Lymphologists, phlebologists, veins and lymphatics
<p>No matter who we are, clinician, allied healthcare professional, scientist, patient or carer, we often focus only on what we know, what we find comfortable and what we have learnt (or been told). In reality, that is not good, we stagnate, our chances for different and perhaps better outcomes are reduced, and strangely, we often […]
Using exercise classes to reduce arm lymphoedema
<p>Background: Arm lymphoedema is a chronic condition affecting multiple aspects of patients’ daily lives but quality of life can be improved with excess volume reduction. Treatment consists of infection prevention, lymphatic massage, compression therapy and special exercises. However, there is little evidence regarding the effect of exercise in a group framework. Aims: Using a series […]
Implementation of a BCRL management programme
<p>Background: Breast cancer-related lymphoedema (BCRL) is a growing concern with the increased survival rate following breast cancer (Smith et al, 2011). However, limited data is available on prospective management designed to reduce the morbidity of BCRL.</p>n<p>Aims: To evaluate the impact of the development of a BCRL programme on the management of women with breast cancer.</p>n<p>Methods: […]
Screening for morbidity following breast cancer
<p>Background: A screening tool was developed to identify morbidity emerging in the years after breast cancer treatment.</p>n<p>Aims: This project aimed to investigate patient responses to a newly developed screening tool for lymphoedema, reduced arm function, fatigue and pain.</p>n<p>Methods: Interviews were conducted following completion of the screening tool by 40 women attending review appointments post-treatment for […]
The skin as a barrier: What does it mean when it fails when lymphoedema is present?
<p>The skin is a barrier and a primitive immunosurveillance organ. When in good health at rest, the skin has no reason to undergo repair. Stretching, compression or stimuli such as stripping with tape or exposure to UVB switch on the repair mode (Ryan, 2004). After a short period, often measured in hours, mitoses appear and […]
Exercise for limb lymphoedema: evidence that it is beneficial
<p>Exercise has been shown to improve lymphatic propulsion, clearance and venous drainage from the limbs. However, awareness of the positive benefits of different exercise regimens for those with lymphoedema of the limb has been slow to emerge. Despite this, studies have demonstrated that various exercise regimens can have a positive impact on limb size, subjective […]
Lymphoedema in Japan: current issues
<p>Lymphoedema is a worldwide problem, and yet, until recently it has been considered a relatively unimportant health concern. In developed countries, it mainly occurs following surgical treatment for cancer. Recent studies have helped to raise awareness of this condition and have indicated that it can lead to a decrease in quality of life (McWayne and […]
Hosiery in lower limb lymphoedema
<p>As part of its work to establish a national provision of lymphoedema services in the UK, the Lymphoedema Framework project has developed guidelines for the use of compression hosiery in lower limb lymphoedema. The guidelines, to be presented in two parts, have drawn together existing hosiery classifications and linked a new classification with clinical descriptions […]
German Society of Lymphology
<p>The German Society of Lymphology (DGL) has existed since 1976, developing as an offshoot from the Society for Manual Lymph Drainage (Dr Vodder) and Related Therapies (GfMLV) that was founded in 1967. It is a membership organisation, recognised as a non-profit society. The goal of the society is to promote research and teaching in the […]
10 years of global efforts to eliminate LF: where are we?
