spa are ephedrine and caffeine. Like other ephedrine/caffeine-based
products, Trim Spa works by inducing thermogenesis (the production of
heat), which speeds up your
metabolism and burns calories. It also
has an appetite-suppressing effect, so you feel less hungry and
therefore eat less Trim Spa now offers an ephedra free version of
their popular ephedra
pills.
--------------------------------------------------------
DO's
and Don'ts:
DO'S and DON'TS of LYMPHEDEMA:
Outdoors
DO
protect your arm from sunburn. Always wear sunscreen.
DO avoid insect
bites. Wear something to guard yourself from insect bites whether it be bug
repellent or
long sleeves and pants.
DO wear gloves when
gardening, shovelling, and yard work.
DO exercise and do stretches
before outdoor work. Be careful you don't over exert.
DO NOT allow
outdoor pets to scratch or bite you. Be sure if you do happen to get
scratched, you clean
it properly and quickly to avoid infection and
make sure your tetnus shots are up to date.
DO NOT expose your affected
areas in outdoor hot tubs.
DO NOT play sports that can injury you with
falling, bumps, bruises, etc.
Indoors
DO wear gloves when doing
housework or cooking. If you do happen to get cleaning products on
yourself, wash immediately and look for irritation. Apply
antibacterial or necessary ointment to prevent
infection from any
breaks in the skin. This also applies to burns. The OVGlove works wonders for
taking
pans out of the oven for those with arm/hand
lymphedema.
DO NOT allow pets to bite you or scratch you even in play.
Always be careful when handling any pets.
DO NOT iron or sew without
proper hand protection whether it be a thimble or glove when
ironing.
Hygiene
DO make sure you keep your affect areas clean
and use moisturizing lotions to keep the skin supple.
DO make sure you
wash and apply any ointments, lotions, and antibacterial remedies immediately
after a
cut or scratch.
DO dry your body thoroughly after
bathing, and be sure the water is warm, not hot. It is good practice to
do skin brushing wet work or dry work before or after bathing. Skin
brushing helps remove dead dry skin
and also stimulates the
superficial lymph nodes under the skin to promote lymph flow. While in the
tub, you
can make it a practice to save time (for women) to do
breast exams. Everyone can also check their body
over for any odd
moles or patches of skin (skin cancer check). You can also save time by doing
some self
massage as well.
Grooming and
Accessories
DO wear a well fitted bra. There are actually bra's made
for lymphedema, one company makes a
compression bra. The company
is named Bellise. Be sure the straps on your bra do not cut in your
shoulders
and the edges of the bra don't have anything to irritate the skin (sharp edges
on lace, etc). Some
prefer to go bra-less. Some also use stick on
patches. Be careful of the adhesive on these as it can irritate
the skin. If you wear a prosthetic, be sure it's a light weight
one.
DO NOT use a disposable razor if you can help it. Electric razors
give a smoother shave which is less
likely to harm the skin with
little cuts or abrasions. Be careful with cutting finger and toe nails as
well.
Cutting the cuticles isn't advised with arm/hand lymphedema.
If you have hard, brittle nails (Toe or Finger)
please see your
doctor or podiastrist. You may have a fungal or some type of infection that
should be
treated. (Lamisol is the treatment of choice).
DO
NOT wear tight jewelry of any kind on your affected areas. For abdominal
lymphedema, body
piercing is not an option, it's a danger.
Anklets, bracelets, rings and other jewelry can cause irritation and
become tight with swelling. It is also advised not to carry a heavy
purse, bag, laptop bag or briefcase over
the shoulder of an
affected arm.
Travel
DO wear compression garments when
travelling. Make sure you get up and move around as much as you
can. Remember to stretch and do range of motion exercises if possible,
and to deep breathe. Also
remember to take your special supplies
(Soap, creams, bandages, etc) with you.
Medical
DO NOT allow
blood to be taken from any arm affected with lymphedema, nor allow vaccines or
shots to
be given in the arm. IV's are also troublesome, as well
as blood pressure cuffs. The vaccine or shot causes
a prick in the
skin which is a risk for infection as well as trauma to the area. The blood
pressure cuff exerts
a force on the area traumatizing it as
well.
----------------------------------------------
COMPREHENSIVE
TREATMENT GUIDELINES
Establishing Disease Management Guidelines
for
LYMPHEDEMA
Cyndi Ortiz
Contributing Authors:
Phyliss
Tubbs-Gingrich, RN, LANA-CLT
Wade Farrow, MD, CWS, FCCWS
Cheryl L.
Morgan, PhD
Lawrence L. Tretbar, MD, FACS
Benoit Blondeau, MD
Disease
Management Practice Guidelines
Lymphedema
Cyndi Ortiz, with Phyliss
Tubbs-Gingrich, RN, LANA-CLT, Wade Farrow, MD, CWS, FCCWS, Cheryl
L. Morgan, PhD, Lawrence L. Tretbar,
MD, FACS, Benoit Blondeau,
MD
COPYRIGHT 2005 All Rights Reserved
Lymphedema:
Goals and
Objectives:
Goals and objectives in current medical practice for lymphedema
are concentrated on assisting affected
individuals with successful treatment
and long-term disease management of chronic intractable lymphedema,
with a
focus on patient independence. Lymphedema is a chronic disease due to an
obstruction, interruption,
or
malformation of the lymph system.
Currently, there is no cure for lymphedema. The physical results are
chronic
edema caused by excess fluid that accumulates in the interstitial tissue. This
fluid is high in protein
content, which distinguishes it from other types of
swelling. This fluid also has not yet been filtered and has a
high content
of bacteria and other waste products not normally found in this tissue. Health
risks include
progressively degenerative edema, tissue fibrosis, fibrotic
skin changes, blisters, wounds, re-occurring
cutaneous
and
sub-cutaneous infections (cellulitis), osteomylitis, deformed limb(s),
decreased mobility due to inactivity,
repeated hospitalizations for
infections, severe weeping of lymphatic fluid from swollen wounds
(lymphorrhea),
and in severe cases can even result in amputation, or
death due to sepsis. The psychological affects due to
appearance, pain,
reduced function, can be devastating to the quality of life of affected
patients.
As with many chronic diseases, untreated lymphedema tends to
worsen over time, resulting in increased
complications and morbidity over
time without treatment. When this chronic diseases are not
effectively
managed, the disease process progresses causing significant and
expensive health complications. Collateral
affects resulting from physical
limitations and complications can interrupt a patient’s normal lifestyle
activity
including employment, family relationships, social activities, and
exercise activity. Patients report a lack of
desire
to socialize
due to appearance, difficulty purchasing clothes and shoes that fit properly,
which in turn, causes
depression. The change in physical abilities
contribute to depression causing a feeling of being needy or
worthless.
Prior to experiencing lymphedema, many individuals report being able to perform
normal daily
functions as well as actively assisting friends and family in
meeting their needs. Once the disease progresses
to a
point of
affecting function, they are no longer able to participate in normal daily
activities such as cleaning
their
home, shopping for groceries,
caring for children or family, or other menial but important activities
healthy
individuals take for granted.
Goals and objectives must include
the education of medical practitioners in properly diagnosing upon
early
onset, education of medical professionals in properly identifying risk of
onset, early diagnosis,
appropriate
treatment, and educating
patients about the management of this life long disease. Treatment and
disease
management that are geared towards individual needs will create an
environment for successful long-term
management. This environment should
consider and provide treatment and tools that facilitate effective
results,
compliance, independence, exacerbation prevention, and
complication prevention. Treatment and
management
that is
individual needs based not only should include effective treatment, but
providing an individualized
treatment plan allows patients to enjoy a
psychological view that gives them control over their disease. This
improves
compliance by increasing their ability to maintain normal lifestyle activities,
while implementing
disease management into their daily regime.
Because 20
to 45% of cancer survivors who are treated with surgery, radiation, and/or
lymph node
removal develop lymphedema at some time in their lives, patient
education and early intervention for “at risk”
cancer patients is essential.
Some develop lymphedema immediately after treatment, and some years later.
Many
cancer survivors never develop lymphedema; therefore, those who
do may have an existing obstruction or
minor
congenital defect
of the lymph system prior to treatment, which predisposes them to experiencing
lymphedema.
Education for at risk cancer survivors provides them
with the necessary information for early recognition, so
they
are able to obtain treatment immediately upon symptom
onset.
Early intervention is essential in achieving treatment success. As
with any chronic disease with early
intervention, desired goals are achieved
at an accelerated rate, thus reducing the need for lengthy
treatment,
preventing expensive and debilitating health complications, and
better enables patients to continue with
normal
lifestyle
activities. Failure of medical practitioners in properly diagnosing early on,
ordering the proper
treatment,
and long-term disease management
can facilitate disease progression that can not only lead to
health
complications but facilitates employment loss, and other devastating
life changing events. In order to achieve
effective results and better
enable long-term success, several factors must work together in order to ensure
longterm
disease management success: education, early
intervention, effective treatment, and effective needs based
home management
tools that will allow independent, successful, and long-term home disease
management.
Treatment and management should include a comprehensive
approach that addresses each individual’s
physical,
mental, and
social objectives. Considerations during the treatment and long-term management
planning
should
not only include the patient’s objectives, but
their level of motivation, physical abilities, system of support,
employment
and social activity schedules. A realistic approach to disease management
should include the
evaluation of each patient’s ability and motivation to
implement management into their daily regime, and
should
involve
the necessary tools that are realistic in independent
application.
Prevalence In the United States:
Lymphatic obstruction
resulting in lymphedema can be caused by a congenital malformation, a
surgical
procedure(s), trauma, a benign or malignant tumor, radiation, lymph
node removal, sentinel node biopsy,
and
disease. Because those
affected are considered an underserved population, a lack of knowledge in the
medical
community has resulted in many individuals who
experience lymphedema to remain undiagnosed. Estimated
figures are available
however, they may be significantly lower than those who truly experience
lymphatic
disease.
Current Cases Estimated in the United States due to
reasons other than cancer or cancer treatment:
An estimated 2.5 Million
current cases of lymphedema that exist in the United States resulting
from
congenital malformation, trauma, surgical procedures, or disease.
Approximately 26% of cancer survivors
treated
with surgery
and/or radiation will develop lymphedema at some time in their lives. The
National Cancer
Institute
reports in a survey of 1151 women
treated with radiation for breast cancer, 23% reported lymphedema at
zero
to
two years after treatment and 45% of these women developed lymphedema at
fifteen or more years after
treatment. In patients treated with surgery
alone, 20% developed lymphedema at zero to two years and
30%
at
fifteen or more years after surgery. The National Cancer Institute
further documents patients with
lymphedema
reported an impaired
quality of life.
Lymphedema is seen more prevalently in cancer affecting the
stomach, colon, anal/rectal system, urinary
tract,
respiratory
system, biliary and gallbladder systems, bones and joints, soft tissue, skin,
breast, genital (both
male
and female) system, lymph system as
is seen in lymphoma, and sometimes the brain, other nervous system,
or
endocrine system. There are approximately between 2.02 million to
4.5 million cancer survivors in America
who
experience
lymphedema, with 156,214 to 351,481 new cases of lymphedema in cancer survivors
yearly. As
cancer treatment improves and more individuals survive cancer,
these numbers will continue to rise.
Total Americans estimated to experience
lymphedema as of 2006 is an estimated 5.1 million to 7.5
million
Americans:
Due to cancer or cancer treatment: 2.1 million to 4.5 million due
to cancer or cancer treatment
Due to trauma, infection, surgery, or disease:
2.5 Million
Due to congenital malformation: 500,000
We suspect these
numbers may be higher due to discrepancies in the definition and a lack of
uniform
diagnostic
criteria. Information concerning cancer
patients, for example, is somewhat limited to breast cancer while
lymphedema
resulting from other types of cancer and from other causes have not been well
reported and
documented.
Economic Impact:
As the disease process
continues to remain untreated and therefore progressively worsens,
individuals
who experience lymphedema become less mobile, less active, and
are eventually unable to maintain
employment. Individuals who were gainfully
employed are able to contribute to the government’s economy
via
income tax, and to the American economy in purchases of consumer
goods above and beyond items that
meet
the needs of minimal
survival. When lymphedema is not effectively treated and managed, allowing the
disease
to progress to severe levels affecting mobility,
affected individuals who are unable to maintain gainful
employment and are
forced to use disability benefits. Thus, they are no longer contributing to the
government’s
economy via income tax and instead are now being
supported by government sponsored long-term disability
benefits for both
income and medical care, and are limited to purchasing only items needed for
survival.
Americans who are not receiving effective treatment have proven to
experience obesity due to a lack of
mobility and exercise. Untreated
lymphedema leads to isolation, impairs patient’s ability to perform activities
of
daily living, and exercise, leading to weight gain and
obesity. Obesity has proven to significantly increase the
cost of health
care.
In an article published in 2004 by Reuters Health News, results of a
study showed a reduction in
compliance with disease management medications
when health insurance benefits reduced coverage. When
a
lack of
health insurance coverage prevents or hinders individuals who experience a
chronic disease from
implementing effective disease management, and the
disease process continues to exacerbate, individuals
experience health
complications that are much more expensive to treat, increasing the overall
national cost of
health care. The rise of health care costs is passed on to
American consumers via higher
insurance premiums and tax dollars, and
increased deductibles and co-insurance. This, in turn, affects
spending
in the economy, as expenditures turn towards health care
expenses, and away from consumer goods.
All of this can be avoided by taking
a common sense approach to health care by implementing improved
coverage and
treatment guidelines for effective disease management of chronic diseases
including
lymphedema.
This common sense approach is similar to
effective vehicle maintenance in utilizing the thought process of
regular
vehicle maintenance that may prevent a more expensive vehicle accident in the
future. Using the same
thought process of repairing a vehicle brake system
will prevent an expensive vehicle accident that can occur
with brake system
failure, we must also apply a common sense approach to health care
delivery.
Lymph System Overview:
The lymph system is an integral part of
the circulatory system and its function is to collect and
return
interstitial fluid, defend the body against disease, and absorb
lipids from the intestine and transport them to
the
blood. The
lymph system consists of the spleen, lymph nodes, lymph ducts, lymphatic
vessels, and lymphatic
capillaries. The lymph system runs parallel to the
blood capillaries and extends into most tissues, and while it
does not
communicate directly with the vascular system, it is
connected to the
vascular system by filaments that are attached to the outer surface of the
capillary wall. The
lymph system is present in almost all tissue, but is not
present in some, such as the central nervous system
and
cartilage.
