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The “SUPER POWERS” of Lymphedema Management and Risk Reduction

Learn about the superpowers of lymphedema management and risk reduction in this informative presentation by Julia Rodrick. Discover resources and websites for further information and training in lymphedema and lipedema.

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The “SUPER POWERS” of Lymphedema Management and Risk Reduction

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  1. The “SUPER POWERS” of Lymphedema Management and Risk Reduction • Presenter: Julia Rodrick, OTR/L, CLT-LANA, WCC • ***No Financial Disclosure or conflicts of interest which influence this presentation

  2. This is us…

  3. Knowledge Application is our SUPER POWER!!!

  4. Lymphedema SUPER HERO Websites: • American Lymphedema Framework Project (ALFP) - www.alfp.org • Lymphatic Education & Research Network (LE&RN) - lymphaticnetwork.org • Lymphedema Treatment Act - lymphedematreatmentact.org • Lymphology Association of North America (LANA) - www.clt-lana.org • National Lymphedema Network (NLN) - lymphnet.org • Training Schools:  • Academy of Lymphatic Studies - www.acols.com • Dr. Vodder School International - www.vodderschool.com • Klose Training & Consulting - klosetraining.com • The Norton School of Lymphatic Therapy - www.nortonschool.com •  Lipedema Websites: • Fat Disorders Research Society - fatdisorders.org • Lipedema Simplified - www.lipedema-simplified.org

  5. The Lymphatic System The lymphatic system is this amazing plexus of vessels , tissue and organs which are uniquely designed to contribute to the Life- sustaining process of microcirculation, partnering with the cardiovascular system to maintain wellness

  6. The Lymph System has multiple, interrelated functions to support your wellness • It maintains the balance of fluid between the blood and the tissue (fluid homeostasis) as an accessory route, interstitial fluid (with it’s contents of metabolic wastes) is absorbed out of the interstitial spaces and returned to the circulatory flow. • Recycle large metabolic proteins and other macro-molecules, as well as waste excreta from the tissue spaces (which can not be absorbed directly via the blood capillary network). • Intestinal lymphatics transport and absorb (metabolize) fatty acids as well as absorption of cholesterol and vitamins A, D, E, and K • The Sophisticated “first line of defense” immunological functions including lymphocyte (WBC) production & storage. It fights and destroys bacteria, foreign cells, cancer cell and cellular debris

  7. The Lymphatic Hierarchy: One Directional, Distal to Proximal and Superficial to Deep Watersheds & Root territories Pre-collector/ Collector network Nodes Lymph Capillary Bed Lymph Trunks Thoracic & Right Lymphatic Duct Right & Left Venous Angles

  8. Lymph Capillary: The primary player Passive influx of fluid is influenced by tissue pressure chances. Arterial pulsation, external tissue pressure (i.e.; Increased interstitial fluid due to increased blood capillary pressure, skin stretch/ mobilization of connective tissue or muscle contraction/ lengthening ) http://www.jdaross.mcmail.com/lymphatics2.htm

  9. The Lymphatic Hierarchy: Pre-collectors Lymph Capillary Bed

  10. The Lymphatic Hierarchy: Collectors (Distal to Proximal and Superficial to Deep) Pre-collector/ Collector network Lymph Capillary Bed

  11. The Lymphatic Hierarchy: One Directional, Distal to Proximal and Superficial to Deep Watersheds & Root territories Pre-collector/ Collector network Lymph Capillary Bed Nodes Lymph Trunks Thoracic & Right Lymphatic Duct Right & Left Venous Angles

  12. Lymphatic Physiology Lymphatic sufficiency LL< TC or TC = 10x LL Healthy lymphatic system Edema TC No Edema FR LL LTV

  13. LYMPHEDEMA Defined… A Pathophysiological condition in which fluid and protein accumulate in the interstitial (tissue) space. The condition is associated with the development of physical and psychosocial symptoms. (Ridner, S. http://lymphaticnetwork.org, 2018) A chronic condition caused by insufficiencies of the lymphatic system which is manifested as an accumulation of (protein-rich) inflammatory fluid within the interstium, leading to tissue swelling, due to inadequate drainage. ( Foldi 2006; Zuther 2009, Lasinski, 2012)

  14. Risk Factors Influencing the Management of Lymphedema • Medical History and the management of Co-Morbidities • You (psychosocial) • Trauma/ infection • Nutrition/ Obesity • Inactivity/ muscle weakness/ lack of mobility

  15. Medical History and the management of Co-Morbidities(Supporting insufficiencies of the Lymphatics) • Dynamic insufficiencies = the car is fine but the road is blocked or damaged. Service the road (work with your health care provider to manage any complicating pathologies. Adjust lifestyle towards wellness • Mechanical insufficiencies: The “car” is damaged so protect it from further damage Combined insufficiencies: Due to bad roads, over time, the car wears down and becomes damaged. Promote your overall wellness

  16. If you have been diagnosed with lymphedema, other pre-existing medical conditions, if poorly managed, may complicate your lymphedema, through dynamic insufficiency, by adding lymphatic stressors. Some co-morbidities might include: • History of DVT (blood clots) post thrombotic syndrome • Peripheral Vascular disease (chronic venous insufficiency) • Renal or cardiovascular disorders • Diabetes • Neuro pathologies like MS or Parkinson's, fatigue syndromes, others Our Super Power: Risk Reduction through Compliance in the management of our general health

  17. Risk Reduction: Psychosocial struggles of chronic illness Know about risk reduction strategies to control your vulnerability Attitude can be our super power or our kryptonite

  18. “I think there is a deeper level to body acceptance and it has nothing to do with what people can see but everything to do with what you can feel…. My body doesn't exist solely to bring me physical or emotional pain. I don't view it as an enemy or a friend…I guess I would tell someone not to fight the pleasure of being alive because you pack your body away in your disease”. (excerpts from https://riverandquill.com/loving-your-body-again-chronicillness).

