Treatment for Secondary Lymphoedema, Primary Lymphoedema, Lipoedema, Chronic and Complex Oedema and Venous Conditions.
EARLY DETECTION AND SCREENING
Early Stage Lymphoedema can be detected using Bioimpedance Analysis or L-DEX. This quick, non-invasive measure can detect swelling (specifically the presence of lymphatic fluid) at the sub-clinical stage, well before early signs are visible to the patient. An L-DEX measure is also vital for established Lymphoedema, giving the clinician valuable insight to the stage of the swelling and it is indicated in both upper and lower-limb Lymphoedema. The clinic is currently in a transition phase from the older model U400 over to a Sozo unit. In the interim patients can be guided to access Noosa Hospital Allied Health or Bloomhill Cancer Care to have a Sozo reading taken. Fees’s for an L-DEX measure vary between $25-$30.
Early intervention and management can reduce the severity of lymphoedema and its debilitating functional, physical and psychological impacts to the individual. Optimal results for Early Intervention Screening are achieved by taking measurement at:
· Pre-op
· Post-op
· 3 months, 6 months and 12 monthly intervals.
GRADUATED COMPRESSION GARMENT PRESCRIPTION and SIPC (compression Pumps)
Specialist prescription is available for Custom-Made and Ready to Wear graduated compression garments for upper limb/lower-limb and trunk oedema. Sunshine Coast Lymphoedema Therapy uses a number of the leading manufacturers, Jobst Elvarex, Haddenham, Medi, Second Skin, Juzo, Venosan and Sigvaris. We also prescribe Mobiderm, Comfiwave and Compression Wrap systems. Patients may be eligible for a QLD Health Prescription to assist with costs of garments, see guidelines on: see link
Sequential Intermittent Pneumatic Compression (SIPC) pumps can be a vital self management tool. The pumps require measurement and prescription but can be rented for a trial period. Pumps work well in Lymphoedema, Lipoedema and Venous conditions to reduce swelling, soften tissue, reduce pain/ache and improve wound healing. The practice uses Medi-Rent. Garments for an arm/ chest wall or lower-limb can be prescribed. See the link.
MANUAL LYMPHATIC DRAINAGE MASSAGE
This is a specialised and effective type of massage, utilised to increase the uptake in the superficial lymphatics, soften fibrosis (tissue thickening), reduce scar tissue and facilitate collateral lymphatic drainage pathways. Laura has completed her Lymphatic Anatomy course at the ALERT team in Sydney understanding how ICG (near-infrared fluorescence lymphatic imaging) is used to visualise the lymphatics in real time, mapping lymphatic territories and lymphosomes. This cutting edge research by Prof Hiroo Sumai (Plastic Surgeon) is changing the way the Lymphoedema Clinician applies manual lymphatic drainage techniques.
LOW-LEVEL LASER THERAPY
The clinic is equipped with the Riancorp Low-Level Laser unit, (LTU-904), approved by the TGA and FDA for lymphoedema treatment. This is a painless and non-invasive laser with a large volume of evidenced based research papers indicating its efficacy. Laser is shown to be effective in the reduction of lymphoedema, scar tissue fibrosis, pain and cellulitis recurrence. The laser treatment protocols when used in conjunction with soft tissue release and MLD can also soften fibrosis and resolve cording. Please see link to the Riancorp website.
EXERCISE PRESCRIPTION
Exercise plays a vital role in the treatment of Lymphoedema, Lipoedema and Venous Conditions. Studies show that exercise does not cause Lymphoedema or a worsening of pre-existing Lymphoedema, in fact research tells us that exercise plays a vital role in the prevention and management of Lymphoedema. Exercise improves lymphatic efficiency, maintains joint ROM and reduces treatment related side-effects from chemotherapy. Exercise prescription is best tailored to the individual depending on the clinical presentation, surgical history, co-morbidities, exercise history and goals. Lipoedema and Venous Conditions require their own specialist exercises. We also work closely with local Exercise Physiologists in our Special Populations.
Laura is certified to implement the Strength After Breast Cancer Rehabilitative Exercise Program. This is an evidence based slow-progressive weight training program shown in the literature to reduce the initial incidence of lymphoedema by 70% and reduce an existing lymphoedema by 50% - view link for education session.
KINESIO TAPING
Utilising specialist methods of application to compliment lympahatic drainage pathways, kinesio tape might be used to aid in the reduction of lymphoedema, inflammation and to enable the lifting of scar tissue. The theory behind K-tape is that pressure changes and movement of the skin open and close the initial lymphatics facilitating drainage. Cure tape is also used for a head/neck application or for sensitive skin.
Compression Bandaging
The more intensive phase of Lymphoedema management may require a course of compression bandaging. A clinical decision will be made with you and recommendations for either the Coban 2 system by 3M, Compri2 by Jobst or multi-layer lymphoedema bandaging (MLLB). Fast n Go is a new self bandaging system which is also an excellent system for self maintenance. The bandaging systems allows for improved lymph drainage, assists wound healing, reduces inflammation and when MLLB is mixed with padding, it can break down thickened tissue and can reshape the limb.
PSYCHOSOCIAL SUPPORT, COPING STRATEGIES AND SELF MANAGEMENT
Lymphoedema/Lipoedema and Venous Conditions can bring about a combination of physical, functional and psychosocial factors. The treatment goals are to tailor an individual approach with general goals to improve self-esteem, coping strategies, self-management and trying to achieve a balance in activities of daily living. Persistent pain management strategies can also be taught along with referrals to the MDT (multi-disciplinary team) or the Persistent Pain Management Service at QLD Health.
SKIN CARE, CORDING, SCAR MANAGEMENT
Skin care is a vital part of lymphoedema management to protect and hydrate the skin. It’s important to prevent cellulitis infections, which can further exacerbate the Lymphoedema/ Mixed Oedema / Venous Insufficiency. Skin care products as recommended by the ALA / wound care nurses will be recommended.
Cording can occur after breast cancer related lymphoedema, usually in weeks 1-5 post-operatively and can severely limit functional range of movement. The cords or fibrosed lymphatic vessels can be treated with a combination of soft tissue methods, laser and gentle exercises.
Scar tissue management can be taught to the patient and assists to prevent lymphatic blockages, especially after radiation. Scar treatment can soften fibrotic tissue and improve the general appearance of the scar. In some cases Silcone based products may be recommended including CICA Care, Scar gel, Mepitac taping. Negative Pressure Therapy is also an excellent method to improve scar adhesions. Negative Pressure or “cupping” can be taught as an effective home management tool that works quickly to release fascial adhesions. Safe treatment protocols must be directed by the therapist, based upon clinical assessment and stage of the scar, following surgery or radiotherapy.
FOR APPOINTMENTS CALL: 07 5474 9093
c/o Alchemy in Motion www.alchemyinmotion.com.au
35 Mary Street, Noosaville, QLD, 4566
Laura Manning - Lymphoedema Occupational Therapist