One of my clients, Chris, has very kindly given permission for me to share her photos and reports to write this blog.
Chris is what I'd call a very "motivated" client. She is determined that she will kick lymphoedema's butt, no matter how many times I tell her that she can control it with good maintenance but it will always be a part of her life. She believes in positive thought and who am I to knock that?
Chris first came to see me in January 2016 at the age of 72, complaining of swelling and discomfort mainly in the left lateral chest wall and through to her back as well as her upper arm. She had had a squamous cell carcinoma removed in the area (as well as many others in different parts of her body), along with a total axillary clearance and radiation to the area. The swelling became noticeable almost as soon as the radiation finished in October 2015.
She had a number of physiotherapy sessions prior to coming to see me but hadn't found these beneficial. I checked her self-clearing technique (she was directing fluid to the armpit so we adjusted that and I showed her how to do deep breathing as well).
Over the last year we have used a number of techniques. Manual Lymphatic Drainage is the main therapy used but I have also added Low Level Laser and deep fibrosis techniques.
Chris uses a Mobiderm arm sleeve day and night (she finds this more comfortable than elastic compression sleeves). There are days that she does use her normal compression sleeve as well, but she finds the Mobiderm more effective.
I have fitted her for a compression vest which she also wears daily, with Mobiderm swell spots inserted in the areas of greatest fibrosis. Photo below
Chris uses her own low level laser daily at home - she has a Pulse Laser.
Once a week she applies kinesiotape down her arm and across her back - she takes this off just before coming to her MLD sessions and reapplies once she gets home.
She swims daily in the ocean when it is warm enough and does a lot of walking (she delivers pamphlets every day) and running. She is incredibly fit, active and full of energy (she credits the energy to taking lots of spirulina, but I can't vouch for that - she's just full of life!).
After a few months of treatment Chris went to Mt Wilga Hospital for a three week intensive course of treatment. She now has a very personal relationship with Dr Helen Mackie!
Even though visually you cannot tell Chris has lymphoedema, she is aware of it constantly and it affects her daily life. So she went to see Dr Mackie and the surgical team at Macquarie Hospital in October 2016, to see if perhaps there was a surgical solution to her issue.
She spent about four hours with the team, being measured with different diagnostic tools and when using Indocyanine Green (ICG) Fluorescence Lymphography, they found she had some issues in the dorsum of her hand but that her arm was ok. There was also an issue in her lateral chest (where she had the most discomfort) and no evidence of functional lymphatic vessels, with no lymph movement down to the lower abdomen. She did however have a strong pathway across her chest to the opposite side, as well as one on her back going in the same direction. And the scans showed up lots of fibrosis in the chest wall which needed to be broken up with deep friction massage.
Armed with that information, we were able to tailor her treatment with a real focus on breaking up the fibrosis using laser and deep work, as well as stretching of the arm/shoulder area.
Chris had follow up scans on 23rd March 2017 and the difference was quite astonishing! She had a new pathway going from her armpit down into the abdomen and the fibrosis had reduced significantly. So much so that they felt she wasn't a surgical candidate and she should continue the conservative treatment in the pathways that are now available!
If only more people had access to scanning using ICG - it has been a very useful tool for customising Chris' treatment and has been beneficial in her progress which in turn has made her much more comfortable with her lymphoedema. There have even been times when she's chosen not to wear all her compression for a few hours and she's enjoyed the freedom that's given her.