With arterial inflow, protein plasma, a blood
component, is released into the interstitial tissue to deliver
moisture,
nutrients, and oxygen. Some excess fluid is collected during vascular outflow.
At the lymphatic
capillary end, the lymph system collects what the vascular
system does not collect, which consists of larger
molecules including
proteins, fat, and debris. The capillary end contains overlapping endothelial
cells that
form
“swinging tips” that open and close by constant
interaction of the capillary blood pressure, the plasma colloid
oncotic
pressure, the interstitial fluid pressure and the interstitial colloid oncotic
pressure. A pressure
gradient is
created by fluid pressure
differentials. The overlapping endothelial cells, open allowing fluid intake
but not
fluid
outflow. Once fluid enters the lymph system, the
fluid becomes lymph fluid.
The head and neck drain into the jugular then the
supraclavicular trunk. The upper extremity drains into
the axillary nodes,
which then drain into the subclavian trunk. The foot and lower leg drain into
the popliteal
and then inguinal nodes. The pelvic, abdominal wall, and
viscera return to the bloodstream primarily through
the thoracic duct. The
major node group that drains the body wall are external iliac, common iliac,
internal
iliac,
and visceral groups. The lymph flow is produced
by respiratory movements, muscle contraction, and the
stretching of lymph
vessels. In the normal lymph system, as the vessels become stretched with
lymph, the
smooth muscle wall of the vessel then contracts, pushing fluid
into the next segment.
Diagnosing Lymphedema and Determining the
Cause:
One or several factors can cause imbalance in extracellular fluid
volume. When one or more of the
pressure differentials is disrupted, the
fluid does not adequately eliminate from the interstitial tissue and
edema
results.
Edema due to lymphedema arises from a chronic failure in lymphatic function
caused by
malformation,
obstruction, or interruption of the
lymphatic system that results in the disruption in fluid differential.
Excess
fluids, proteins, immunological cells, and debris in the interstitial
tissues cause inflammation. If untreated, the
disease progressively becomes
worse. The accumulation of proteins result in tissue fibrosis or hardening
and
thickening of the interstitial tissue, which makes elimination more
difficult.
Obvious signs and symptoms indicative of insufficient lymphatic
transport include progressive chronic
edema, stasis dermatitis, blisters,
weepy wounds, and reduced extremity function. Some individuals
experience
pain, while others do not. When chronic edema is present,
other possible causes are ruled out. These
include:
congestive
heart failure, deep vein thrombosis, kidney failure, venous insufficiency
(sometimes is seen
concurrent with lymphatic dysfunction), abnormal hormone
levels, side affects of some prescription drugs,
and
occasionally
other temporary obstructions, i.e. ovarian cysts. A Venous Doppler may be
administered to
rule out
DVT, arterial insufficiency, and
vascular insufficiency. Lymphangiography may show where the
lymphatic
blockage is and the extent of the blockage, however not all labs
offer this diagnostic test, nor are they readily
available in all major
cities.
There are two types of lymphedema; primary which is caused by
congenital or hereditary defect, and
secondary, which is acquired resulting
from secondary factors such as surgery, trauma, disease, radiation, or
other
reasons. Primary Lymphedema is caused by developmental abnormalities, which may
be part of
chromosomal abnormalities (i.e. Turner’s Syndrome) or inherited
single gene defects, or by other
malformations
during gestation.
Other congenital abnormalities resulting in lymphatic dysfunction can include
Downs
Syndrome or Spinal Bifida, or other developmental malformation. Onset
occurring at birth is congenital
lymphedema, onset after birth but before
age thirty-five is Lymphedema Praecox. Onset occurring after
age
thirty-five is called Lymphedema Tardum. Some patients present with symptoms of
lymphedema as
adults
after an incident of trauma is reported.
Congenital abnormalities may have been present at birth but not
significant
enough to present symptoms until trauma, severe illness, or other event (some
report after flying
on
an airplane) occurred. These individuals
report no symptoms prior to the incident, but recall paternal or
maternal
relatives having symptoms. Obtaining previous medical
history and family history can assist in diagnosing the
patient who may have
a congenital malformation, but no symptoms until adulthood.
Secondary
Lymphedema is acquired and results from obstruction, interruption, or
obliteration of the
lymphatics. Cancer, trauma, severe infections, disease,
lymph node dissection, lymph node removal,
radiation,
sentinel
node biopsy, lymphoma, filariasis, and thrombosis can result in secondary
lymphedema. Some
medical
professionals also attribute lymphatic
dysfunction to other diseases, such as fibromyalgia, and reflex
sympathetic
dystrophy, although further evaluation of
this is
warranted. An evaluation was conducted on patients with unilateral lower
extremity lymphedema
using a
color Duplex Doppler scanner and
the results published in Lymphology 1999 March;32(1):11-4. Results
showed
soft tissue edema from lymphatic stasis gradually impedes
venous return. Chronic venous insufficiency, if not
treated, may also cause
fluid overload resulting in lymphedema. This further complicates the treatment
and
outcome. Patients with both chronic venous insufficiency and lymphedema
are more at risk of amputation
because due to a reduced blood flow, the skin
begins to die, and infection is more of a risk.
Complications include
re-occurring infections which include fungal, cellulitis, streptococci
and/or
staphylococci, and
osteomylitis. Infections result from lymph
stasis, decreased local immune response, tissue congestion,
accumulated
proteins, and other debris. Excess edema causing is high in bacteria, which
places affected
individuals at high risk of severe cutaneous and
subcutaneous infections. This excess fluid furthers the
obstruction of
healing as it prevents blood capillaries from delivering oxygen and nutrients
to keep the skin
healthy and respond positively to topical wound treatments.
Lymphorrhea or weepy wounds occur with
severe
lymphedema and
result from permanent tissue damage, and the skin’s inability to accommodate
excess fluid.
Excess lymph fluid begins to weep through the damaged skin
causing a blister that then results in a weepy or
a
heavily
draining non-healing wound. Other complications affecting the skin include
lymphoceles, papillomas,
and hyperkeratatosis.
Staging of lymphedema as
reported in the Lymphology 36, 2003, The International Society of
Lymphology
(ISL) Consensus Document, reviews the staging of lymphedema in
four stages as follows:
Stage 0 – “refers to a latent or sub-clinical
condition where swelling is not evident despite impaired
lymph
transport.”
Stage 1 – “represents an early accumulation of fluid relatively
high in protein content (e.g. , in
comparison with “venous” edema) and
subsides with limb elevation. Pitting may occur. “
Stage II – “signifies
that limb elevation alone rarely reduces tissue swelling and pitting is
manifest. Late in
Stage II, the limb may or may not pit as tissue fibrosis
supervenes. “
Stage III – “encompasses lymphostatic elephantias is where
pitting is absent and trophic skin changes
such as acanthosis, fat deposits,
and warty overgrowths develop.”
“Within each Stage, severity based on volume
difference can be assessed as minimal (<20% increase) in
limb volume,
moderate (20-40% increase), or severe (>40% increase).”
Lymphedema can
affect any part of the body. It most often affects either the upper or lower
extremities.
It can, however, also affect the head, neck, chest, back,
abdomen, hips, buttocks, and both male and female
genitalia. Congenital
defects can result in edema affecting the part of the body where the lymphatics
are
malformed. Secondary lymphedema can occur as follows:
Head and Neck:
regional lymph node removal and/or radiation. Surgical removal of a tumor
possibly
interrupting lymphatic flow. Disease, infection and regional trauma
may also cause regional lymph damage.
Upper Extremity: regional lymph node
removal, sentinel node biopsy, lymph node dissection, surgical
interruption
of lymphatic vessels, and the application of radiation. Disease, infection, and
regional trauma
may
also cause regional lymph damage.
Back and
Chest: Lymphedema can affect the chest and back area due to radiation,
congenital
deformation, regional lymph node removal, trauma and disease. It
is most often seen in post-mastectomy
patients.
Abdomen, Hips, Waist and
Buttocks: Abdominal surgical procedures including hysterectomy in which
inguinal
vessels and/or nodes were incised, and/or nodes removed.
Lymphatic interruption may occur without lymph
node removal. Disease,
infection, and regional trauma may also cause interruption to the inguinal
lymphatics
resulting in chronic lymphedema.
Male and Female
Genitalia: Occurs primarily due to the application of radiation, but can also
result from
rectal surgery interrupting medial vessels of the thigh, disease
or infection. The female genitalia tissue does
contain superficial inguinal
vessels that drain into the supermedial superficial inquinal nodes.
Surgical
interruption may also contribute to female genital
lymphedema.
Lower Extremity: Because the lower extremities drain into the
popliteal and inguinal nodes, any surgical
interruption of those vessels and
nodes can cause lymphedema. Regional trauma of the inguinal vessels
and
nodes, or popliteal nodes, disease infection, or radiation may result in
and interruption in lymph flow.
Surgical
procedures, such as vein
harvest, knee surgery, tumor excision, hysterectomy, or any surgical
procedure
interrupting lymphatic vessels and/or nodes can cause an
interruption severe enough to result in lymphatic
dysfunction. Because
intercostals and vertebral nodes are located in and around the spine, some
patients
who
have undergone surgical procedures involving the
spine result in lower extremity lymphedema.
Long term lower extremity
paralysis can be complicated by lymphedema due to the lack of a muscle
pump
assisting in gradient fluid differential due to reduced venous return, the
involvement of gravity, and
sometimes a trauma contributing to the paralysis
result in lymphatic dysfunction.
Not all individuals who experience surgical
procedures, radiation, trauma, disease, or infection develop
lymphedema. The
explanation for this may be due to a previous unknown factor of reduced
lymphatics
which
would interfere with the normal increase in
lymphatic uptake compensation for damaged or interrupted
lymphatics. If
there is an undisclosed predisposition of reduced lymphatics, this would result
in remaining
lymphatics to be insufficient in increased uptake performance,
when trauma to the body occurs.
Early Intervention and
Prevention:
Patients who have undergone treatment of cancer, surgical
procedures, and those who have been
diagnosed with venous disease should
receive a consultation for educational purposes for prevention and to
ensure
treatment during early onset of lymphedema. Patients whose cancer treatment
included the following
procedures are at high risk of developing
lymphedema:
1. Lymph node dissection
2. Sentinel node biopsy
2. Lymph
node removal
3. Radiation
4. Major surgical procedures
Prevention of
lymphedema includes:
1. Keeping the skin clean and moisturized
2. Avoid
having blood drawn from the affected extremity.
3. Avoiding hot showers,
saunas, or steam rooms.
4. Avoiding bug bits by using insect
repellents.
5. Protecting the skin from sun burn.
6. Avoid lifting heavy
objects and over strenuous activity.
7. Wearing a compression stocking when
flying on an airplane.
8. Use an electric razor to shave affected
extremity.
9. Education on signs and symptoms of onset and
complications.
10. Avoid sleeping on the “at risk” side of the body.
The
sooner treatment begins with a chronic disease, the less likely serious health
complications will
occur. Teaching “at risk” individuals to watch for signs
and symptoms of lymphedema will better ensure
early
treatment
intervention. Treatment applied immediately after onset has proven to achieve
more effective
longterm
results, exacerbation of the disease
process, and expensive health complications.
Treatment:
Criteria Used for
Review:
Various treatment modalities and technologies exist and are very
effective. Current clinical studies
published to date have been conducted on
many treatment options, however, much of the information in
these
studies is subjective and not objective, there are too few
subjects included in the studies, subjects are not
evaluated over a long
enough period of time, some published studies show conflicting results Some
studies
fail
to disclose important variables and factors in the
studies.
Some of the important variables and factors not reported in
current medical studies include length of time the
disease has been present,
condition of tissue, whether or not radiation was applied directly to
affected
edematous areas which may result in the requirement of increased
therapy, level of patient compliance, and
additional therapies that were
applied to some subjects and not others during the study. This overview will
seek
to address objective information and review the
physiological affects and benefits of various treatments
versus
subjective information provided in some of the available
published data.
Initial Evaluation:
Once the proper diagnosis has been
obtained, the treating therapist should gather the following
information
during the patient’s initial evaluation: health history, signs and symptoms,
disease etiology,
history of
complications including current,
social demographics, employment status, the system of social and
emotional
support, nutritional status, and specific treatment goals.
Treatment should be adjusted to meet the patient’s
physical needs while
considering level of motivation of compliance, and ability to be compliant.
Daily
schedule,
social activities, financial status, and mental
capacity should be considered when developing a treatment
plan,
and setting specific reasonable and attainable goals.
Contraindications should be ruled out, which include
deep
vein
thrombosis, renal failure, and active cancer unless providing palliative care,
active infection, and
congestive
heart failure. Allergies to
creams, foam, and bandaging products should be obtained and alternatives
considered
when allergies are present. Treatment may not be applied
to areas with localized trauma, and
hyperthyroidism
prohibits
neck treatment.
Treatment should be applied by a licensed medical
professional who have received at least 135 hours of
specialized training in
the disease etiology and treatment of lymphedema which includes combined
decongestive
therapy. Combined decongestive therapy includes the
application of manual lymph drainage and external
compression. Because
lymphedema is accompanied by health complications, specialized training is
required.
When a non-medical and/or insufficiently trained individual
attempts to treat a medical disease, further
complications can ensue causing
physical harm to the affected individual.
A two phase treatment approach
that includes an intensive treatment phase, followed by a long-term
disease
management phase is optimal. The first phase involves direct one on one
application of manual
lymph
drainage and short-stretch
banding.
Manual Lymph Drainage:
In the overview of normal lymphatic
function, fluid enters the lymph system in two ways: pressure
gradient
dynamics, and as the lymph vessel are stretched with lymph fluid, it is pushed
into the next deeper
segment. When the lymph system is dysfunctional, this
action can be done manually by the application of
manual lymph drainage.
Manual lymph drainage is a
specialized massage technique, in which lymphatic
receptors are manually stretched. Because the lymph
system
operates by the outward pressure differential pushing the
fluid into the lymph collectors, manual therapy
physically manipulates the
lymphatic collectors by manually doing what the lymph system is unable to do on
its
own.
