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13AH002 - Advanced Topics in Lymphedema Management (9-5 Both Days)

DescriptionObjectivesCredits & FeesRegistrationRefunds/Cancellations

October 5, 2012 - October 6, 2012Description:

This two-day advanced seminar provides the information and techniques needed to problem solve through a complex variety of diagnoses relating to the lymphatic system. Diagnoses covered include co-morbidities such as obesity, diabetes, auto-immune diseases, CHF, chronic inflammation, venous-lymphatic, phlebo-lymphatic, lipo-lymphatic insufficiencies; post thrombotic syndrome and venous insufficiency; lipedema and primary lymphedema; and complications related to advanced lymphedema such as fistulae, papillomas, and cysts.

The hands-on techniques presented in the lab sessions will include a series of specialized, unique, integrated techniques which will address the musculo-skeletal system, the nervous system, the vascular system, and their integration with the lymphatic system. Therapists with prior lymphedema experience will benefit from the application of these advanced clinical treatment techniques that will add expertise to their treatment protocols, optimize the functioning of the lymphatic system, resulting in a more sustainable patient outcome that includes more cost effective compression bandaging and garment options for their patients. Ways to develop and expand the therapist's current lymphedema management program will be discussed.

Alternative treatment techniques including current holistic trends, pharmaceutical options and therapeutic taping for lymphedema will be explored and demonstrated. This course presents evidence-based practices in the management of lymphedema, as well as providing dynamic laboratory time. The concepts obtained and practiced in this course can be immediately applied in clinical situations providing consistent functional outcomes.

*Note* Space is limited -- register early!!

Audience:

Certified Lymphedema Therapists (OT, OTA, PT, PTA, Massage Therapists, Nurses)

Location:

Mountain Area Health Education Center, Balsam Room, 121 Hendersonville Road, Asheville

Faculty:

Carmen Thompson, BS, LPTA, CLT-LANA

https://www.mahec.net/calendar/detail.aspx?a=1&eid=37452&sid=0&str=3

Lymphedema Tied to Obesity

By Todd Neale, Senior Staff Writer, MedPage Today

Published: May 30, 2012

Obesity may contribute to the development of lymphedema, a small study showed.

Among 15 obese patients with enlargement of the legs, the average body mass index was significantly greater for those with confirmed lymphedema (70.1 versus 42.0 kg/m², P<0.001), according to Arin Greene, MD, of Children's Hospital Boston, and colleagues.

"Our findings suggest that obesity ... may be a cause of lower-extremity lymphedema," they wrote in a letter to the editor in the New England Journal of Medicine.

"As the amount of adipose tissue increases in the lower extremity, lymphatic vessels may become dysfunctional (possibly because of compression or inflammation), thereby reducing proximal lymphatic flow," they explained.

"Alternatively, elevated production of lymph from an enlarging limb may overwhelm the capacity of a normal lymphatic system to remove the fluid from the extremity," they continued. "Although lymphedema is typically progressive, we speculate that major weight loss (e.g., after a bariatric procedure) might reverse lymphatic insufficiency in obese patients with this condition."

All of the patients in the study were referred for bilateral enlargement of the lower extremities; 12 were women, the mean age was 58, and the mean BMI was 51.4 kg/m². None of the patients had a history of primary (idiopathic) lymphedema, inguinal lymphadenectomy or radiation, or ulceration of a lower extremity.

All of the patients underwent evaluation with lymphoscintigraphy. Five showed abnormal lymphatic draining consistent with lymphedema and the rest had normal results.

The BMI was greater than 59 kg/m² for all of the patients with lymphedema and less than 54 kg/m² for all of those with normal lymphatic function.

"As BMI increases, there might be a threshold above which lymphatic flow becomes impaired," Greene and colleagues wrote. "Proximal transport of lymphatic fluid from the extremity is dependent on the function of the lymphatic vasculature (clearance) and the volume of lymph produced by the tissues (load)."

Sex and age did not differ based on lymphedema status.

The authors reported that they had no conflicts of interest.

Primary source: New England Journal of Medicine
Source reference:
Greene A, et al "Lower-extremity lymphedema and elevated body mass index" N Engl J Med 2012; 366: 2136-2137.

Health Wise: Summertime heat and Lymphedema

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Health Wise

During summer when people prefer loose-fitting clothing, treatment of Lymphedema  includes wrapping the affected limb in tight bandaging to increase uptake of the fluid.

Posted: Friday, May 4, 2012 12:00 am | Updated: 2:20 pm, Thu May 3, 2012.

By Patricia Oliver | 0 comments

Summertime temperatures can be uncomfortable, but for those with Lymphedema, the rise in ambient temperature can increase symptoms and discomfort. Lymphedema is swelling in your arms, legs, fingers and toes caused by a blockage. Managing care of the affected extremity becomes more challenging as the numbers on the thermometer rise – particularly when the treatment requires tight fitting body wraps.

The lymphatic system is a network of vessels, nodes, and lymphocytes that circulate protein rich fluid throughout the body and flushes out wastes. When this system is impaired, fluid buildup occurs impacting an arm, leg, fingers or toes. The result is painful swelling of the impacted area, a feeling of tightness or heaviness, recurring infections and hardening or thickening of the skin.

It frequently is a side effect of cancer treatment, but Lymphedema is also found in people who have had surgery, infection, or a history of lymph system issues. Obesity can also be a trigger.

Symptoms of Lymphedema:

Symptoms may include unexpected painless swelling of the trunk, arms, or legs. Skin changes in the area may include thickening or discoloration. Particularly troubling is the inability of a skin infection to heal. Symptoms may increase with changes of outdoor temperature such as a hot summer day, using a hot tub, pressure changes such as using a blood-pressure cuff or flying in an airplane; or some symptoms may appear without warning.

The management of Lymphedema can vary from a massage technique to increase the re-absorption of the lymph fluid (manual lymph drainage) to exercises that increase circulation. During summer when people prefer loose-fitting clothing, treatment of Lymphedema often includes wrapping the affected limb in tight bandaging to increase uptake of the fluid. Special garments can be worn to maintain compression and some even include a pneumatic compression pump to apply constant pressure.

Wound Treatment:

Like Lymphedema, there are other conditions that may result in chronic or non-healing wounds. Without proper treatment, wounds can be debilitating and hinder a person’s quality of life.

Examples of some of the wounds that are treated in our center include: acute and chronic non-healing wounds, pressure ulcers, venous stasis wounds/ulcers, and arterial ulcers.

There are three objectives in wound care – treatment, education and prevention. Naturally, treating the wound to speed healing and prevent infection is the first step. Partnering with patients is important so they can identify what they can do at home to care for a wound and how to recognize when help is needed. Finally, the patient needs to understand how they can prevent a future wound.

Treating Lymphedema and wounds sometimes requires a specialist. Mark Twain St. Joseph’s Hospital offers the only outpatient Wound Care Center in the three county area devoted to wounds and Lymphedema. Our Wound Care Center sees one patient at a time by appointment, allowing for room sterilization between patients to prevent cross-contamination between patients. The Wound Care Center is conveniently located next to the lab should patients require lab work or wound cultures.

If you or someone that you know is fighting a chronic wound or swelling condition, please contact us.

Patricia Oliver is an occupational therapist, wound care consultant, and Lymphedema therapist at Mark Twain St. Joseph’s Hospital’s Physical Therapy Department. Contact her at 754-2609.

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