Hello, and welcome! I’m Giovanni, and today I want to share some insight into the available treatment options for lymphoedema. If you or someone you know is dealing with this condition, I understand how overwhelming it can feel to navigate the many different approaches to treatment. As someone specialising in lymphoedema management through Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT), I aim to provide a holistic approach to managing and reducing the symptoms of lymphoedema. I’ve studied with the Vodder Academy and am a Clinical Myotherapist, so my work is built on solid, evidence-based practices. But I also believe that looking at all available treatment options for lymphoedema —medical, surgical, and holistic—is key to finding a management strategy that works for you. What is Lymphoedema? Before we dive into treatment options, let me quickly touch on what lymphoedema is. Lymphoedema is a condition that causes fluid retention and swelling, usually in the arms or legs, as a result of damage or blockage to the lymphatic system. This can occur after surgery, radiation treatment, or due to inherited conditions. While lymphoedema may be chronic, the good news is that with the right treatment, symptoms can often be managed or reduced significantly. Medical Treatments options for Lymphoedema Medical treatments for lymphoedema typically focus on managing the fluid buildup and improving lymphatic drainage. Here’s a quick overview of what you might expect in a clinical setting: Compression Therapy Compression garments are often a cornerstone of lymphoedema management. They help reduce swelling by applying controlled pressure, which encourages the flow of lymph fluid. These garments come in different forms, including stockings, sleeves, and bandages, and they can be custom-fitted to provide maximum comfort and effectiveness. Compression stockings are recommended to be purchased from a clinic who does take measurements of your limb and makes the stocking based on the measurements. The benefit of this approach is that you will have a compression that is ideal for your limb, with no less risk of fluid congestion and other side effects. Pharmaceuticals and Diuretics In some cases, medications may be prescribed to address symptoms like inflammation or to reduce fluid retention. However, it’s important to note that diuretics are generally not a primary treatment for lymphoedema, as they don’t directly address the underlying lymphatic issue. Other medications that are prescribed for Lymphoedema are creams to maintain skin moisturised in order to reduce the chance of cracking and skin damage. Manual Lymphatic Drainage (MLD): I specialize in MLD, a gentle, hands-on technique that stimulates the anastomosis of the lymphatic system and encourages the movement of excess fluid from swollen areas. MLD can be incredibly effective in reducing swelling and relieving discomfort. It works by targeting stretching and letting the skin recoil under some really gentle pressure. This way the lymphatic system is stimulated to work harder, and uptaking the fluid to healthier parts of the body where it can be processed more efficiently. Combine Decongestive Therapy (CDT). It is part of the treatment I offer for Lymphoedema patients here at Melbourne Massage and Treatment. It consists of bandages used to compress the affected area. The compression is applied after MLD has been delivered, and it is applied to maintain fluid movement throughout the anastomosis, which is the alternative connection of the lymphatic system through which the liquid moves after the MLD stimulation. The bandages are applied and are recommended to stay on for about 24 hours. After this time, once you remove them, you will wash them, roll them and come back for another treatment. A back to back treatment would ensure that the swelling of teh lymphoedema can be managed and reduced as quick as possible. Laser therapy: Laser therapy is a non-invasive treatment that can be used in a clinical setting to treat specific lymphoedema presentations. Indeed, Laser therapy is used when the patient already presents with fibrosis, the hardening of the skin. Low-frequency lasers are the ones used most often, and we know there are also portable pen lasers that are efficient enough for this therapy. Pneumatic compression therapy: This therapy consists of using a sleeve pump machine, that get’s placed over the affected area and inflates sequentially to apply pressure. The rhythmic compression helps stimulate lymphatic flow, reduces swelling, and improves circulation by encouraging the movement of excess fluid toward lymphatic drainage sites. All those therapies are recommended in combination with each other. To start with, for best result and quick reduction, MLD and CDT would be the more effective. Surgical Treatment Options for Lymphoedema While surgery is generally considered a last resort for lymphoedema, there are certain cases where it may be necessary or beneficial: Liposuction for Lymphoedema This technique is sometimes used to remove excess fat tissue that has accumulated as a result of chronic lymphoedema. It’s not a cure, but it can help reduce the volume of swelling and improve the appearance of the affected area. Lymphovenous Anastomosis (LVA)/Bypass: It involves connecting the lymphatic vessels and nearby veins, allowing excess lymph fluid to drain into the bloodstream instead of accumulating in tissues. Vascularized lymph node transfer (VLNT): a surgical technique used to treat lymphoedema by transplanting healthy lymph nodes along with their blood supply to the affected area. The transplanted lymph nodes, typically harvested from the patient’s groin or other regions, are reconnected to the recipient’s blood vessels. Lymph Node Transplantation In some specialised cases, surgeons may transplant healthy lymph nodes from one part of the body to another to help restore lymphatic drainage. This option is more complex and is usually reserved for severe, treatment-resistant lymphoedema. Surgery, of course, comes with risks and recovery time, so it is typically considered only after all other treatments have been explored. Holistic Treatments: Taking a Whole-Body Approach While medical and surgical treatment options for lymphoedema can certainly help with this presentation, I firmly believe that a holistic approach is crucial for long-term success. Here are some natural and complementary therapies that can support overall well-being: Exercise and Movement Regular, […]