Manual lymph drainage further assists the body in
redirecting fluid away from damaged or impaired
lymphatics and towards
working lymphatics. Fluid can be redirected around scarring that may be
“blocking”
lymphatic flow. Therapy begins proximally in order to clear a
path for distal fluid, allowing for a place to
send
excess fluid.
The jugular/subclavian vein junction at the base of the neck is cleared first
as this is the main
pathways of lymph elimination.
Deep breathing
exercises performed during this therapy assist in stimulating deep lymphatic
flow.
Lymphatic flow is increased with lymphatic output of the thoracic duct
and lymphatic trunk by deep
diaphragmatic breathing exercises. This also
contributes to peripheral lymphatic increased flow. Exercise is
also
beneficial in moving lymph fluid as the intrinsic contraction
of muscles and movement of veins during exercise
helps to mobilize lymph
flow.
External Compression:
Stimulation of the lymph system with manual
lymph drainage does assist in clearing, redirecting fluid,
and stimulating
stagnant lymphatic flow, it does not actually significantly reduce edema due to
excess fluid.
External compression must be applied in order to produce
significant reduction and maintain reduction.
Tissue
compression
helps prevent fluid refill, softens hardened tissue, and aids in fluid
re-absorbtion by acting as a
resistive force. External compression assists
in edema reduction by helping to move fluid out of the interstitial
tissue
and into the vessel system for elimination.
Phase One – Intensive Therapy
Phase:
The initial treatment phase should include direct one on one
therapist’s application of manual lymph
drainage. Optimally, therapy is
applied for twenty consecutive days or more if needed to achieve
reduction
goals. Some individuals who have very mild lymphedema and are
treated immediately at onset may require
less
however, treatment
plans should be
-6-developed to meet each individual’s needs. Patients with
severe cases who may have hardened fibrotic
tissue
that is more
difficult to eliminate, wounds, or other health complications may require more
therapy. It is
essential to address the disease adequately during the
intensive therapy phase so that complications do not
arise
and
home disease management is achievable for the patient.
The therapist should
treat the disease in its entirety during the intensive phase, and assist the
patient in
keeping the disease maintained at home. Failure to adequately
treat affected patients during the intensive
therapy phase will result in
treatment failure because when significant reduction is not achieved, wounds
are
not
healed, and a patient is left to complete treatment on
their own. This is much like a surgeon handing a patient
the scalpel halfway
through surgery, and asking the patient to complete the surgery, and suture
their own
incision. Unfortunately, inadequate insurance coverage many times
results in the non-completion of
necessary
and essential
therapy. This causes treatment failure and the result almost always is the
requirement to return
to
therapy after a exacerbation of edema
and/or serious and expensive health complication has occurred.
During
therapy, each visit should consist of at least the following:
1. Therapist
application of manual lymph drainage. The therapist should not only apply
manual lymph
drainage on the affected extremity, but it is essential to
first apply therapy to stimulate the
jugular/subclavian vein. This is needed
to stimulate and prepare it for receiving fluid. Therapy is then
applied
proximal to distal. When bilateral extremities are affected, therapy
focuses on one extremity at a time, with
treatment starting with the worst
extremity first. After the most severe extremity is adequately
treated,
therapy begins on the second extremity.
2. Diaphragmatic
breathing exercises.
3. Application of Short-stretch bandaging -
gradient.
4. Exercises specifically designed to assist in promoting working
pressure against the bandages can be
done to increase lymphatic flow.
Modifications can be made in bandaging techniques to address
phlebolymphatic
components of the disease as well.
5. During the intensive treatment phase,
the therapist is also educating their patient on this process, so
that
therapy can continue self-application of therapy during the home management
phase. Patients should
also
be educated on the importance of
good skin care, prevention of complications such as exacerbation
and
complications.
Time of application:
Each therapy visit for
combined decongestive therapy is based on the severity of the patient’s
condition.
Considerations include whether or not there is a wound present
that will need addressing, the stage of the
lymphedema, and whether or not
there is hardened fibrotic tissue to address. Fibrotic tissue is difficult
to
eliminate and requires more attention during manual lymph drainage. More
severe and advanced stages of
lymphedema require longer therapy times, while
early stage lymphedema may not require more than forty-
five
minutes of lymph drainage.
Other considerations include
areas of the body that are affected. Some affected individuals
experience
lymphedema in more than one region, therefore, more time is
required to address all affected areas. For
example, a patient who
experiences lymphedema in the chest, back, and upper extremity will require
more
therapy time than a patient who experiences lymphedema affecting only
the upper extremity.
The average treatment time for lymphedema is typically
as follows, but should be adjusted
according to the patient’s specific
health needs:
Manual Lymph Drainage (MLD): 60 minutes
Diaphragmatic
breathing exercises 5 minutes/intermittently during MLD
Application of
short-stretch bandage 15 to 30 minutes
Exercise 15 to 30
minutes
Education 15 minutes
Wound Management in Presence of Severe
Oedema: Severe oedema due to chronic lymphedema or severe
venous
insuffieiency with secondary lymphedema results in massive buildup of
interstital fluid. Swollen limbs
are more prone to loss of skin integrity
and skin breakdown. In the case of ulceration or trauma, the
excess
interstitial fluid must be reduced in order for wound healing to
occur. There are several reasons why
reduction
of excess
interstitial fluid is critical to wound healing. First, fluid buildup leaks
into open wounds, following
the
path of least resistance. The
ulcer then becomes an outlet for reducing the interstitial fluid, similar to a
faucet
being turned on. Draining ulcers are much less likely to heal due to
the fact that the leakage of the fluid
actually
creates a
hemodynamic steady-state situation. Therefore, without reduction of
interstitial edema, healing
cannot
occur as the ulcer is an
outlet for fluid.
Secondly, there is dramatic decrease in oxygen
delivery to wound beds in the presence of significant
interstitial
edema. The reason is simple. Oxygen and nutrients must
diffuse from the capillaries and then through the
interstital fluid, in
order to reach cells. There is increased metabolic rate in wounds needed for
healing,
including collagen production and cross-linking. Further oxygen is
processed by the body's immune cells to
kill
bacteria by the
oxidative burst method. Furthermore, cell waste products and toxins must be
removed by
diffusion back into the capillary system. Without reduction of
the interstitial edema buildup, bacteria are not
killed and are more likely
to travel into the interstitial fluid planes where they can multiply,
dramatically
increasing the risk of infection.
In summary, reduction of
edema achieves several vital functions related to wound healing:
1) Allows
capillary seal in the wound bed, which speeds healing.
2) Reduces fluid in
wound bed, reducing bacterial colonization and infection rates.
3) Increases
oxygen deliver to speed wound healing.
4) Reduces risk of infection.
5)
Prevents skin macerationof periwound skin.
6) Increases removal rate of
toxins and cellular byproducts, CO2.
Optimal wound care includes:
1.
Wound cleaning. Sterile saline is the preferred agent using gentle pressure. In
simple wounds, a blunt
cannula with syringe can be used. The gentle pressure
of 8-15mm has been demonstrated to reduce
bacterial
load on the
wound bed. In more extreme cases, pulse lavage is needed. Cytotoxic agents such
as hydrogen
peroxide and betadine and most commercial cleansers should be
avoided except in wounds heavily
colonized
with bacteria.
2.
Skin barrier. Since the affected area will be bandaged, a skin barrier needs to
be applied to the limb
to ensure proper skin care. Typical products used
have 2% dimethicone, which prevent skin drying and
chaffing, and also help
prevent maceration. For the periwound skin near draining ulcerations, a more
moistureresistant
barrier dressing is needed, such as one with
high zinc content.
3. Moist wound healing. Wound healing is much improved in
the presence of a moist wound bed. A
properly moistened wound bed
facilitates autolytic debridement, which speeds the bodies own
healing
mechanism. Moistened wound beds are much quicker to epithelize, and
scabs and eschars slow healing
rates
and increase scarring.
Scarred wounds do not have the same skin integrity as properly healed wounds,
and
have some increased likelihood of reulceration. Much of modern wound
care focuses on adequate control of
drainage. For heavily draining wounds,
special dressings need to be used to wisk away the drainage from
the
wound bed and periwound. A good example of such a dressing is
Exudry, which is a dressing made of
similar
design as a diaper.
This is the preferred dressing by many professionals for ulcers draining
lymphedema fluid
(lymphorrhea). For more modrately draining wounds, ABD
(abdominal) pads can be used. For lightly
draining
wounds, gauze
is adequate. For wounds that are not draining, often a telfa dressing is useful
to cover the
topical medicine applied to the wound bed, to prevent drying.
For very dry wound beds, a dressing which
contributes moisture to the wound
bed is needed, such as hydrocolloid dressings. The highest moisture
donor
medication is a hydrogel, which contains over 90% water and
can rehydrate eschar.
4. Appropriate medication selection. Use of
antimicrobial dressing is often desired. Silvadene, used
long for burn care,
is cytotoxic and has no place in wound care outside of burn care. It is still
preferred for
burns due the ability of Sulfamylon to penetrate eschar with
silver ions which are antimicrobial. Preferred
dressings are not cytotoxic,
but wound have antimicrobial properties or facilitate active wound healing.
There
are many hundreds of products and their discussion and
efficacy is out of the scope of this document.
Examples
include
Aquacel Ag, Acticoat, and Silvasorb hydrogel. Needless to say, proper dressing
selection and
application
techniques often makes a significant
difference in the outcome rate of wound healing.
5. Removal of nonviable
tissue. Necrotic and nonviable tissue should be removed from the wound
bed
to stimulate healing. This can sometimes be done through use of
enzymatic debriding agents. For wounds
with
significant slough,
mechanical or sharp debridement is recommended. Use of topical anesthetics such
as
EMLA
cream or 2% lidocaine are sometimes used as topical
numbing agents as needed.
6. Dressings may need to be changed daily. Heavily
draining wounds need to be changed more often.
Adequate use of compression
can greatly reduce drainage levels over time. Often, bandages need to
be
changed daily for wounds with severe lymphorrhea. As compression reduces
the interstitial fluid, dressing
changes can be spaced out less often. Use
of antimicrobial dressings allows less frequent dressing changes.
In
modern wound care clinics, dressing changes once to twice weekly
are possible after interstitial edema is
reduced through proper technique
and dressing selection.
7. Compression bandaging. The gold standard for
lymphedema management is short-stretch bandages.
These bandages have unique
properties that make them ideal for lymphedema management. These
bandages
are usually applied over cotton batting. The number of layers and
technique of application is specialized, and
requires special training. This
requires extensive training, such as is given only in specialized classes
focusing
on
lymphedema treatment. For lower compression,
a
spiral bandage is applied. For more compression, a figure 8
application is used. Often, bandages with less
width are used on the distal
limb, and then wider bandages are used on the more proximal limb. Technique
can
be used to apply the bandage with gradient compression, by
varying the stretch of the bandage and altering
technique and number of
bandage layers.
Multilayer compression wraps or limited reusable garments
such as the FarrowWrap WoundOp(TM) line
are
possible. Completely
nonelastic bandages such as the Unna boot are other options, although they
lose
compression as edema reduces and so are not as ideal as short-stretch
bandages with some elastic
compression.
8. Foam padding. Foam
padding is often necessary for lymphedema patients. There are several
foam
types used in lymphedema management. White foam is softer (lower
inflection load density of approximately
30) and used to pad sensitive areas
such as the ankle bones and tendons over the top of the foot. More
dense
foam with IDL of around 60 is often used to create small pads
with waffle-like configuration. This
configuration
is used over
areas with chronic fibrotic changes due to lymphedema. The foam can help reduce
fibrotic
areas
and restore more normal limb function. Padding is
also necessary between skin folds. In severe
lymphedema,
there
are often large crevices that form between massively swollen limb portions.
These crevices often
become
macerated and are a haven for fungal
infections, ulcerations, and bacterial infections to form. These skin
folds
must
be properly cleaned, appropriate skin barriers or antifungal creams applied,
and then foam wedging
used
to provide gentle compression to the
area to reduce lymphatic swelling.
Gradient Pumps or Manual Lymph Drainage
Pumps During Therapy: Gradient pumps may be
applied during therapy as an
adjunct to treatment. There are newly developed and FDA approved
compression
devices that apply both external compression and manual
lymph drainage mechanically. While mechanical
devices should not take the
place of therapist applied manual therapy, they may be used in addition to
therapist
manual therapy. These devices assist in achieving further
reduction when a patient has reached a plateau, but
requires more reduction
in order adequately treat the lymphedema.
Gradient pumps may be applied for
half an hour to an hour after manual lymph drainage, followed by
the
application of bandaging. Some therapists continue to apply therapy
during application of the gradient pump.
Therapy is applied towards regional
nodes proximal to the affected extremity.
Phase Two – Independent Home
Management Phase:
The independent home management phase occurs after
treatment goals have been accomplished which
includes significant edema
reduction, approximately 30 to 60% depending on the disease stage, and
wounds are
healed. Patients should be supplied with a daytime
compression stocking or garment. Prior to discharge,
each
patient should have a good understanding of proper application
of manual lymph drainage, diaphragmatic
breathing exercises, extremity
exercise, skin care, nutrition and proper application of compression
bandage
systems.
Because compliance during the maintenance phase is
essential, evaluation for long-term external
compression
is
essential. Long-term many patients are not able to be compliant with
bandaging, possibly due to other
physical
limitations such as
arthritis, back injuries, or other conditions that prevent their ability to
properly apply
bandages. Patients report a lack of confidence in their
ability to properly apply bandages, they are not
physically able to apply,
or they simply refuse to wear them because they are time consuming and tedious
to
apply and uncomfortable. In order to adequately address long-term goals,
a realistic approach to disease
management compliance and independence must
be applied with consideration to long-term use of external
compression. This
can be accomplished by evaluating the patient’s physical abilities, system of
support,
lifestyle,
motivation to apply treatment, and the
psychological value in allowing each patient to control their
disease
management tools. A Pre-Discharge Questionnaire assists in
determining what external compression
alternatives
might be most
effective based on the individual patient’s needs.
The “Bandage Only”
approach:
Patient feedback indicates some practitioners have advised patients
that the only way to effectively
manage their disease is by application of
short-stretch bandage. This approach is limiting and not realistic.
