Help­ing can­cer pa­tients re­cover

Havelock North Village Press - - News - BY BRENDA VOWDEN [email protected]

March is Lym­phoedema Aware­ness Month, and I caught up with ther­a­pist Amanda Bell who is tri­alling some new equip­ment which may help those af­fected.

What are your qual­i­fi­ca­tions and how did you got into treat­ing peo­ple with lym­phoedema?

I have a Level six qual­i­fi­ca­tion in neu­ro­mus­cu­lar mas­sage ther­apy (2009), a cer­tifi­cate in on­col­ogy mas­sage (2011) and a cer­tifi­cate in the Dr Vod­der Method of Com­bined De­con­ges­tive Ther­apy (2015). While work­ing at the Can­cer So­ci­ety, I re­alised that I was see­ing a lot of peo­ple who were de­vel­op­ing lym­phoedema, but I was un­able to help. So I un­der­took the month-long train­ing for lym­phoedema man­age­ment in 2015 with sup­port from the Gen­e­sis On­col­ogy Trust and the Can­cer So­ci­ety — and my mum. This in­volved spend­ing two weeks in Aus­tralia, then two weeks in Aus­tria.

What is lym­phoedema and how are pa­tients’ lives af­fected?

Lym­phoedema is a con­di­tion that de­vel­ops when some­one’s lym­phatic sys­tem isn’t work­ing prop­erly, whether they are born with a dys­func­tional sys­tem (pri­mary lym­phoedema), or the lym­phatic sys­tem has been dam­aged (sec­ondary lym­phoedema) through in­jury, surgery, lymph node dis­sec­tion for can­cer treat­ment or ra­di­a­tion ther­apy, for in­stance.

It causes swelling in the af­fected part of the body — usu­ally a limb, but can ef­fect any part of the body. The swelling is caused by the lym­phatic sys­tem be­ing un­able to re­move ex­cess pro­tein-rich fluid from the tis­sues. This can cause not just an in­crease in size of the limb, but also for the tis­sue to be­come hard­ened, thick­ened and prone to in­fec­tion. In early stages, some­one may feel that their limb is tight, heavy and un­com­fort­able, but in lat­ter stages, they may be­come im­mo­bile, have se­vere skin changes and even leak­ing skin.

In New Zealand, the ma­jor­ity of cases we see are a re­sult of breast can­cer treat­ment, although I have worked with peo­ple who have de­vel­oped it fol­low­ing in­jury rather than can­cer. It isn’t a well un­der­stood con­di­tion, and the med­i­cal pro­fes­sion are taught very lit­tle about it at med­i­cal school, so of­ten the con­di­tion is poorly man­aged. The con­di­tioned can’t be cured, but it can be man­aged, es­pe­cially if caught in the ear­li­est stages.

Why do we have Lym­phoedema Aware­ness Month?

It’s a global fix­ture, with March 6 the Lym­phoedema Aware­ness Day. I would say it is in re­sponse to the poor aware­ness and man­age­ment of lym­phoedema around the world. The lym­phatic sys­tem is only briefly taught in med­i­cal school, so most health pro­fes­sion­als are un­aware of the best treat­ment or where to ac­cess it. A lot of pa­tients talk about their doc­tors just shrug­ging their shoul­ders or pre­scrib­ing di­uret­ics, which aren’t ap­pro­pri­ate. Ac­cess to treat­ment is dif­fi­cult and usu­ally pri­vately funded. In New Zealand, fund­ing for com­pres­sion wear varies from DHB to DHB.

What typ­i­cally hap­pens in Lym­phoedema Aware­ness Month?

That varies a lot, and it’s largely up to char­i­ta­ble or­gan­i­sa­tions or in­di­vid­u­als to do any­thing. I or­gan­ised a large in­for­ma­tion day on March 2. It was re­ally suc­cess­ful, with five speak­ers and a num­ber of providers demon­strat­ing their treat­ment tools. We had about 100 peo­ple at­tend, in­clud­ing pa­tients, nurses, doc­tors and other health prac­ti­tion­ers.

Tell me about the new ma­chine/s you are tri­alling?

The gold stan­dard treat­ment for lym­phoedema is CDT or Com­bined De­con­ges­tive Ther­apy. This is made up of the hands-on mas­sage tech­nique man­ual lym­phatic drainage (MLD), com­pres­sion ther­apy (multi layer ban­dag­ing in the re­duc­tion phase and com­pres­sion gar­ments (stock­ings or sleeves), ex­er­cise and skin care.

While there are a lot of ther­a­pists around who do MLD, it’s im­por­tant to find ther­a­pists who are trained in CDT, as they are trained in adapt­ing MLD to each per­son’s re­quire­ments. Us­ing stan­dard MLD on some­one with a com­pro­mised sys­tem may cause more harm than good. In Napier, there are three ther­a­pists who are fully trained — me, Mandy Heeger in Have­lock North, and Rachel Ward at Align, who spe­cialises in ex­er­cise and can­cer re­hab. There isn’t a lot of fund­ing avail­able within the health sys­tem, so the big­gest hur­dle is be­ing able to af­ford the pri­vate treat­ment and new gar­ments ev­ery six months. How­ever, pa­tients who are dis­ci­plined about wear­ing their com­pres­sion, look­ing af­ter their skin, ex­er­cis­ing and do­ing daily self-MLD, can help them­selves im­mensely, which cuts down on the cost.

There a num­ber of other tools we can use in sup­port of this, in­clud­ing low-level laser ther­apy which is great for soft­en­ing fi­brotic tis­sue and scar tis­sue which block lym­phatic flow, lymph tap­ing which is great for ex­tend­ing the drainage for up to a week, es­pe­cially in body parts that are dif­fi­cult to com­press and in­ter­mit­tent com­pres­sion pump­ing.

I use tape and laser in my clinic. Fol­low­ing the info day, one of the providers who at­tended, Medi­rent, has loaned both Rachel Ward and me an IPC ma­chine each. While it’s not a treat­ment tool on its own, it is valu­able to use along­side CDT, par­tic­u­larly for peo­ple who may strug­gle to do daily self-MLD sup­port MLD. It is a bit like sev­eral very large blood pres­sure cuffs that in­flate and de­flate in se­quence to pro­mote lym­phatic drainage.

The ad­van­tage of this ma­chine is that pa­tients can pur­chase them them­selves and use them daily in the com­fort of their home. In my clinic, I’ve been able to of­fer shorter, more fre­quent treat­ments by us­ing the pump on their limb, while I work on the rest of the lym­phatic sys­tem. This means we can keep the cost down while in­ten­si­fy­ing the treat­ment.

How many peo­ple are you treat­ing?

I’ve used it on two pa­tients in­ten­sively for the last cou­ple of weeks, and have added it as a bit of a “see what you think of this” for other clients who aren’t com­ing as of­ten. For best re­sults, it should be used reg­u­larly and with MLD. So far, it has proven quite pop­u­lar as an ad­di­tional tool.

How did you first learn about the pos­si­bil­ity of this ma­chine mak­ing a dif­fer­ence for pa­tients?

I’ve known about the pumps for a few years, but couldn’t af­ford to buy the pump and each nec­es­sary sleeve, body or leg piece. I’m go­ing to look at ways to fi­nance it, as I’m find­ing it quite use­ful as an ad­di­tional tool.

Amanda Bell is tri­alling a ma­chine dur­ing Lym­phoedema Aware­ness Month.

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