Helping cancer patients recover
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.