Patient
feedback specifically shows a window of application for about two weeks. After
about two weeks,
the
bandaging ceases application by most
patients, therefore, their condition exacerbates. Once the
disease
progresses to a place that is intolerable for the patient, they are
forced to return for therapy. This occurs
repeatedly for years. Patients
must be offered realistic external compression that they are able and
motivated
to
apply daily. Proper evaluation, proper education as to all the external
compression tools available and
patient
choice not only assists
with realistic application, but gives control back to the patient. Most people
are more
compliant with treatment that they choose for themselves. Since
they are the ones who must live with the
disease and the treatment, they
should be the decision maker. The medical practitioner’s job is to
educate
patients on available treatments, the function of each external
compression device, and the proper use of the
external compression device
once the item has been provided. It is then up to the affected individual to
make
the final decision as to what they believe they can live with, and be
compliant with.
Types of External Compression:
The compression
applied externally can apply either resting pressure or working pressure.
Working
pressure refers to pressures that increase with activity. Working
compression is temporary and allows for
superficial vessel refill. This
compression is rigid compression and offers the most resistance against
expanding
muscles. It is most effective when a
patient is walking
or exercising. Examples of working compression are short-stretch bandage, Unna
boot,
rigid
bandages, adhesive bandages, moderate short-stretch
bandages short-stretch compression stockings.
Resting pressure refers to
external compression that pressures increase with rest. This compression
is
constant pressure and involves the use of strong, very elastic bandages.
Since resting compression is
constant, it
does not allow for
superficial vessel refill. Examples of resting compression include, ace wraps,
long-stretch
bandages, and long-stretch stockings.
Pressure Gradient is
essential in the application of external compression. Since one goal in
treating
lymphedema is to restore pressure gradient fluid differentials,
uniform compression can result in pressure
disturbance. Non-gradient
compression can result in compression of proximal vessels and thus, blood
being
trapped in the periphery. This in turn, compromises venous return in
from the distal part of the limb. Because
the venous in-flow increases
lymphatic flow, lymphatic dynamics are reduced. It is much like squeezing a
tube
of toothpaste in the middle. Fluid back up can cause pain, and
exacerbate edema. Because the body
operates
on a pressure
gradient system, treatment should physiologically mimic the body’s system as
close as
possible.
Dr. Smith, Scurr published an article in
Surgery 1990;108:874, in which they discuss the criteria used for
external
compression used in their study. They used Doppler
ultrasonography to review the affects on the veins when
using uniform
compression versus gradient compression. Uniform compression was shown to
collapse the
proximal veins first with the wave of vessel collapse moving in
the distal direction, while gradient
compression
was seen to
collapse the distal veins first with the wave of vessel collapse moving
proximal. Uniform
compression, in collapsing proximal to distal resulted in
a “trapping” of blood in the distal veins, whereas
gradient compression
resulted in a more complete emptying of the distal veins. Patients have
reported
nongradient
compression causes severe paid and
exacerbation of edema. This may be attributed to the distal
trapping of
blood when uniform compression is applied., as it operates against the body’s
natural pressure
gradient system.
Bandaging Alternatives
Overview:
External Compression Devices should be applied by either a trained
therapist, or a certified
compression therapist who has received at least 40
hour of training specific to disease management of
lymphatic
and
vascular disease. Durable medical equipment companies providing these devices
through delivery
personnel or shipping to patients with little or no
instructions can allow for misuse, or placement in spite of
the
existence of contraindications. Because these items are
medically prescribed by a physician, failure to
provide
proper
instructions by trained therapists can lead to serious health complications,
just as providing
prescription
drugs through the mail with little
or no instructions. Trained professionals should always be involved in the
setup
and instructional phase of providing medical equipment and
supplies for lymphedema.
Foam Compression Garments: Foam compression
garments include the Reid Sleeve, Circ-Ai, and Leg
Assist Garments. These
garments work by applying high low pressure points. Foam, when compressed
against
edematous fibrotic tissue works by physiologically by
applying increased pressure, providing a more even
pressure distribution,
helps to provide as foam moves against the skin, it assists in stretching the
skin thereby
stimulating lymph function. When foam is applied with gradient
compression, it assists with the breakdown
and
softening of
hardened fibrotic tissue. This facilitates the elimination of fibrotic tissue
that would not otherwise
eliminate. These devices utilize a system of Velcro
straps and/or an outer spandex type garment that simulate
bandaging.
Patients are much more compliant with these devices as they are easier to apply
and more
comfortable to wear over lengthy periods of time. Foam compression
devices may be worn for nighttime
compression and the devices that are not
accompanied by Velcro straps can be used with gradient pump
therapy. The
compression applied by foam compression garments provide protection for the
superficial
lymphatics, while applying resting compression.
Directional
Flow Garments: Directional Flow garments, such as the Jovi Pak and the Solaris
Tribute
Garment use a similar technology as the multi-density foam
compression garments, but are designed with
seams
that assist in
directing lymphatic flow towards proximal lymph nodes for elimination. Various
foam densities
and the shapes of foam chips enhance lymphatic circulation
and assist fibrotic tissue for elimination. These
garments are used with a
compressive outer garment that assists with increased compression. Bandaging
can be
applied over these devices as can gradient pumps. These
devices provide compression for affected areas of
the
body such
as the face and neck, the genitals, the chest, the hips and abdominal region.
These devices are a
thinner than foam compression garments, and patients
compliance is extremely high because of their ease of
use. These devices
offer technology that assists the body in stretching superficial lymphatics,
thereby
stimulating
lymph flow in the proximal direction for
elimination.
FarrowWrap(TM) Classic Arm-Wraps and Leg-Wraps: This
technology uses short-stretch
compression technology to simulate
short-stretch function in a garment. The garment has similar
compression to
two layers of short-stretch. The garments can be used
to simulate bandaging. The short-stretch function
augments the muscle pump
to augment venous return. The low active compression prevents garment
slippage
and
allows accomodation to limb size. Physiologically, the short-stretch function
is very effective in removing
excess fluid, creating the "pumping" action
that that it is not able to provide on its own. The garment has
been
demonstrated to be easier to don than compression stockings,
and can be used in patients with low
Activities of
Daily Living
(ADL) scores to give them more independence in controlling their swelling. The
FarrowWrap
(TM)
is the only garment in the world with
short-stretch technology.
FarrrowWrap WoundOp (TM) Arm-Wraps and Leg-Wraps:
This line of FarrowWrap products is
designed for Wound care and
post-Operative use. It uses short-stretch technology to provide safer
compression
garments.technology
uses short-stretch compression technology. The WoundOp product line has
slightly
lower
resting compression levels than the Classic
model. The product, however, is breathable and easy to dry, and
more
suitable for use on active wounds. This limited reusable garment has expected
life expectancy of at
least
three months. Since it is reusable,
it is cost-effective over many disposable garments, such as
multilayer
compression wraps, which must be reapplied at least once per week
and in many cases several times per
week.
Circ-Aid Silhouette:
This unit is made using soft foam technology and assists patients with
bandaging.
Foam is applied under bandaging in order to prevent slipping, to
assist with increased local pressure and in
fibrotic tissue breakdown. Many
patients have difficulty bandaging with individual pieces of foam. Holding
the
foam in place while wrapping the bandage around the extremity is
difficult, especially when bandaging the
upper extremity. This device better
facilitates bandaging as it provides the foam in one easy “slide-on”
unit.
This device also reduces the patient’s expense of having to
continually re-purchase new foam.
Circ-Aid Non-Elastic Legging: This
technology non-elastic sustained compression device consists of a
series of
straps that simulate bandaging. With the application of gradient compression,
this device uses
working
pressure to assist in stimulating
venous return and as the patient walks, the superficial lymphatics are
stretched
assisting in increased lymphatic flow. They are easy to
apply and compliance due to ease of use, is very high.
Physiologically, this
device is effective by assisting the body in removing excess fluid, by creating
the
“pumping”
action that it is not able to provide on its
own.
Foam Pads: Reid and Solaris Tribute provide foam pads or crescent
shaped pads that assist with
hardened areas of over large lipomas or fatty
lumps, to assist in break down and elimination. Pads, using
applicable
shape, can be placed around ankles or just under the lipoma and bandages
applied over them in
order to address the edematous and fibrotic tissue.
Lipomas are extremely difficult to bandage and bandages
tend to slip.
Application of foam pads assist in addressing these tough areas by adding soft
high low pressure
directly to the problem area.
Pumps: Pumps in
particular have been widely misapplied, and misrepresented within the
medical
community. These devices can either cause lymphedema to exacerbate
when not applied properly, or when
applied properly they are an invaluable
tool for many affected individuals who have achieved significant
disease
management success over a long period of time. Pumps are not
recommended for everyone, and the
mechanism of compression of some pumps can
cause harm. Due to the lack of education and standard of
care
with these devices, this document seeks to establish a model of
application for sequential pumps when
treating
lymphedema.
There are three different types of
pumps:
1. One chamber intermittent: This pump by applying uniform
compression works against the body’s
natural physiological pressure gradient
system. In doing so, it causes a reflux of fluid in the distal veins,
thereby
increasing
pain upon compression, and increasing edema. This device may reduce edema
initially, however
long
term use can cause further damage to the
lymph system. Patients who use a one cell or one chamber pump
cease use
after a few months due to pain, and as edema becomes worse instead of better.
These devices
are
contraindicated for the treatment of
lymphedema.
2. Sequential non-gradient: This pump applies compression using
three to six chambers. These devices
also in applying uniform compression
sequentially, have shown to cause severe pain upon compression and
increased
edema. Since treatment of lymphedema seeks to restore the pressure gradient
differentials,
application
of compression that works against
pressure gradient differentials are contraindicated for the treatment
of
lymphedema. Short term use may show some reduction, however long-term use
has shown to cause
exacerbation. Compliance becomes an issue as the patient
sees his or her condition exacerbating.
-11-3. Gradient Sequential: Pumps
that apply gradient sequential compression are more closely mimicking
the
body’s pressure gradient system, and more accurately assist in edema reduction,
by helping to restore
pressure gradient differentials. Gradient compression
pumps contain six to twelve chambers, depending on
the
model.
Compression is applied distal to proximal with more pressure distally than
proximal. Gradient
sequential
pumps that apply compression using
a shorter cycle time, more closely mimic venous inflow during walking.
Since
the venous inflow occurs from the planter veins to the femoral vein in
approximately thirty seconds, a
thirty second cycle time is preferred. By
applying compression at the plantar veins, venous inflow is
increased
through the deep venous system. When compression is
applied to the plantar veins, venous out-flow
increases
at a
higher rate of speed. Some medical practitioners believe that this sheer force
against the endothelial cells
releases a natural anti-coagulant into the
blood stream, which prevents or reduces the occurrence of deep
vein
thrombosis. As the gradient pressure continues its sequence
distally the peripheral venous inflow increases,
and
excess edema
causing fluid is pushed back into the vascular system for
elimination.
Peristaltic Wave: Since larger lymphatics have a peristaltic
rhythm, a gradient pump that applies
peristaltic compression is optimal. In
utilizing a gradient compression pump that utilizes the maximum number
of
non-overlapping chambers, as compression is applied sequentially, one chamber
is compressing as
proximal
chambers are releasing compression.
This action results in a slight pulling of the skin as compression
moves
distally, which stretches the superficial lymphatics causing an
increase in lymphatic flow. This technology
more
closely mimics
manual lymph drainage. As the chambers deflate, they allow for capillary
refill. This cycle
compresses distal to proximal every thirty to sixty
seconds during compression pump therapy.
Compression setting: External
compression has shown with the use of a laser Doppler probe,
showed
micocirculatory flow velocity and concentration of moving blood cells reduced
when pressures were
too high. Vascular flow increased upon application of
external compression until 60mmHg, at which time,
microcirculatory flow
began to decrease. Pressure settings between 45 mmHg and 55mmHg, depending
on
patient tolerance are optimal to achieve significant reduction of
edema.
Duration: The duration of gradient compression when used in a clinic
setting should be applied
for about one half hour after the application of
manual lymph drainage. Manual lymph drainage may also be
applied in the
region of drainage during gradient compression therapy. For long-term disease
management
two
hours BID is optimal, as one hour of use only
address “new” fluid, and does not allow time for addressing
“old”
fluid or fibrotic tissue. Once significant edema reduction is
achieved, and wounds are healed if present,
gradient
compression
may be applied as needed to maintain edema reduction and manage
lymphedema.
Gradient Compression Pumps are not recommended when a patient
experience severe renal
failure, active infection, active cancer unless used
for palliative care, deep vein thrombosis, or with
congestive
heart failure. If a patient has a history of congestive
heart failure, has been clear for six months or more and
is
compliant with diuretics, a pump may be applied; however
application may be reduced to one hour BID. A
pump may not be appropriate
for patients who experience limited lymphatics in regional nodes where
drainage
occurs, such as the inguinal region for lower extremity
drainage, or the
back or chest wall, for upper extremity drainage.
Application of a pump may further complicated edema by
pushing fluid to
already affected areas. Some compression devices provide garments that extend
over the
back
and chest wall, and/or over the
hips, waist,
abdomen, and even the female genital region that are appropriate in these
cases, and will
address
edema in these drainage regions,
however, gradient compression should not be applied without extensions
to
address edema in areas affected. Gradient pumps are also not appropriate
for use when male genital edema
is
present, unless the device is
accompanied by an appliance, such as the device that addresses the hips waist
and
abdomen, and when a foam pad is included. These appliances
look more like pants, and allow for
compression
to begin
distally, to just under the chest, addressing affected regions as described
above. Pumps should
always
be used in conjunction with manual
lymph drainage.
Foam Compression for Use with a pump: Foam compression
garments, such as the Reid Optiflow,
Jovi Pak, or the Solaris Tribute
garments may be used with gradient sequential compression devices.
The
application of foam garments with compression therapy assists by
providing addition compression, breaking
down fibrotic tissue that would
otherwise not be eliminated, protecting the superficial lymphatics from
over
compression, and reducing pain. The application of foam with external
compression devices is similar to
bandaging over foam, and because of the
comfort and ease of use, compliance is significantly higher than
the
application of the pump or banding alone.
