Homework pays off for those with lymphoedema

"All my patients get homework!" says lymphoedema expert Michele Urlich. Last week, Michele spoke to the Head and Neck Cancer Survivors' Support Network in Auckland. She explained how important it is for patients to become involved in their care. Her "homework" includes deep breathing techniques, massage and exercise.

Michele explained there are primary and secondary lymphoedema. Head and neck cancer people are likely to have secondary lymphoedema. The cause is various treatments, surgery, radio therapy, and trauma.  75% of head and neck cancer people will have lymphoedema in some form.

Lymphoedema occurs when you have a swelling. It can occurs around your face, head and neck. It can also occur internally, with your in the throat and tongue affecting swollowing.

Treatment of lymphoedema in HNC is through manual lymph drainage. This means gentle massage of the affected area. Michele suggests this is "light and slow". An easy way to remember is to imagine you were stroking a cat. Breathing helps to move this trapped liquid.

The lymphatic systems is a "one way' system working from your feet to your heart. Most drainage occurs by moving liquid north. When the head and neck areas are involved, then head south down the sides of the neck to the collar bone.

Lymphoedema is a plumbing problem." says Michele. "Keeping skin in tip top condition will help", says Michele. Moisturising and massage will encourage elasticity needed for drainage. The real miracle lies in medical taping. This is where tape is placed on the surface of the skin. It is lightly stretched to channel liquid to healthy lymph nodes to be "disposed of". The tape works by convoluting the skin to release the fluid immediately beneath.

Michele is a big fan of diaphragmatic breathing. You can learn this from yoga and meditation teachers. Try it. You breathe deeply into your stomach, then your chest. When you feel the breath of your throat it is time to breathe out. To avoid light headedness, make sure the breath out is longer than the one in. 

Michele explained that exercise helps patients to regain movement in the neck and shoulders. She demonstrated some simple exercises to stretch the neck and rotate the head.

Michele shared the story of David with us. David is a Head and Necker from Queensland. He travelled to New Zealand for Michele's treatment. Michele applied taping to encourage drainage. She taught his wife how to apply the tape once he returned home. She  suggested breathing, and exercises to encourage movement. A year later the lymphoedema was gone, and David was doing very well.

Michele introduced Graham to the group. Graham is from the Bay of Islands. He is currently in treatment with Michele.  Graham had suffered swelling after treatment. He felt as if his face wanted to "explode'. His muscles were contracted. He was troubled by his shoulder that had moved out of position.

By taping and lifting the skin Michele was able to move the fluid. The swelling went down, Graham's shoulder returned back into position. Bravely, Graham took his shirt off, so we could admire Micheles' handiwork. She is an artist.

What was once regarded as "fringe medicine", is now a highly regarded allied health service. Lymphoedema specialists are of real value to HNC people.

You can read two great case studies here.

Graham's Story PDF

David's Story PDF

Thank you, Michele for an informative presentation.

A few tips from Michele:

Before surgery

* Learning diaphragmatic breathing, daily massage and moisturising of the affected areas to promote healing and drainage post-surgery.

Post-surgery care

* If medical tape is applied to areas that are swollen it is possible to massage over the top to further encouraging lymphatic drainage.

* The tape is manufactured in many countries and is ideally sourced by lymphoedema therapists to meet your specific needs.

*The trick is knowing where to apply the tape. That's where certified lymphoedema specialists’ are needed.

* Anyone can be referred to a lymphoedema specialist. Your GP, oncologist or surgeon can do this for you. Just ask for a referral into your local district health board (DHB) to access free treatment and garments. To access a therapist in private practice visit www. Lymphoedemanz.org.nz.

*The Cancer Society provides this service in some areas. Check with our local network.

If only we had known, Michele says we can help prevent severe symptoms from occurring. What is needed is education, understanding and awareness of this chronic debilitating condition.

E-mail me when people leave their comments –

Authored by Diana Ayling

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  • I'm again  really disappointed.  We were told that there was nothing  that could be done for Lymphoedema.  We were told that it would eventually  resolve itself. It did, sort of, but took 3 years or so. If only we had been advised to  moisturise.

    Again, aftercare lets  us down.

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