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Lymphoedema is a condition often associated with cancer survivors, particularly those who have undergone surgery or radiation therapy, but it can also occur due to other chronic conditions or injuries. Characterized by the swelling of limbs due to the accumulation of lymphatic fluid, lymphoedema can significantly impact a person’s mobility, emotional well-being, and overall quality of life. Early diagnosis of lymphedema and management are key to preventing long-term complications, and at Melbourne Massage and Treatment in Fitzroy North, Giovanni, a skilled Myotherapist and Lymphoedema therapist, specializes in identifying and managing this condition using a combination of manual techniques and physical assessments. In this blog, we’ll explore how lymphoedema is diagnosed, the challenges of identifying it early, and Giovanni’s approaches to detecting and managing the condition. What is Lymphoedema? Lymphoedema occurs when there is a disruption in the lymphatic system, leading to the accumulation of lymph fluid, a protein-rich fluid that sits beneath the skin and between the body’s tissue, which often causes swelling in the limbs or other areas of the body. This condition can develop due to a variety of factors, such as lymph node removal during surgery, radiation treatments, injury, or genetic predisposition. Early detection of lymphoedema is crucial to prevent the condition from worsening and causing complications like tissue fibrosis, infections, or reduced mobility. Challenges in the Diagnosis of Lymphoedema Lymphoedema can be difficult to diagnose, especially in its early stages. In its initial phase, symptoms such as heaviness, tightness, or mild swelling may seem subtle and easy to overlook. Patients might attribute these sensations to muscle strain or arthritis, delaying the diagnosis. Furthermore, swelling can fluctuate, making it even harder to identify at the outset. By the time noticeable swelling occurs, the condition may have already advanced, complicating treatment and requiring more intensive management. This is why early detection is so important, as it allows for less invasive treatments and better long-term outcomes. Giovanni’s Approach to Diagnosis of Lymphoedema As a Myotherapist and Lymphoedema therapist at Melbourne Massage and Treatment Lymphoedema Clinic, Giovanni uses manual techniques and physical assessments to diagnose lymphoedema. Although he does not use imaging technology or machines to detect the condition, Giovanni’s training and experience enable him to identify the signs and symptoms through careful observation, palpation, and physical examination. That said, if it is needed, Giovanni can write a referral doctor for your GP to indicate why he believes it is important for you to undertake a specific scan or some medical test. 1. History taking The earlier approach to Lymphoedema diagnosis is an extended look at the medical history, where any past surgery, injury, accident or medications need to be outlined and taken into consideration. 2. Clinical Assessment Following the history taken to diagnose lymphoedema is the clinical assessment. Giovanni conducts a thorough physical examination of the affected limb or area, paying close attention to key signs of lymphoedema, such as: Persistent swelling that doesn’t subside with rest Feeling of heaviness or tightness in the limb Changes in skin texture, such as hardening or thickening Reduced range of motion in the affected area Along with your booking confirmation, you would also receive a form to fill in online, which would start paving the road to your diagnosis. 3. Tape Measurement Method One of the simplest, yet effective, ways Giovanni diagnoses lymphoedema is by using tape measurements. This involves measuring the circumference of the affected limb at various points (e.g., wrist, forearm, upper arm) and comparing these measurements to the unaffected side. Over time, consistent and progressive changes in limb circumference can indicate the development of lymphoedema. While this method is cost-effective and easy to perform, it may not detect early, subtle changes in limb volume. However, when paired with other assessments, it offers valuable information about the progression of the condition. 4. The Pitting Test Giovanni often performs the pitting test, a hands-on method to assess fluid accumulation in the affected area. This simple test involves pressing down on the swollen area with his fingers. If an indentation (or “pit”) remains for several seconds after the pressure is released, it indicates the presence of excess fluid in the tissue, which is a hallmark of lymphoedema. The pitting test helps Giovanni evaluate the severity of fluid retention, but it is more subjective than advanced diagnostic tools. 5. Stemmer’s Sign – Tissue assessment Giovanni also uses palpation (manual examination through touch) to assess the affected area’s tissue texture and consistency. In the early stages of lymphoedema, the tissue may feel soft and puffy, but as the condition progresses, it can become firmer, and in some cases, the skin may develop a thicker, fibrous texture. These changes are essential indicators of lymphoedema and are crucial for determining the stage of the condition. In addition to this, the Stemmer’s Sign is a test that consists of picking what we would expect to be wrinkled skin, like the one just before the toe/tarsal joint. A positive test would result in the impossibility of pinching any skin due to the swelling in the area. 6. Lymphoscintigraphy A lymphoscintigraphy is a scan that is part of nuclear medicine tests, and it is specifically used to detect any interruption within the lymphatic system. The test is done in the specific clinic, and no recovery is needed for it. The procedure consists of injecting a radioactive liquid either in the feet or hands and with a specific camera, detecting the movement of the liquid within the body. We would expect the liquid to move within a certain timing and pathway along the lymphatic system. If that doesn’t happen, this test can give a good understanding if anything is not functioning with the lymphatic system. Why is Early Detection Crucial? The earlier lymphoedema is detected, the easier it is to manage. Early-stage lymphoedema is often easier to treat with less invasive interventions, such as manual lymphatic drainage (MLD), compression therapy (CDT), specific exercises, and skin care. These treatments can help reduce swelling, prevent the condition from worsening, and improve […]