Compression stockings:
Despite the fact that compression stockings are considered by many as
a
“conservative method of treatment”, compression stockings are not a
“treatment” at all. When used during
early
onset, in conjunction
with manual lymph drainage and exercise, they may assist in effective
disease
management. However, compression stockings do nothing to actually
treat lymphedema. Compression
stockings are a must for use as a daytime
garment to maintain reduction achieved with manual lymph
drainage,
bandaging, and other compression devices. Stockings that
apply 20 to 30 mmHg of graduated compression
should be applied as a part of
the disease management plan in order to continue reduction during daily
activity.
-12-
Miscellaneous treatment overview:
Diuretics:
Diuretics must be used when prescribed by the examining physician, and are
needed to treat
various health conditions, however, when they are used
solely for treating for lymphedema, they can do
more
harm than
good. Diuretics work by removing water from the subcutaneous tissue. In doing
so, they leave
behind proteins and bacteria, now in a higher concentration.
This places the patient at a greater risk of
infection, and long-term use
causes fluid to become hard and fibrotic, making elimination more
difficult.
Furthermore, once the tissue is starved for water, it pulls more
water to the tissue, making the edema worse
long-term. Reduction achieved by
diuretics, unless edema results from causes other than lymphedema, is
shortlived.
Diuretics
further deplete the system of potassium which can cause lower extremity
pain.
Elevation: Elevation assists in edema reduction by eliminating
gravity, and allowing edema causing fluids
to flow towards regional drainage
nodes, however, as soon as elevation ceases, edema returns. This also is
not
a long-term effective method of treatment. It further hinders
the patient’s ability to maintain an active and
productive
lifestyle.
Pool therapy: Pool therapy is an effective adjunct to lymphedema
treatment as the water applies external
compression. External compression
during exercise assists in stretching the lymph vessels improving flow.
Pool
therapy also assists in protecting from muscle strain which can
exacerbate lymphedema, by preventing quick
strenuous movements and allowing
for more slow precise exercise movements. By itself, however, it is not
an
effective long-term disease management tool. When included with
manual lymph drainage and effective
external compression, pool therapy is an
effective exercise technique.
Set-Up Procedures for External
Compression:
External Compression Devices should never be shipped to
patients unless a patient has been properly
trained in its use, and multiple
follow-up visits have been conducted to ensure this is the case. Just as
antibiotics
or any other physician prescribed medical treatment
requires proper use, so does external compression
used to
treat
lymphedema. When used appropriately, these devices can provide an effective
adjunct to disease
management however they can also cause health
complications when not used appropriately. It is
recommended
that external compression devices be provided by a
licensed medical professional with training specific to
treating lymphatic
disease, or a properly trained certified compression therapist.
Each patient
should receive the following with the set-up of home medical supplies or
external
compression devices:
1. Home Set-up
2. Measurements starting
at the ankle or wrist, unless edema involves another area of the
body,
measuring every four centimeters distal to proximal. These
measurements can be entered into various
available
computer
programs in order to determine volume of edema, and reduction.
3. The
patient should be shown how to apply the device, and then allowed to apply the
device
themselves.
4. Have the patient use the device while reviewing
other information, such as:
a. Confidence level in their independent
application of MLD
b. Knowledge of proper exercise technique.
c.
Knowledge of breathing exercises.
d. Knowledge of proper skin care.
e.
Knowledge of proper diet.
f. System of support
g. Confidence level in
their independent application of daytime compression garments.
All
information reviewed above should be reviewed again, when needed, and written
information should
be left
for the patient at their home with external
compression devices.
5. After the device has been applied for no less than
half an hour, measurements should be taken again
and reviewed with the
patient. Problem areas can be addressed that may require special
attention.
6. Review questions and concerns, and refer the patient referrals
to the treating therapist, may be
suggested when there is any question or
lack of confidence in self application at all.
Follow-Up:
Follow-up is
essential for successful long-term disease management. When external
compression is
provided, a seven day phone call should be made to ensure
patient comfort, ability to consistently and
independently apply, and to
address any questions, concerns, or complications they may be
experiencing.
Six to eight week measurements should be taken in order to
monitor continued reduction after external
compression devices have been
provided. In severe cases, three to four subsequent follow-up evaluations
may
be needed. Improvements in edema reduction, skin presentation,
and mobility should be noted and shown to
the patient during each follow-up
visit.
Subsequent six month follow-up visits should be provided to ensure
continued reduction and
maintenance throughout the patient’s lifetime. Any
life changing event or lifestyle change warrants a review of
daily disease
management as these occurrences typically alter a patient motivation and
ability to implement
their
daily disease management regime. A
career change, a divorce, children leaving the home or entering the
home,
loss of a loved one, relocation or other such events can
completely interrupt the daily habits of treatment,
therefore, assisting
patients with re-implementation ensures continued long-term
care.
Conclusion
Lymphedema is a chronic disease, and currently there
was no cure. Technology and treatment exists,
however, that effectively
treats and manages this disease long-term. Disease management failure occurs
when
inexperienced practitioners do not properly apply treatment,
educate patients on self-care, and the proper
longterm
disease
management tools are not provided. Each patient’s needs are unique and
therefore require an
individualized long-term plan of care. Long-term,
successful and independent management can be achieved
when practitioners who
are properly trained, assist those affected in the daily and proper
implementation of
daily management. Improved long-term management increases
mobility, quality of life, and reduces the risk
and
occurrence
of expensive health complications. The optimal standard as outlined in this
document will help to
reduce the overall cost of health care by setting a
national model and standard of care, thus reducing
complications that lead
to hospitalizations and additional medical care. Implementing proper treatment
also
reduces the need for long-term disability and better enables affected
individuals to continue an active and
healthy
lifestyle.
REFERENCES:
1. American Cancer Society
2. National Cancer
Institute
3. The American Society of Lympholgy
4. The United States
Centers for Disease Control – Health and Human Services
5. J. Smith,
LePalliative Care Oxford 2004 Final Chapter 14
6. Solomon, Schmidt, Adragna,
Human Anatomy & Physiology – Second Edition, Harcourt Brace
College
Publishers, 1990
7. M. Foeldi, E. Foeldi, S. Kubic, Textbook of Lymphology,
Urband & Fisher 2003
8. Gardner & Fox, The Return of Blood to the
Heart, John Libbey & Company, LTD. 1989
9. Abu-Own, Shami, Chittenden,
Farrah, Scurr, Colerdige Smith, Microangiopathy of the Skin and
the Effect
of Leg Compression in Patients with Chronic Venous Insufficiency, Journal of
Vascular
Surgery 1994;19:1074-1083
10. Wilson and Bilodeau, Current
Management Concepts for the Patient with Lymphedema,
Journal of
Cardiovascular Nursing 1989: 4(1) 79-88
11. Coleridge-Smith, Sarin, Hasty,
and Scurr, Sequential Gradient Pneumatic Compression
Enhances Venous Ulcer
Healing: A Randomized Trial, Surgery 1990; 108:871-875
12. The Diagnosis
and Treatment of Peripheral Lymphedema, Consensus Document of the
International
Society of Lymphology: Lymphology 36 (2003) 84-91
13.
Individual Vendors listed provided information regarding products
listed.
CONTRIBUTING AUTHORS:
1. Phyliss Tubbs Gingrich, RN, BSN,
CLT – LANA
2. Wade Farrow, MD, CWS, FCCWS
3. Cheryl L. Morgan, PhD
4.
Lawrence L. Tretbar, MD, FACS
5. Benoit Blondeau, MD
Winter
Tips for Lymphers by Tina
Most of us have seen the preventative tips and
heard what we should and should not do regarding our limbs
and
swollen areas. We all must be careful in the summertime about overheating,
sunburn, and warmth along
with humidity. But what about
winter?
Winter is an equally important season in which we must be
careful. After trial and error I have come up with
a list of things
I’d like to share:
1. Be very careful of ice. Remember you can’t always
see ice, it can be what they call black ice, a very fine
coat. Walk
on surfaces very carefully. You don’t want to fall.
2. Dress
appropriately. Keep your limbs comfortably warm but not too warm or too tight.
Remember that
you can swell in wintertime as well. Think of the hot
malls when out shopping and dress appropriately.
3. Always wear
appropriate footware. Make sure you have worn and broken in your boots,
sneakers or
your winterwear before you tread out. Awkward foot gear
can cause falls, and again on ice it’s dangerous.
4. Moisturize!
Remember in wintertime skin can be extremely dry with the furnace air
blowing.
5. Make sure if you happen to get your garments or socks wet,
change them as soon as possible.
Remember we lower lymphers are
prone to fungal infections as well as skin irritations from wet materials.
Waterproofed and insulated boots keep the feet drier than plain rubber
ones.
6. Remember the sensible tips for avoiding illnesss, if you can
get inoculated for flu/pneumonia. Wash your
hands after touching
things someone sick has touched. Try not to have sick people breathe in your
face.
Wearing a scarf helps warm the air for those of us who have
breathing problems as well as keep out germs.
7. Eat a healthy well
balanced diet as usual.
8. Remember that hypothermia and frostbite are
dangerous. Note that wind speeds can make for
dangerously cold
conditions even if the temperature is not below freezing.
9. If you can
wear mittens, they provide more warmth than gloves. Gloves can also become
tight on the
fingers if you swell.
10. Get lots of rest,
drink plenty of fluids, and if you think you are or someone else is
experiencing
hypothermia, avoid caffeine. Warm up slowly with a
blanket and by drinking fluids slowly.
11. Keep a lymphedema and winter
survival kit in your car. Try to carry extra medications, bandages, extra
blanket, batteries, flashlights, etc with you in case you are stranded
somewhere.
12. Keep a list on you in a wallet or purse of emergency
contacts, medications you are on and your doctors
name and
number.
Lymphedema Gardening Tips
Wear gloves that actually
fit, make sure they are not too loose or too tight.
Leather gloves with
a cloth back are a good general purpose glove.
If you plan to work in
wet soil, select rubber gloves with cotton lining
Wear Neoprene gloves
to use when spraying or working with pesticides.
If you are pruning or
trimming shrubbery, wear gloves that have long wrist protectors.
If your
gloves get muddy you can washing the gloves while on your hands!
If you
wear your compression garments under the gloves, make sure you don't
get
them wet, if wet, change immediately.
Avoid direct sunlight, even Spring
sunshine can cause sunburns.
Always wear sunscreen.
Wear
comfortable clothing.
If you get overheated, take a shower in cool
water, not cold, you don't want to cool off too fast.
Make sure you
don't get dehydrated! Drink lots of water and/or gatorade.
Work at a
steady pace with frequent breaks, switch gardening chores often to avoid
repetitive injuries.
Warm up before you garden.
Use as many
ergonomic tools as possible.
Wear shoes that will protect you from
hazards such as nails, sharp objects on the ground.
If you do get
scratched, wash the area right away, apply an antibacterial cream or
zinc.
For any puncture wounds, make sure your tetnus shot is up to date,
wash thoroughly, depending
on how deep they are, clean/bandage, or go to the
emergency room.
Make sure you put tools away when finished to avoid
later injuries.
Some good warm ups: From Tina, who
gardens.
Use hands to squeeze stress balls or balls with seed like
materials in them. Do 10 each hand.
Stretch your hands straight out,
link your fingers and pull lightly to feel a stretch in hands,
elbows and
arms. Do 10 times.
Stretch your hands above your head, again link your
fingers and stretch. Do 10 times.
Bend at the waist downward letting
your arms dangle in a relaxed position, this stretches the
upper
back.
Put your right hand on your left shoulder, turn your body slightly
to the left until you feel a stretch.
Reverse to left hand on right
shoulder, turning right. Switch back and forth, 10 times, so it
will be 5
stretches to each side.
Put your hands on your hips and lean backward,
arch your back, this stretches the ribs. Do 5.
To stretch your low back,
lay down, bend your legs. Put your right foot up to left knee, take a
hold
of your knee and lightly pull to feel a slight stretch. Do the other
side. Do each side 5 times.
Never do exercises until you check with
your doctor.
--------------------------------------------
Skin
Brushing Benefits
Tightens Skin
Helps digestion
Removes
Cellulite
Stimulates Circulation
Increases Cell Renewal
Cleanses
Lymphatic System
Removes Dead Skin Layers
Strengthens Immune
System
Improves Exchange between cells
Stimulates the Glands, thus
helping All of the Body Systems to perform at peak efficiency!!
Easy and
Inexpensive
The Basis for Dry Skin Brushing
The skin is our largest
route of elimination, excreting more than 2 pounds of waste each day, and
taking in
air and sunshine. Our skin breathes! And yet, in most
people, this vital route of detoxification is operating
far below
it's capacity, because it is clogged with dead skin cells and the un-removed
waste excreted
through perspiring.
Dry skin brushing is a simple,
inexpensive way of removing the waste from the skin and breaking down old
toxic deposits through it's unique action on the lymph vessels and
capillaries. Our bodies make a new top
layer of skin every 24 hours
- skin brushing removes the old top layer, allowing the clean new layer to come
to the surface, resulting in softer, smoother skin.
Draining
the Lymph
The lymph is the interstitial fluid that bathes our cells,
bringing them nutrients and removing their waste - all
detoxification occurs first and foremost through the lymph. Our bodies
contain far more lymph than blood,
and yet the lymph is dependent
upon outside forces for it's circulation around the body; the lymph has no
heart to pump it! Consequently, the lymph relies upon exercise and
massage for it's vital circulation, two
things that are lacking in
most people's everyday lives.
For many years, the only way to drain the
lymph was through lymph drain massage or manual lymphatic
drainage,
a powerful massage technique credited to have originated from ancient Chinese
Medicine. Dry
skin brushing prompts the body to release its’ toxic
deposits into the lymph, whilst simultaneously cleansing
the lymph
itself, through it's return to it's two plexuses, or centers, near the
heart.
Because of it's ability to release the skin's detoxification
potential and to cleanse mucoid deposits from the
cells directly
into the colon, dry skin brushing is considered by many (including such
luminaries as Bernard
Jensen and Robert Gray) to be an essential
part of any intestinal cleansing program.
Dry Skin Brushing
Technique
Start with a natural bristle brush
1. Skin Brush before
showering, bathing or sauna
2. Do not wet skin
3. ALWAYS brush towards
heart
4. Begin with the soles of feet, then ankles, calves, and
thighs.