  19. Mindfulness-based Stress reduction resources: Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction … J Carmody, RA Baer - Journal of behavioral medicine, 2008 – Springer Teaching self-care to caregivers: Effects of mindfulness-based stress reduction on the mental health of therapists in training. SL Shapiro, KW Brown, GM Biegel - Training and education in …, 2007 - psycnet.apa.org Mindfulness-based stress reduction and health benefits: A meta-analysis P Grossman, L Niemann, S Schmidt… - Journal of psychosomatic …, 2004 – Elsevier Mindfulness-Based Stress Reduction: What it Is, How it Helps ...https://www.psychologytoday.com/.../mindfulness-based-stress-reduction-what-it-is-h... Cached Mar 18, 2010

  20. Mechanical insufficiencies: The “car” is damaged • Repeated Infection/ Trauma • Poor Nutrition/ Obesity • Inactivity/ muscle weakness/ lack of mobility Our Super Power: lifestyle strategies Aimed at reducing the risk of further damage

  21. Risk Reduction: Skin Care & Infection Skin care precautions tips • Skin cleansing and moisturized • (Upper Extrem.) wear gloves when washing dishes, gardening or cleaning with hash chemicals • (Lower Extrem.) wear shoes and socks to protect surfaces. • Carry a purse size “first aid kit” for unexpected scratches or bug bites • Clean cuts ASAP and apply antiseptic • Know the signs of skin infection as they appear to the effected limb, don’t delay to seek medical attention • Sun Screen (high 30 + SPF) is your friend • Nail care considerations: If you enjoy the salon, you can bring alcohol wipes; bring your own manicure/ pedicure tools. • Yard care gear, insect repellant, please

  22. Risk Reduction: Trauma Find your voice to minimize vulnerability of your affected limb. Do not allow flu shots, etc. or multiple or dramatic searches for veins . If a venipuncture occurs on the affected extremity, insist that the puncture be cleansed and apply a cold pack (carry one with you). if you notice any increase in irritation or swelling, contact your doctor ASAP • Be aware, prepare • Avoid constriction of clothing… • Lets talk Blood pressure cuffs /adaptations • Pace your activity and monitor the limb, for tissue/size changes, pain/soreness, perception of limb heaviness or induration (thickness) • A Word about Airplanes and travel • Be careful while shaving; keep your pet’s claws trimmed • Limb sensation may be altered, Test water temperatures • Practice kitchen safty

  23. Risk Reduction: Obesity & nutrition

  24. Risk Reduction:Inactivity/ muscle weakness/ lack of mobility Exercise/ Bodies need motion • Improves muscle tone • Improves cardiovascular function • Improves the density and strength of bone/connective tissue • Reduces body fat • Assists in wt. control • Increases self esteem • Stress reducer • Enhances quality of life • ↑Fluid exchange

  25. Complete Decongestive Therapy (CDT) Best Practice by International Consensus 2006 &2016 Complete Decongestive Therapy (CDT) is a comprehensive treatment approach comprised 5 components: • Manual Lymph Drainage (MLD) • (Designer) Compression • Exercise • Skin, wound & nail care • Pt. education/ Empowerment 2nd edition Foldi’sTextbook of Lymphology for Physicians and Lymphedema Therapists, Munchen; Elsevier Urban & Fisher 2006

  26. Manual lymph drainage is a gentle skin mobilization technique designed to promote decongestion of lymphostatic fluid by stimulating superficial lymphatic increases lymph flow through a very individualized re-routing pattern determined by the lymphedema specialist and based on the medical history and evaluation classifications Complete Decongestive Therapies CDT using Manual Lymph Drainage

  27. Find your Own Style or, do the lymphedema towel dance…. In the morning… before you start your day…in the evening before bed, apply some lotion… or don’t… … in the shower, add some lymphatic brushing or use the sensory pressure of a wash cloth…

  28. CDT: “Designer” Compression Complete Decongestive Therapies • Slows the rate of fluid accumulation • Improves efficiency of muscle and joint pumps • Prevents re-accumulation of evacuated edema fluid • Breaks down deposits of indurated tissue

  29. Designing for success… • “I’m already overwhelmed”! (Keep it simple) • “I’m don’t feel real hot” and/or “I’ve got no time”! (Keep it reasonable) • “ I have trouble catching my breath” (Keep it safe) • The famous “Home-made Exercise Kit” (Keep it affordable)

  30. Aquatic Therapy: An Alternative; PROPERTIES OF WATER • Hydrostatic Pressure • The deeper the water, the greater the pressure. • Increases 22.4 mmHg per foot. • Buoyancy • Reduces compressive forces from the joints. • Assists, resists, and supports movement. • Unlike gravity, buoyancy is an upward force. • Temperature • Study showed limb reduction with 83.3°F. • Viscosity • Provides 12x the resistance of air. • Progress by gradually increasing reps, ROM, & surface area.

  31. Instructions for Home Use of Water Tank The Goal is Reducing Swelling • Increase adherence to self therapy (in the shower…) • Enables several sessions a day. • Damage control at the end of the day ( PT clinic closed) • Personal tank – reduce the chance of infections • Height of tank – at least up to the knee • Pumping action • Functional (closed chain) • Self lymphatic massage can be integrated. • Temperature under 89.6 degrees F

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