<p>Lymphatic filariasis (LF) is a mosquito-borne parasitic infection responsible for long-term chronic morbidity in the form of lymphoedema, genital pathology (especially hydroceles), recurrent disabling fevers (lymphangitis) and elephantiasis in over 40 million people around the world (Ottesen et al, 2008). Currently, over one billion people are exposed to infection in 81 endemic countries in Asia, […]
Imaging of lymphatics, LE and lymphatic function
<p>Despite our best imaging techniques and technologies, many are still far from perfect. However, they can give us valuable information about the structural and functional status of the tissues and systems, and specifically about the lymphatic system and the diagnosis of lymphoedema.</p>
We need to help patients to help themselves
<p>Performing the same task day after day, week after week is not only predictably routine, there is also a danger that we may avoid doing it altogether. Perhaps worse, fear of losing face may result in us telling people we have been performing the task when, in fact, we haven’t.</p>
Historical review of lymphatic studies in the head and neck
<p>The discovery of the lymphatic system occurred later than the other vascular systems. Early studies only observed lymphatics of the viscera in mammals. Lymphatics of the head and neck were not revealed until the mercury injection technique was introduced, which detailed in books of Mascagni (1787) and Sappey (1874) that were largely referred by later […]
So, this is lipoedema
<p>I find it hard to remember when I first began to realise that my legs looked different to others. Being obese from the age of six hid the fact that my body was showing signs of other problems. I have always been singled out as being different, and when my knee-high nylon school socks only […]
Lymphoedema and delusional parasitosis
<p>The false and fixed belief of being infected/infested by one or many different living organisms, such as insects or parasites, is not a common condition. Although several cases have been recorded since the end of the nineteenth century, it was the Swedish psychiatrist Karl-Axel Ekbom who first systematically studied the presenile syndrome of delusional dermatozoid […]
Use of laser therapy in the management of lymphoedema
<p>The use of laser therapy has been slow to develop and not without controversy along the way. Forty years have passed since initial research reported positive biological effects from laser light (Carney et al, 1967). Despite the publication of over 2,500 titles relating to therapeutic light, there is still debate over its clinical use particularly […]
Learning from traditional healers in South Africa
<p>In 1999 the South African Ministry of Health (1999) reported that breast cancer was the leading cancer diagnosis among South African women in 1999. More recently, Mqoqi et al (2004) found one in 12 white women and one in 18 ethnically-diverse women were at risk of being diagnosed with breast cancer in South Africa. The […]
Haddenham Healthcare: children with lymphoedema
<p>The treatment of lymphoedema in the UK is predominantly based on the needs of adults with cancer-related lymphoedema (Robertson Squire, 2000). This paper aims to look at the different treatment options available from Haddenham Healthcare and their suitability for children with lymphoedema. Factors such as age, parents’ attitude and severity of oedema all need to […]
Being true to your specialism, is being true to your patient
<p>As we are at the infancy of 2012, we too are at the infancy of the plethora of change within the NHS in the UK. Although the idealism was set out in 2011, it is this year where we will experience the impact of what the reforms truly mean to both patients and those involved […]
Non-compliance? It’s easy for you to say…
<p>Recently, I was delighted to receive an invitation to attend the 20th birthday celebration of the Lymphoedema Practitioners Education Group of Victoria (LPEGV), which I gladly accepted, looking forward to catching up with some old friends from my time with the Lymphoedema Association of Victoria (LAV). I was not disappointed. It was a great evening, […]
Lipoedema management: Gaps in our knowledge
<p>Lipoedema is a condition characterised by abnormal, symmetrical fat deposits in the legs, resulting in a disproportion between a smaller upper body and a larger lower body. Since its first use, the term “lipoedema” devised by Allen and Hines (1940) has been broadened to incorporate patterns of limb adiposity differing from the original pattern, which […]
The facts about liposuction as a treatment for lymphoedema
<p>There is some controversy regarding liposuction for late-stage lymphoedemas. While it is clear that conservative therapies such as complex decongestive therapy (CDT) and controlled compression therapy (CCT) should be tried in the first instance, options for the treatment of late-stage lymphoedema that is not responding to treatment is not so clear. Liposuction has been used […]
Lymphoedema and sexual relationships in mid/later life
<p>Background: Women with breast cancer-related lymphoedema (LE) can experience physical, psychological, and sexual problems as a result of both physical limitations and appearance associated with this condition. Aims: This study investigated the effect on quality of life of the sexual relationships with intimate partners for women with LE. Methods: Participants were 11 women with LE. […]
An overview of lower limb lymphoedema and diabetes
<p>The prevalence for individuals diagnosed with lower limb lymphoedema and coexisting diabetes is unknown. However, both conditions cause significant problems that can compromise the viability of the lower limbs. An extensive search of the literature including medical databases (MEDLINE, PubMed and CINAHL), plus hand searching through diabetes journals, podiatry journals and wound care journals, was […]
BCRL questionnaires: climate and indigenous groups
<p>Valid and reliable subjective questionnaires are essential to enable research regarding the effect of breast cancer-related lymphoedema (BCRL) on quality of life (QoL). This review was undertaken to determine the reliability and validity of four current subjective questionnaires for the evaluation of BCRL, particularly with respect to climate and ethnic or indigenous groups. Searches were […]
Audit of the use of kinesiology tape for breast oedema