5. Then Brush across abdomen and buttocks. Use
circular
counter-clockwise strokes on the abdomen
6. Now brush your
hands and arms and gently the underarms
7. Reach for that back and
neck
8. Lightly brush the breasts
9. Brush each part of the body
vigorously, completely several times.
10. Wash your brush every few weeks
in water and let it dry.
http://www.racingsmarter.com/skin_brushing.htm
article by doctors on skin brushing, this ones copyrighted
and no
permission granted to use it, sorry gotta go to their site to read
it!
When you brush the pores of your skin clear, your skin is able to
absorb nutrients and eliminate toxins.
Clogged pores are not just a
cosmetic concern. Healthy, breathing skin contributes to overall body
health.
To dry brush, use a soft natural fiber brush (available from health
food stores), a loofah sponge, or a rough
towel. It is important to
use a natural bristle brush, or a loofah sponge, or even a coarse bath glove.
Nylon
and synthetic fiber brushes are too sharp and may damage skin.
Always dry brush before you shower or
bathe because you will want
to wash off the impurities that you scrape up from the brushing
action.
Begin with your feet and brush vigorously in circular motions. Brush
away from your extremities and toward
your heart. Continue brushing
up your legs, then proceed to your hands and arms. Brush your entire back
and abdomen area, shoulders and neck. Do not brush any sensitive,
irritated, infected or damaged areas of
the skin and avoid facial
skin as well.
After brushing, rinse off in the shower. Paavo Airola, author
of Swedish Beauty Secrets, recommends
alternating temperatures in
the shower from hot and cold. This will further invigorate the skin and
stimulate
blood circulation, bringing more blood to the outer
layers of the skin.
Don’t forget to clean your dry skin brush or sponge
regularly, using soap and water. After rinsing, dry your
brush in an
open, sunny spot to prevent mildew from developing
More specific
Instructions:
Dry skin brushing tones the immune and circulatory systems. It
may reduce the duration of infection and
accelerate the clearing of
toxins. It will reduce cellulite, help support the immune system during cancer
and
other chronic illness treatment. Best of all, it feels really
good!
Using your right hand, gently slide the brush along your right jaw
line starting from your earlobe to the
underside of your chin 7
times.
Place the brush at the hairline on your neck and gently pull around
the right side of your neck to the Adam's
apple 7 times.
Hold
the brush with your right hand at the bottom of your neck (where it joins the
top of your back) and
bring it around your neck to the right and
down along your right collar bone and end up between your collar
bones.
Stroke your breastbone in a circular fashion to stimulate the
thymus gland. Carefully brush the breast in a
circular motion. Do
all of Step 1c 7 times. Repeat steps a, b and c on your left side holding the
brush with
your left hand. 2. To stimulate the pituitary gland,
hold the brush on the back of your head near the base of
your neck
and rock the brush up and down, then side to side, both 14 times.
Hold the
brush in your left armpit with your right hand and rotate it counter clockwise
7 items, then
clockwise 7 times. Repeat on your right armpit with
your left hand.
Brush upward 7 times from your upper right thigh to your
right armpit. Repeat process on your left side.
Women may need to
hold their breast out of the way with their free hand.
Brush back and forth
over your belly button and around your waistline 14 times (like passing a
basketball
behind your back).
Brush in a circular motion over
your belly-button, counter-clockwise 7 times then clockwise 7 times. Finish
brushing the front of your body in any direction starting at the bottom
and brushing all the way up 14 times.
Very little pressure needs to
be applied to the genitals and women's breasts because the skin is sensitive
and will redden if irritated.
Brush up and down your spine from
the base of your neck and down as far as you can 14 times Finish your
upper
back by stroking it around toward your 11 sides.
Brush your spine from
tailbone up as high as you can reach 14 times, holding the brush with two hands
or
with the detachable wooden handle. Finish your lower back by
stroking it around toward your sides).
Brush up from right ankle to right
knee and work all the way around your leg, brushing up towards your
heart This improves blood circulation, firms skin and gets rid of
cellulite.
Hold the brush in the right groin with both hands and rotate it 7
times counter-clockwise, then 7 times
clockwise. Repeat with the
left groin.
Brush from right knee to right hip 7 times. Work all the way
around your leg continuing to brush upwards
(towards the
heart).
Brush up from right ankle to right knee and work all the way around
your leg, brushing up towards your
heart (Figure 11). This improves
blood circulation, firms skin and gets rid of cellulite.
Brush around your
right ankle 7 times.
Brush back and forth over the top of your right foot
from toes to ankle.
Brush across your right toes on top and underneath 7
times.
Brush the bottom of your right foot heel to toe 7 times.
Repeat
numbers 11-12 for your left thigh, left leg and foot.
Brushing upward from
right elbow to your armpit and shoulder, cover that entire area 7
times.
Brush from your right wrist to the elbow in the same manner 7
times.
Repeat number 14 for your left arm.
Lightly brush the webbing (or
junction) between your left thumb and index or pointer finger on the palmside
14 times, then on the non-palmside 14 times (Figure 15).
Brush
your left palm from wrist to fingertips and back 7 times. Brush the back of
your left hand the same
way 7 times.
Brush each left hand finger
individually back and forth 7 times on the areas that have not been brushed
yet.
Repeat steps 16-17 for your right hand.
NOTE: YOU CAN DO THE
BRUSHING HEAD TO TOE OR TOE TO HEAD. SOME
THERAPISTS RECOMMEND TOP
TO BOTTOM YET OTHERS PREFER BOTTOM TO TOP.
This article was featured on
Cleansing Waters website which no longer exists, The article is worthwhile and
valuable to lymphedema patients so I chose to keep it up here, it
has been edited by the Lymphland
Editoral Team, 10/08. Before
doing any skin brushing, check with your doctor, we are not medical
professionals and cannot give medical advice. Some lymphedema
therapists recommend brushing, others
do not.
Skin brushing
is one of the better self-help health care methods available to us today. It be
can be
performed on your self while the skin is dry or wet.
Stimulation of the skin activates natural healing
pathways within
your body and it removes toxins from pores and other external surface areas. It
also
stimulates nerve beds within its structure that in turn
activate normal healing pathways and healing processes
throughout
your body. There are no drugs involved, no toxic reactions or contraindications
to be concerned
about, only the commitment to yourself to perform
it on a regular basis. Skin brushing can be used over the
entire
body or just to special local areas to stimulate the body’s normal inflammatory
healing response. The
skin is the largest eliminative organ of the
body and one of the four major intake and eliminations systems.
The
digestive tract, kidneys, and lungs are the other three. Over the course of a
regular inactive day the skin
eliminates over a pound of waste
products mixed in with its sweat. In individuals who are active or in
athletes
who are very active the skin eliminates many times more. Sweat glands are
located through out the
skin's surface and automatically eliminate
unwanted metabolic waste produced. *Never do brushing during
active
cancer, sunburn, or infection.
For maximum lymph drainage both the sequence
and direction of the brushing are important. The area
closest to
the drainage point is treated first. Brush the armpit region before the chest
and both before the
head and neck. The groin region is brushed
before the abdomen. To reduce the resistance of gravity, brush
the
upper body before the lower body. Use 7 brush strokes for each step.
Brush
up the arms from the hands to shoulders.
Armpit: Use 7 circular clockwise
strokes and 7 counterclockwise strokes.
Chest: Brush from the breastbone to
each armpit, 7 times on each side. Women avoid direct brushing to the
breasts,
use curving strokes below the breast. Brush sides upward from the waist to
armpit.
Back: Brush upward and outward from spine, 7 strokes on each side,
starting at the base of the neck. The
upper back and shoulder
blades drain into the armpit.
Neck and throat: Start at the back and brush
outward and upward from the spine, then forward over the
shoulder
to the soft hollow at the base of the throat. Turn head to right when working
on left side and vice
versa. Place brush vertically at the base of
the skull and brush along the jaw line to throat and down over
the
collar bone to the chest.
Lower and mid-back and buttocks: Holding the brush
horizontally with both hands, start at the lower
sacrum, pull brush
upward with firm pressure to the bottom of the shoulder blades. Use 7 strokes
each up
the center, left and right of the back. Buttocks: firm,
upward and outward strokes. Begin at the top, circle
around hip to
groin region. Gradually work down to the gluteal fold where the buttocks join
the thigh, and
then back up to the top.
Leg Region: Brush left
leg first, using firm gliding strokes rush upward 7 times on the inside,
outside, front
and back, front and back, from knee to the top of
the thigh, brush from the ankle upward to the knee.
These instructions
were given to me by my lymphedema therapist who no longer practices. I am not
a
medical professional and cannot give advice, I am only sharing
knowledge in the event it can help another
patient manage
lymphedema. Check with your doctor before you do any skin brushing. Tina
Budde 10/08.
----------------------------------
Remember that the
sun can damage more than the skin.
The eyes are six times more sensitive
to UV rays than the skin. UV radiation increases the likelihood of
cataracts, a condition which clouds vision. If not properly treated, it
can cause blindness. Wearing proper
eye protection can reduce the
likelihood of developing cataracts.
Overexposure to UV radiation can
suppress the immune system. It can cause decreased response to
immunizations, increased light sensitivity and reactions to some
medications.
SUNBURNS...HOW TO TREAT
When, why and how to treat for
sunburn.
Sunburn should be treated before it happens, when it might and
after it does happen. This can be in winter
or in summer, on land
or on water, wherever direct sun or highly reflected light may reach and
therefore
threaten bare skin.
Sunburn should be treated for
the healing of current sunburn pain, skin damage and potential skin cancer as
well as to prevent further sunburn. Here are the several ways we
may do this.
Use Aloe Vera.
Aloe Vera comes from the aloe vera plant
and may be squeezed from its leaves. Purchasing and learning to
care for an Aloe Vera plant through the summer can be a wonderfully
relieving investment. This healthful
moisturizer is frequently used
for sunburn and is applied to the affected areas of the skin as a rub to re-
moisturize the dried and burnt surfaces. You can also purchase aloe
vera creams and ointments that may
include other moisturizers or
treatments for dry or burned skin.
General Moisturizers.
A general
skin moisturizer such as Noxzema can be applied to sun burned areas to cool and
sooth the
painfully itchy malady. Baby oil is a good moisturizer
but don’t use it in the sun or it may help fry you
further.
Anesthetics.
Anesthetics such as the popular skier’s
treatment Cool Blue actually kill the pain of most sunburns for a
time. This is applied to the skin in the form of a spray or gelatinized
rub. It is also frequently mixed with
Aloe Vera as sold. Aspirin
dissolved in water in small doses may be tried directly applied to affected
areas.
Other medications.
Unguentine is used to treat the ache and
itchiness of sunburns. There are other brand name and store brand
treatments you may want to ask your pharmacist about. Mycetracin or
other multiple healing ointments may
help to speed healing though
you will want to ask your pharmacist to be sure.
A hot shower.
A hot
shower immediately after mild sunburn can bring about peeling sooner and rid
you quickly of
discomfort.
Vitamins taken internally or
applied.
Vitamin E, one of the antioxidants, can be taken regularly as part
of a daily vitamin and mineral supplement
or spread as in an
ointment on sunburn. Vitamin C is another antioxidant that will help prevent
severe
damage from sunburn and shorten its effects. Selenium is a
mineral that will help fight sunburn.
Preventing further sunburn while
you heal.
To protect the eyes and the area around the eyes, try placing thin
slices of fresh cucumber over closed
eyelids when lounging in the
sun. The cucumber will absorb all the ultraviolet light and keep the eyes safe
and cool.
Sunscreens cannot be over recommended in my
opinion. Being someone who is sensitive to light and burns
readily
I know that an SPF 8 or greater sunscreen rating is needed if you plan to only
reapply it every two
hours or less often, at least for those who
need to be as concerned as I do.
At any sign of infection, get to a
doctor as soon as possible.
BUG BITES:
Mosquitoes are known to
pass blood-born illnesses from one victim to another. They are a major health
hazard and are responsible for the transmission of yellow fever,
malaria, dengue fever, encephalitis, filariasis,
and many other
serious diseases. ... Ticks can transmit Lyme Disease so you really want to
avoid being
bitten as much as possible
August officially
begins the peak season for bug bites.
Dr. Dirk M. Elston, a
dermatologist with Pennsylvania's Geisinger Health System, offered the
following tips
on prevention and treatment of common summer bug
bites at ACADEMY ‘03, the American Academy of
Dermatology's summer
scientific meeting in Chicago, Ill.
PREVENTION TIPS:
The key to
preventing such things as West Nile Virus and Lyme Disease is protection from
being bitten. Dr.
Elston recommends the following practical
tips:
Wear long-sleeved shirts and pants when outside
Stay indoors at
dawn and dusk (when mosquitoes and other insects are most active)
Remove
standing water in yards and clean out clogged gutters, which are breeding
grounds for mosquitoes
and other bugs
Install or repair window
and door screens so that insects cannot get indoors.
Before going outdoors,
it is important to use insect repellents on the skin and clothing to be
completely
protected against bug bites. The active ingredient in
most commercial agents is either the insecticide
permethrin or the
chemical repellent DEET.
TREATMENT TIPS:
If an insect flies through
your defenses and leaves a bite, Dr. Elston reports the best treatment method
is to
apply ice or products containing camphor or menthol to the
affected area in order to reduce itch. The
average insect bite is
harmless and may leave a small red mark or bump that will disappear within a
week.
Persistent itch can also be treated with
prescription-strength cortisone products.
"If your bug bite lingers and
a rash develops, or if you experience a fever, headache, episodes of joint
pain,
dizziness or fatigue following an arthropod bite, it is
important to consult a dermatologist or other
appropriately trained
physician immediately in order to rule out a potentially serious condition,"
said Elston.
See also ants, spiders, poison ivy page.
This comes from
another great article that is no longer available on the internet. The
original author was a
Dr. Elston, but we do not have any
credentials for the doctor. Please check with your doctor to see if the
tips provided here are right for you, this is not meant to replace any
medical advice from your doctor. We
are not medical professionals
but are only sharing information on our site in order to help others with
lymphedema.
This page was edited by Lymphland editorial team
2/07.
---------------------------------------------------
BEES
Bees
and wasps inject venom with their stingers. (Only honey bees leave a stinger
behind. The poison sacs
are still attached to the stinger, and
continue to pump venom into the skin after the bee departs.) There will
be stinging, swelling, and redness at the sting site. Usually, the
symptoms subside after 20 to 30 minutes
Allergy to insect stings can be
deadly. Symptoms of allergy can include faintness, dizziness, general itching,
shortness of breath, or swelling in places away from the sting
site.
A second type of allergy is much less serious. This is allergic
swelling around the sting area. It usually starts
the next day, and
can persist for up to 5 days. The area is red, raised, hot, itchy and
tender.
Infection is also possible. Infection is common with honey bee
stings (because of the stinger "foreign body"),
but is rare with
wasps. Beesting infection usually appears as red streaks.
Immediate
care:
If a stinger is present (honey bee sting), remove it. Drag a sharp
object gently across the skin, so it catches
the stinger and drags
it out.
Don't press hard -- this turns the blade into a "shaver" so it cuts
the stinger off at the skin line, leaving part of
it in the skin. If
you have splinter forceps, steady hands, and good eyes, you can grab the SHAFT
(not the
top) of the stinger and pluck it out.
Insect Sting
Relief pads contain alcohol and benzocaine. Benzocaine is a topical anesthetic.
The pads can
relieve the pain of a fresh insect sting. Cold packs
can limit swelling. Elevate the sting area. Take an
antihistamine
such as diphenhydramine to reduce swelling and reaction at the sting
site.
See the doctor if you: become short of breath or wheezy, develop a
severe throbbing headache, get hives,
general redness, or
widespread itching
or become faint or lightheaded
Ongoing
care:
Continue antihistamines until all swelling is gone.
Local
swelling:
The day after a beesting, you may see severe local swelling. If
it's itchy, hardens gradually to a central
"pimple" at the site of
the sting, is surrounded by a thin border of whitened skin, is not particularly
tender,
tends to go DOWN the extremity as much as (or more than) it
goes up, and is NOT accompanied by fever
or body aches, it's
probably a local allergic reaction. This reaction tends to last about 5
days.
Watch for:
See the doctor if there is increasing tender red
swelling around the wound, red streaks, drainage, fever,
tender
bumps in the groin or armpit upsteam from the sting, or an unexplained increase
in pain or tenderness
An insect repellant containing DEET will keep
mosquitos at bay. For determined the horse flies, you may
have to
spray your clothing, because they can bite through it.
Mosquitos, black
flies, horse flies, and deer flies inject saliva containing an anticoagulant
before they start
sucking your blood. You have an allergic reaction
to the saliva. (Although if you get bitten enough,
eventually the
reaction is less severe -- kind of like allergy shots.) There are two types of
reaction:
immediate edema (watery swelling) caused by antibodies,
and delayed cell-mediated hypersensitivity
caused by your immune
cells.
The immediate reaction usually goes away in about an hour, but some
people have itching that persists for a
couple of days. The delayed
hypersensitivity comes later -- often the next day -- and persists for several
days.
Concerns:
Severe (life-threatening) allergy to insect
bites is rare. Symptoms of systemic allergy can include faintness,
dizziness, general itching, shortness of breath, or swelling in places
away from the site of the bite.
The second type of allergy is annoying, but
not dangerous. This is allergic swelling around the area of the
bite. It usually starts the next day, and can persist for up to 5 days.
The area is red, raised, hot, itchy and
tender.
Immediate
care:
If you come home itching, take an antihistamine such as
diphenhydramine (sample brand Benadryl). An
adult can use 50 mg (2
over-the-counter caps) every four hours. If you're prone to prolonged itching,
scrub
the bite well with soap and water, let it dry, then rub
hydrocortisone 1% cream into the bite
Put another dab of hydrocortisone
right on top of the bump, then cover it with a bandaid. The bandaid
drives the medicine into the skin -- and it keeps your fingernails
away
For the delayed hypersensitivity, antihistamines alone won't cure the
underlying problem. Take an anti-
inflammatory medicine, such as
ibuprofen 600 mg four times daily. Apply warm packs, 20 minutes every
two
hours. If it's itching, add diphenhydramine 50 mg every four hours. Rub
hydrocortisone 1% cream over
the bite site three times daily. If
the reaction is particularly severe, you may need to see the doctor for
steroid pills (such as prednisone or Medrol).
Watch for:
See the
doctor if there is increasingly painful red swelling around the wound, red
streaks, drainage, fever,
tender bumps in the groin or armpit
upsteam from the bite, or an unexplained increase in pain or
tenderness
NASTY SPIDERS
Black Widows hang out in the
darkness.
Description:
You'll always feel a black widow bite. It feels
like a sharp pinprick. Looking closely at the skin, you may
see a
couple of tiny red fangmarks about 2 mm apart. Within minutes, the area around
the bite becomes
vaguely reddened, to a diameter of about an inch
or two. The area begins to tingle. In a half-hour or so,
painful
muscle cramps develop upstream from the bite. (If the bite is on the leg, the
thigh then the abdomen
will begin to cramp and hurt. If the bite is
on the arm, the venom affects the upper arm and shoulder, then
the
chest.) As the poisoning progresses, there's shortness of breath, chest pain,
and generalized muscle
pains.
Concerns:
While a black widow
bite is very painful, it rarely kills a grown adult. But children and elderly
victims can
die.
Immediate care:
Get to the hospital. You may
require IV medication (calcium, muscle relaxers like diazepam, and narcotic
pain medication). For life-threatening bites, antivenin may be
required.
The brown recluse (fiddleback spider) has tiny fangs. The bite is
almost never felt. Because this spider is
reclusive, it usually
isn't seen either. The bite starts as a blister, which then becomes bloody. The
blister
pops, leaving an ulcerated hole in the skin that gradually
enlarges over many days.
Immediate care:
Relax. First of all, that funny
bump on your skin almost certainly ISN'T a brown recluse bite. Second, we
don't do much about them. We just bandage the hole up and watch for
infection. Most other therapies, such
as cutting the bite area out,
using steroids, etc, are controversial. If you do develop an enlarging skin
sore,
go see your doctor
garden spiders do the most biting. But
the bite isn't dangerous. You may develop some local swelling and
pain at the site of the bite. The local reaction can persist for
several days, and often looks like an infection.
(It rarely IS
infection, but if you go to the doctor, he'll probably treat it as infection
just to be safe.)
ANTS
Fire Ants:
1. Remove all ants from the body
to prevent further stinging.
2. Elevate the extremity where the person
was bit.
3. Apply a topical steroid cream, such as hydrocortisone,
with a concentration of at least 0.25 percent.
4. Administer oral
antihistamines.
5. Monitor carefully for severe allergic reactions.
6. Monitor carefully for infection.
POISON IVY
Poison ivy
causes misery for thousands of people each year. Its sticky resin causes
symptoms such as
swelling, a red itchy rash, blisters and oozing
which may appear as soon as a few hours after exposure to as
long
as two weeks later. The more sensitive someone is to poison ivy, the sooner the
symptoms will appear.
And if they have had a reaction to poison ivy
before, they will be even more sensitive to it the next time they
are exposed. It is important for these people to avoid the plant
carefully.
Poison ivy usually appears on the body in the areas where the
skin is the thinnest. The arms, the legs
(especially the shins),
and the face are affected most often. The rash will break out in a straight
line of
blisters that itch intensely, or in patches of red, bumpy
skin. About five days later, the blisters crack open
and release a
watery discharge. It takes at least a week to two weeks for the irritation to
heal. Most people
can treat themselves at home, with no need to see
a doctor.
Here are some things to do if you have been exposed to poison
ivy:
1. Wash the exposed area as quickly as you can. If you don't have quick
access to a shower, a water hose
will do. You want to remove as
much of the resin as possible, as soon as possible. Sometimes thorough
washing is enough to prevent the rash from developing.
2. Change
clothes and wash the clothing as soon as you can. Any sticky resin on the
clothing will remain
until the items are washed. Simply coming into
contact with the resin can cause irritation. Any items that
can't
be washed should be isolated and stored in a well ventilated area for at least
three weeks. This
includes shoes and boots.
3. If you do develop
a rash, you can help relieve the itching by sponging the affected areas with
alcohol,
applying a paste of baking soda, using calamine lotion, or
soaking in a tub of warm water with a handful of
baking soda thrown
in.
4. Take an antihistamine like Benadryl. This will help the itching and
the swelling. If the itching becomes
unbearable, ask your physician
to recommend something.
Some people are highly allergic to poison ivy and
experience extreme reactions. In severe cases, the
person's eyes
may swell shut, they may develop a fever and intense pain, swollen lymph nodes
in the neck,
armpits or groin, and have difficulty breathing. If any
these symptoms occur, it is important to seek a
doctor's help
immediately. An infection this severe will have to be treated with an
antibiotic.
A poison ivy irritation is extremely uncomfortable and far too
easy to develop, but you don't have to be a
victim. Here are a few
things to keep in mind when you're in an area infested with poison
ivy:
Learn what the plant looks like and avoid it! An old expression goes
like this: ‘Leaves of three, let it be!'
The plant's appearance
varies in different areas of the country. Find out what the species in your
area looks
like and memorize its appearance.
When walking in
wooded areas, wear long sleeves and gloves. Tuck pants legs into boots or
socks. Don't
wear shorts or sleeveless shirts!
Don't let your
dogs or cats run loose through the area. Poison ivy resin will stick to their
fur and you can
come into contact with it simply by petting the
animals. Bathe your pets as soon as possible if you think
they've
been near poison ivy.
Don't burn the poison ivy plants. This may sound like
strange advice, but the oil from the plants can be
inhaled through
the smoke and cause lung irritation.
And don't be fooled into thinking that
you are immune to poison ivy. Just because you've never been
affected before is no guarantee that the next time you come in contact
with it you won't break out into itchy
blisters. Take the necessary
precautions to protect yourself from this potent
plant.
---------------------------------------------
ICD 10
Codes
I 97.2 Lymphoedema arm, axillary lymph flow
area
I 89.0 Lymphoedema leg, inguinal lymph flow area
(primary or secondary)
I 89.9 Other diseases of lymph
vessels
R 60.0 Oedema without specification
R
60.0 Oedema with CVI (chronic venous insufficiency -
Ed!)
R 60.1 Cyclic Idiopathic Syndrome
R 60.9
Lipoedema and E 88.2
----
http://www.medscape.com/viewarticle/703674?src=mp&spon=17&uac=91492PV
From Medscape
Business of Medicine
Best Ways to Deal With Noncompliant Patients
Mark
Crane, BA
Authors and Disclosures
Published:
06/05/2009
Once you've figured out what's ailing your patient, the
real challenge is convincing him or her to follow your
advice. Only
half of all chronically ill patients take medicines as directed, and many don't
even bother to get
the prescription filled, according to a 2003
World Health Organization study.
Beyond that, many patients refuse to make
recommended lifestyle changes that can improve their health.
Noncompliance
is dangerous for the patient and frustrating for the physician. As more
insurers and Centers
for Medicare & Medicaid Services (CMS)
promote pay-for-performance programs, physicians will
potentially
be scored and reimbursed on the basis of patient outcomes -- meaning that
noncompliant
patients could drag down doctors' scores.
Patient
refusal to follow a treatment regimen also affects the nation's healthcare
system. "The cost of patient
noncompliance is easily in the tens of
billions of dollars a year in needless complications and
hospitalizations," says David B. Nash, MD, MBA, an Internist and
Chairman of the Department of Health
Policy at Jefferson Medical
College in Philadelphia, Pennsylvania. "If we could improve compliance, we'd
be well on our way to fixing the healthcare system regardless of
what reforms are ultimately passed."
Up to 11% of hospital admissions, 40%
of nursing home admissions, and about 125,000 deaths a year are
due
to noncompliance with prescribed medication regimens, according to the American
Pharmacists
Association. As former US Surgeon General C. Everett
Koop once lamented, "Drugs don't work in
patients who don't take
them."
Economic Woes Increase Noncompliance
Today's tough economy has
created new reasons why more patients are noncompliant. Patients don't take
medications if they can't afford them. Many patients who have lost
their jobs and health insurance are
forgoing prescription drugs or
office visits.
"People who have lost jobs are putting off preventive care
and canceling routine visits," says Rick
Kellerman, Chair of the
Department of Family and Community Medicine at Kansas University School of
Medicine in Wichita, Kansas, and past president of the American Academy
of Family Physicians (AAFP).
"That creates long-term potential for
conditions to develop into more serious illnesses."
On the basis of
widespread money problems, physicians should take the time to ask about a
patient's
financial circumstances that can affect
compliance.
"Patients are often reluctant to tell physicians that they've
lost a job and can't afford medicine," says
Kellerman. "Perhaps it
should be part of a standard history to inquire about whether they might have
trouble
filling prescriptions or returning for follow-up
care."
It's especially important to counsel patients about dosage when money
is tight because some patients split
pills to make them last
longer. Physicians can also provide free samples, substitute generics whenever
appropriate, and refer patients to pharmaceutical company or
government assistance programs.
Section 1 of 6
Best Ways to Boost
Patient Compliance
Physicians face 2 chief noncompliance challenges:
patients who can't comply due to financial reasons, and
those who
don't want to make the effort to lose weight, test their blood sugar, or say no
to harmful lifestyle
choices.
For doctors, it's vitally
important to take time to tell patients why the treatment is necessary.
"As
many as 1 in 5 patients don't fill the original prescription because the doctor
didn't convince them that
they really needed it," says Kellerman.
"It takes time to sit down with the patient and make sure they have
all the information they need, but currently, the reimbursement system
and shortage of primary care doctors
doesn't make that
easy."
"There are multiple reasons for noncompliance," adds Donald J.
Palmisano, MD, JD, a vascular
surgeon/attorney in Metairie,
Louisiana, and former president of the American Medical Association
(AMA). "Patients may not understand what you told them. I typically ask
the patient to repeat back to me
what it is he's supposed to do.
It's important to explain that if the patient doesn't take the medicine, he's
at
increased risk for stroke or some other illness.
"If I suspect
the patient is unclear, we give written instructions and may follow up with
phone calls. It's
important to know if the patient is able to read.
I've been amazed over my career at how many patients
cannot," says
Dr. Palmisano.