<p>Background: Lymphoedema developing in the breast and truncal area after treatment for breast cancer can be challenging to manage and distressing for patients. Kinesiology tape has traditionally been used in sports injuries and is considered effective at improving lymph drainage (Kase et al, 2003). It offers potential as a self-care option for managing swelling in […]
A new treatment for soft tissue fibrosis in the breast
<p>Background: Soft tissue fibrosis is a common consequence of breast cancer treatment and chronic lymphoedema. It can compromise function and quality of life, but research regarding interventions is limited.</p>n<p>Aims: To assess the efficacy of using JoViPitPak® (JoviPak Corporation) to influence soft tissue fibrosis change by looking at tissue density, perceived cosmesis and perceived breast pain.</p>n<p>Methods: […]
Using honey in post-excision malignant melanoma ulcers
<p>Malignant melanomas are extremely difficult to treat conservatively at primary care level since the precise diagnosis requires a skin biopsy, which then undergoes dermatoscopy or epiluminescence microscopy. The treatment also varies according to the stage of melanoma and whether it is a superficial spreading melanoma or a melanoma in situ (Lorentzen et al, 1999). For […]
Lymphoedema prevalence in the West Midlands region
<p>A report was produced, focusing on the overall prevalence of lymphoedema in the West Midlands region with further analysis relating to diagnosis, caseload gender, average caseload, and staffing levels. The information was provided by 43% of British Lymphology Society members in the West Midlands between May and June 2012. However, the figures were affected by […]
A rare case of lymphoedema-distichiasis
<p>Lymphoedema-distichiasis is a rare autosomal-dominant condition characterised by a second row of eye lashes (distichiasis) and pubertal onset of lower limb lymphoedema. It was first described in 1964 by Falls and Kertesz, but it took almost 40 years for the gene that causes the condition to be located on chromosome 16 (Fang et al, 2000). […]
Society update Vol 3, No 2
<p>- British Lymphology Society – The Australasian Lymphology Association (ALA) – The International Society of Lymphology – Leg Club – The Japanese Society of Lymphology – The National Lymphedema Network (NLN) – The Lymphoedema Support Network – The Israel Lymphedema Association (ILA)</p>
Lymphoedema is part of who I am
<p>In 1999, when I was 19 years old and in my second year of university, I remember standing in the living room saying to my housemates, ‘Do my legs look swollen to you?’ They agreed they did look a little swollen but we did not know why, so left it there. A few months later […]
Use and response to treatment using low level laser therapy
<p>Laser therapy for lymphoedema treatment has been used internationally for many years but has been slow to be accepted in the UK. The science behind the technique and its effectiveness in reducing fluid viscosity and encouraging motoricity of the lymphatics has been reported (Lievens, 1987; Eliska and Eliskova, 1997). The evaluation reported in this paper […]
Klippel-Trenaunay-Weber syndrome — a case report
<p>Klippel-Trenaunay-Weber syndrome is a rare congenital syndrome involving enlarged veins and arteries, limb hypertrophy and capillary malformations. In 1900, French physicians, Klippel and Trenaunay, first described what became known as Klippel-Trenaunay syndrome after two patients presented with a triad of symptoms — port-wine stain, varicose veins, and bony and soft tissue hypertrophy involving an extremity […]
Role of GPs in breast cancer-related arm morbidity care
<p>Background: This paper addresses a gap in the literature on breast cancer-related arm morbidity care regarding clinician responsibility for the management of women’s treatment-related arm morbidity needs. Using a qualitative research method, the authors spoke to general practitioners (GPs) about their perceptions, knowledge and experiences of breast cancer-related arm morbidity, and what role, if any, […]
Human functioning in lymphoedema
<p>Background: The description and testing of the different levels of human functioning is essential prior to beginning the treatment of patients with lymphoedema.</p>n<p>Aims: The International Classification of Functioning, Disability and Health (ICF) offers an international framework for the classification of health and health-related domains. ICF Core Sets are lists of selected ICF categories concerning the […]
Clinical effectiveness and patient considerations in oedema management
<p>This article aims to strike a balance between compression bandaging to treat oedema and a positive patient experience. Compression therapy is well recognised as a key component in the management of venous and lymphatic conditions. Science indicates that intermittent pressures provided by inelastic bandage systems rhythmically stimulate venous and lymphatic flow to reduce and contain […]
Myiasis in a bancroftian filariasis endemic area
<p>Background: Human myiasis in bancroftian filariasis endemic areas, although rarely reported in the literature, might pose an important aggravating factor for patients with swollen limbs with wounds, such as varicose ulcers and mossy lesions (lymphangiomatosis).</p>n<p>Aims: To study the occurrence, clinical and parasitological characteristics of wound myiasis in individuals living in a filariasis endemic area in […]
Use of a Velcro® wrap system in the management of lower limb lymphoedema/chronic oedema
<p>Lymphoedema and chronic lower limb oedema are conventionally treated with multi-layer bandaging, followed by compression hosiery. Inevitably, this management system can be difficult to maintain in some patients, especially those with hand weakness, back problems, obesity, or those who are elderly, have abnormal limb shapes or are palliative patients. Farrow Wrap™, a Velcro® wrap system, […]
Mapping of lymphatic filariasis in Rwanda
<p>Background: Infections with Wuchereria bancrofti causing lymphatic filariasis (LF) still represent one of the major health problems in the tropics. In Rwanda, where LF has been considered endemic by the World Health Organization (WHO) and the Global Alliance to Eliminate Lymphatic Filariasis (GAELF), there are no reliable data on distribution and prevalence of the disease. […]
Is BIS ready for prime time as the gold standard measure?