Patients need to know what the drug is and how it works in
terms that are understandable to them. How
and when should they
take the drug? For how long? What side effects can be expected? What are the
consequences of stopping the medication? If doctors can answer these
questions, it's far more likely that
your patients will follow your
advice.
Depending on your practice workflow, it may be useful for a medical
assistant or nurse to discuss the
prescription with the patient. He
or she can stress the importance of the prescription and make sure the
patient understands what is expected.
Section 2 of
6
Technology Can Help Promote Patient Compliance
Type the words
"patient compliance" into Google and you'll get 3.7 million hits, mostly from
vendors eager
to sell you programs to encourage patient compliance.
Some of them can be helpful.
The solutions take the form of patient
education, reminders, and ongoing monitoring, including call centers,
reminder programs, computer programs, high-tech packaging, and other tools to
remind patients of
dosages and refills.
As electronic health
records and e-prescribing grow, these technologies help physicians and health
plans
determine whether patients are taking their medications.
Horizon Blue Cross Blue Shield of New Jersey, for
example, is
working with Merck & Co., Inc. to send text messages to physicians,
informing them of patients
not filling their prescriptions. Another
program, supported by Pfizer Inc., provides automatic voice mail
reminders to patients, replacing mailed notices.
Electronic alerts
have proven helpful and effective in encouraging patients to get screening and
treatment for
dyslipidemia. A report published in the January 2008
issue of Circulation described a randomized
controlled trial in
which investigators from The Netherlands found that 65% of patients who
received
electronic alerts were screened vs 35% of patients who had
inquired by themselves.[1]
Numerous new high-tech devices can help patients
remember when to take their pills. Some offer
subscribers a
reminder service via a pager or other wireless device. MedivoxRx Technologies
Inc., in
Pittsford, New York, has a talking pill vial that reminds
blind, visually impaired, and illiterate patients to take
their
medicines.
The Med-eMonitor System, developed by Rockville, Maryland-based
InforMedix, Inc., combines
compliance and disease management on the
basis of the patient's care plan. The system includes a portable
drug storage device that uses chimes to prompt the patient to take the
medicine. It also asks patients
whether they have taken the meds,
monitors their health status by asking other questions, and records the
time and date of all interactions.
The system automatically uploads
the patients' information to a central database. If there is cause for
concern, it triggers an outbound email, page, or cell phone text message
sent to the patient's physician.
Section 3 of 6
Companies Help
With Nurse Coaches and Teaching Aids
Some manufacturers are using nurse
coaches to promote compliance, especially with high-cost specialty
drugs. For example, McKesson Specialty, a provider of reimbursement,
distribution, and clinical services
for specialty drugs, runs
nurse-coach programs through partnerships with manufacturers and health plans.
For drugs that require self-injection, McKesson's nurses teach
patients how to inject the drug, conduct
monthly phone-ins, and
coordinate care.
Some pharmaceutical companies are providing physicians with
practicing counseling tools to help patients.
For example, a portable
teaching aid from teriparatide (Forteo®), an osteoporosis drug, demonstrates to
patients how bone strength and density can improve from treatment.
The teaching aid is a 3-dimensional
model that replicates
before-and-after treatment bone biopsies from the hip of a clinical-trial
patient of the
drug.
A program for tazarotene (Tazorac®) is
designed to encourage teens to regularly apply the acne medicine.
Messages are delivered through text messages received on teens' cell
phones from a mobile "buddy" who
they've selected. The program
offers patients a series of incentives and rewards, such as wallpapers and
ringtones, the magazine reports.
David Nash comments, "All of the
new methods are helpful, but there's no magic bullet and nothing
substitutes for the basics: taking the time to explain to the patient
why you're prescribing the medication."
Section 4 of 6
Should You
Dismiss Noncompliant Patients?
At times, you'll encounter patients who
complain endlessly about their conditions but stubbornly refuse to
follow the recommended treatment.
"We doctors tend to blame, but
perhaps I could have done a better job of communicating," says Kellerman.
"If I have trouble communicating with a patient, I try to look at
myself first. It's rare to discharge a patient
unless he's
disruptive or abusive to the staff."
Patients who repeatedly break
appointments or don't show up for scheduled procedures may be
discharged from a practice, however.
"I had a patient scheduled to
have his colostomy closed," says Dr. Palmisano. "He never showed up. We
had a hard time locating him. We finally did and reschedule, but he
didn't show up again. He came to the
ER [emergency room] a few
nights later, drunk and creating a disturbance, cussing out the staff.
"I
told him I couldn't continue to treat him and that it was in his best interest
to find another doctor. I gave
him a referral to a clinic and told
him I'd be available in case of an emergency. It's rare to discharge patients,
but sometimes you have to. It gives them a reality check that they
cannot keep acting the same way."
Some pay-for-performance programs could
lead to unintended consequences, including pressuring
physicians to
discharge noncompliant patients who might undermine their performance
scores.
"I worry about 'cherry picking' and 'lemon dropping' in poorly
designed pay-for performance programs,"
says Kellerman. "If I'm paid
based on patient outcomes over which I don't have ultimate control if the
patient is noncompliant, I could be penalized financially. That could
be an incentive to drop patients who
need my help the
most."
"Every doctor has an obligation to do the best he can for patients,"
says Dr. Palmisano. "So doctors may
get an extra percent or two of
reimbursement if they follow certain guidelines under these programs. We
have to remember that patients are individuals, and we can't let
managed care or government policies
dictate the ethical practice of
medicine."
"All physicians can do is make sure patients have the information
they need to make a rational decision,"
says Kellerman. "It's
ultimately the patient's choice whether to accept our advice."
Section 5
of 6
How to Dismiss a Noncompliant Patient
Discharging a patient
should be a last resort only after repeated attempts to find out why the
patient is
disruptive or won't comply with your
advice.
Physicians should personally speak with the patient to ask about any
specific complaints, say malpractice
risk managers. You may learn
that the patient is unhappy with your treatment or office staff. These
situations
could potentially be corrected.
It's important to end
the doctor-patient relationship carefully to avoid getting sued for abandonment
or
discrimination. Most liability insurers have protocols and sample
letters that doctors can use to reduce their
risk for a lawsuit
when they discharge a patient.
It's wise to warn patients first that they'll
be discharged unless their behavior changes. Document any
noncompliance in the patient's chart. You should also document that you
informed the patient of the specific
potential consequences of
failing to follow medical advice, says Dr. Palmisano, who also heads Intrepid
Resources, a risk management firm in Metairie.
Send a
termination letter by certified mail, return receipt requested, and keep the
receipt in the patient's file.
Give the patient sufficient notice
that you will stop treating him or her. A month is usually adequate, but
check with your insurer or state medical society for
guidance.
Inform the patient that you'll continue to treat him or her until
the termination date and for any emergencies
that occur up to then.
Refer the patient to the local medical society or hospital to obtain a list of
physicians.
Offer to transfer the patient's records promptly once
you receive a written authorization.
Section 6 of
6
-------------------------
Frequently-Asked Questions
What is
Lymph Drainage Therapy?
For the past thirty years the benefits of Lymph
Drainage Therapy have been scientifically documented and
medically
prescribed throughout Europe. Now it is rapidly gaining recognition in the U.S.
by health care
providers. Trained in Dr. Chikly's unique technique,
therapists use precise, gentle, wave-like hand
movements to feel
the rhythm, depth and direction of the flow of the body's lymph fluid, to
detect
obstructions, and to map that flow. This enables the
therapist to redirect the lymph to the pathway that is
most
effective for drainage - with far-reaching benefits.
As noted by Dr. Bruno
Chikly:
The lymphatic system belongs to the circulatory apparatus which
provides one way for the blood to leave
the heart, the arterial
system, and two ways for it to return: the venous and lymphatic pathways. The
lymphatic system is therefore another pathway back to the heart,
parallel to the venous system.
The main functions of the lymph system
are:
stimulation of the immune system
stimulation of the
parasympathetic nervous system
stimulation of body fluid
circulation
recovery of crucial substances that have escaped from the
blood
The lymphatic system drains the interstitial fluid. Stress, disease,
injuries, environmental toxins cause the
lymphatic system to
stagnate or be obstructed, leading to the accumulation of excess fluid,
metabolic waste,
cells and toxins, foreign bodies and pathogens,
and proteins in the interstitial environment, compromising
optimum
cellular function. This leads to disease and premature aging. Once the
interstitial fluid enters the
lymph vessels, it is called lymph.
Lymph is then transported to the lymph nodes, purification centers, where
it is filtered and processed for elimination through the
kidneys.
What are some of its benefits?
Stimulates the functions
of the immune system (promotes healing and general well being)
Stimulates
the parasympathetic nervous system while depressing the sympathetic nervous
system (aids
insomnia, depression, stress, digestion)
Relieves
muscle pain and hyper tonus
Reduces edema (swelling)
Alleviates heavy
metal, pesticide and metabolic waste TOXICITY
Reduces pain (fibromyalgia,
chronic fatigue syndrome)
Helps tissue regeneration (pre- and post-surgical,
burns, injuries, reduces scar formation)
Diminishes the effects of
aging
Reduces inflammation
Improves circulation
What are some of its
applications?
Surgical: pre- and post-surgical tissue regeneration
and reduction of edema
Sport injuries: sprains, strains, fractures,
inflammation, chronic pain, whiplash, sciatica
Pediatrics
Ear, Nose and
Throat: sinus, asthma, allergies, ear and throat infections, vertigo,
tinnitus
Neurological: migraines, headaches, stroke, facial paralysis, MS,
Parkinson's disease, myopathy
Gastroenterological: celiac disease, irritable
bowel disease, chronic constipation, weight problems
Dermatological: scars,
burns, wrinkles
Gynecological: infertility, menstruation, PMS, swollen legs,
varicose veins
Metabolic: stress, Chronic Fatigue Syndrome, chronic pain,
cellulite, insomnia, toxicity
Dentistry: inflammation, periodontitis, tooth
extractions, TMJ pain
Geriatrics: promotes tissue regeneration and
oxygenation, improves circulation, relieves muscles soreness
Ophthalmology:
chronic edema of eyelids, cataracts, macular degeneration, reduced visual
acuity
Orthopedics: trauma, sublaxations, sprains, fractures
Osteopathic:
whiplash, back pain, sciatica
Rheumatology: scleroderma, lupus,
fibromyalgia, gout, rheumatoid arthritis, nocturnal paresthetic
brachialgia
Veterinary: Lymph Drainage Therapy can be applied to
animals
What are the contraindications?
Acute
infection/inflammation/fever
Serious circulatory problems
Major cardiac
problems
Hemorrhage
Acute anuresis (absence of urination)
Active
cancer not under medical control, undiagnosed lump
What are the known
effects of Lymph Drainage Therapy?
Manual Lymphatic Drainage is
effective for a wide range of conditions and can be safely applied to
everyone
from children to the elderly, if the basic precautions and contraindications
are respected. Here are
a few of the known effects of Lymphatic
Drainage therapy.
CIRCULATION of lymph, blood capillaries, veins
interstitial liquids and cerebrospinal and synovial fluids
(indirectly) is ACTIVATED. This action helps to reroute stagnant fluid
in the body (i.e., edema, primary
and secondary lymphedema) mucosa,
muscles, viscera, joints, cranial sutures, periosteum, chambers of the
eyes and cochlea.
TOXINS and METABOLIC WASTE PRODUCTS are
removed, making lymphatic drainage especially
effective in TISSUE
REGENERATION. Scars, stretch marks, wrinkles, bruising and fracture or surgical
incision sites are improved. LDT is used as part of DETOXIFICATION
and ANTI-AGING regimens.
MACROMOLECULES (PROTEINS) are drained which
helps to ELIMINATE PROTEIN-RICH
FLUIDS from the extracellular
tissues and aid in the REABSORPTION OF EDEMA.
FATS are EVACUATED through
the lymphatic vessels. These VESSELS ARE located in virtually every
area of the body WHERE FATS MAY ACCUMULATE.
FUNCTION OF THE
IMMUNE SYSTEM is STIMULATED through increased lymph flow. The
additional flow carries more antigens to the lymph nodes, thereby
INCREASING
ANTIBODY/ANTIGEN contact. This has been found to HELP
with chronic or subacute
INFLAMMATORY PROCESSES - chronic fatigue
syndrome, autoimmune diseases, bronchitis, sinusitis,
amygdalitis,
tonsilitis, laryngitis, arthritis, acne and eczema.
FUNCTIONING OF THE
PARASYMPATHETIC system is BOLSTERED, and SYMPATHETIC is
DIMINISHED
with stimulation of the lymphatics. This can be very helpful in dealing with
STRESS,
DEPRESSION, SLEEPING and DIGESTIVE
DISORDERS.
EFFECTS OF PARASYMPATHETIC STIMULATION
Conserves
and restores ENERGY
Helps regenerate injured tissue
Generally most active
during sleep, deep relaxation states
Stimulates immune
functions
Decreases heart rate
Decreases respiratory rate
Decreases
blood pressure
Increases blood flow to skin
Increases blood sugar
level
Increases gastrointestinal motility and kidney function
Increases
secretion of lachrymal glands
Increases secretion of salivary
glands
Increases secretion of digestive glands
Increases secretion of
bronchial glands
Constricts bronchioles
Relaxes sphincters and
spasms
Contracts pupils (miosis)
Contracts ciliary muscles
(accommodations)
Contracts urinary bladder
Stimulates erection
CHRONIC
PAIN is REDUCED as the drainage alleviates tissue-fluid stagnation and possibly
inhibits
nociceptors (pain receptors). TRIGGER POINTS and FASCIA
PULLS can be RELEASED.
VOLUNTARY and INVOLUNTARY MUSCLE SPASMS are
REDUCED, proving helpful in cases of
CONSTIPATION and other
muscle-related maladies.
DRAINAGE of the lobes of the LIVER is
invaluable for releasing most of the post-treatment effects.
As with any
technique, there are conditions under which lymphatic drainage should NOT be
used. These
include ACUTE INFLAMMATION OR INFECTION (especially any
condition with FEVER), MAJOR
CIRCULATORY and CARDIAC problems,
ACUTE BLEEDING and MALIGNANCY NOT UNDER
MEDICAL CONTROL, ACUTE
ANURESIS (ABSENCE OF URINATION).
http://home.earthlink.net/~lymph-drainage-therapy/faq.html