<p>Assessment of lymphoedema can pose challenges to the clinician. There is no universally accepted standardised method for measurement. In this, the first of two articles, Leigh Ward, a pioneer in the application of bioelectrical impedance spectroscopy (BIS) for assessment of breast cancer-related lymphoedema, makes a strong case that BIS technology now warrants consideration as the […]
A quality of life measure for limb lymphoedema (LYMQOL)
<p>Background: This paper describes the validation of a ‘condition-specific’ quality of life (QoL) assessment tool for lymphoedema of the limbs (LYMQOL). Aims: To ascertain whether the tool could accurately assess QoL in this patient group. Methods: Face and content validity were assessed by patient questionnaires; criterion validity by comparison with European Organisation for Research and […]
Is there a role for contrast hydrotherapy?
<p>Contrast hydrotherapy involves the immersion or dousing of a limb in alternating hot and cold water. This ‘tweaks’ the peripheral autonomic nervous system, altering vascular tone and flow and improving nitric oxide production and vessel health. It has been shown (Elmstahl et al, 1995; Fiscus et al, 2005) to improve both short- and long-term distal […]
A shift to chronic disease care management
<p>Lymphoedema is a chronic medical condition which may reduce a person’s quality of life by negatively impacting on his or her medical, physical, psychosocial and functional status. This article argues that lymphoedema progression can be more effectively controlled by focusing clinical care delivery on client self-management, to better address the possible complications of this condition, […]
Relationship between pain, tightness, heaviness, perceived limb size, and objective limb size measurements in patients with chronic upper-limb lymphoedema
<p>Background: Lymphoedema has a significant effect on patient quality of life due to the daily experience of limb symptoms such as pain, tightness and heaviness. While treatment of lymphoedema often focuses on reduction in objective limb measures, there is minimal evidence to support that this reduces subjective limb symptoms.</p>n<p>Aims: This study aimed to investigate the […]
National Lymphedema Network
<p>In 1988 the National Lymphedema Network® (NLN®) was established by Saskia RJ Thiadens, in response to a growing need for awareness, education and, most importantly, an effective treatment for lymphoedema. Recognised both nationally and internationally, the NLN is a California-based 501(c)3 nonprofit organisation dedicated to diminishing the suffering of lymphoedema patients through education, service and […]
Holistic management of lymphoedema in Japan: two contrasting cases
<p>One of the roles of a nurse is to keep patients with secondary lymphoedema from breast cancer treatment motivated to self-care, as its symptoms are chronic and debilitating. Patients need an easy, quick, cheap, and effective self-care programme because they often cannot and do not adhere to complex, timeconsuming, and expensive treatments. The author’s clinic […]
Early detection — a strategy to reduce risk and severity?
<p>Despite changes in surgical techniques, radiotherapy targeting and the apparent earlier detection of cancers, secondary lymphoedema is still a significant problem for about 20–30% of those who receive treatment for cancer, although the incidence and prevalence does seem to be falling. The figures above generally relate to detection of an enlarged limb or other area, […]
ALFP: identifying issues in lymphoedema in the US
<p>The American Lymphedema Framework Project (ALFP) is a national initiative introduced in 2008 to improve the management of lymphoedema (LE) and related disorders in the United States. A National Stakeholders Conference was held in March 2009 to share perspectives on the current state of LE, establish priority issues, and recommend actions to move the field […]
I underwent liposuction to reduce the volume in my leg
<p>I first developed primary lymphoedema ten years ago. I woke up one morning to feel my right leg tight and slightly swollen. I could not recall being bitten or anything untoward and decided it would go away of its own accord. How wrong was I to be proved.</p>
