LYMPHEDEMA CHILDREN'S AND PEDIATRIC
Children with Lymphedema
This page has been updated, please see:
Lymphedema in Children
http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children
Home page: Lymphedema People
http://www.lymphedemapeople.com
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Children's and Pediatric Lymphedema
Signs and Symptoms for Children's / Pediatric Lymphedema
Factors that will determine Treatment of Children's Lymphedema
Treatment of Children's Lymphedema
Complications of Children's Lymphedema
Cellulitis
Long term prognosis for Children's Lymphedema
Stages of Lymphedema
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Discussion
There
are several parents on our list with children that have lymphedema. If
can be a
frightening experience when this shows up and there seem to be little
or no
answers and you are terrified of what the future holds.
As someone who used to be a child with LE, all I can say is relax mom
and dad.
There are certain guidelines that apply to children with lymphedema as
applies
to adults as well. But, please let your children be children. I am
turning 51
very soon and I have lived through falling out of trees, jumping off
roofs,
nails in the feet,
2 broken arms and even being knocked out.
Signs and
Symptoms for Children's / Pediatric Lymphedema
There are almost no articles available for parents who suspect their
child might
have lymphedema. From my childhood, I am going to connect some threads
that
might help. If other readers have additional remarks or symptoms they
noticed in
their children, your input would be a treasure.
Naturally, anytime there is unexplained swelling in a child you must
rule out every possibility, this includes cancers, congestive heart
failure or
anomalies, vascular malformations to mention only a few.
1. The first question to ask is, has there or is there any history or
record of
unexplained swelling in your parents or their parents generation. Was
here an
aunt who suddenly started swelling after giving birth, was there an
uncle that
experienced an injury and suddenly had limb swelling? Remember back
then there
was no real concept of lymphedema as a distinct condition and certainly
even
less
when it came to such conditions being genetically based.
2. If your child is an infant, is the swelling sudden or has it been a
gradual
process. Often infants with lymphedema have periods of "bloating" or
times when their limbs (more particularly legs) swell unexpectedly.
With male
infants, you may have times of unexplained scrotal swelling. Remember,
these easily
swelling more often than not can be transient. The limb maybe swollen
one
day, normal the next.
3. If there has been any swelling in a limb, how does it react to a
mosquito,
flea or other insect bite. In my left leg, which was the first to go
"permanent" an a mosquito, ant or flea bite would become a major boil.
4. When there has been such an incident as an insect bite, or during
periods of
inflammation has you child experience a swollen and painful lump in the
groin?
That could be indicative of where a lymphatic blockage may be.
5. If there has been swelling and the child goes swimming, does it
return to
normal size? Swimming most mimics the naturally movement process of the
body in
conducting lymph that in very earl stages of lymphedema, the water
pressure will
cause the limb to be normal in size.
6. Meige lymphedema or lymphedema praecox presents itself at puberty.
It is assumed that the plethora of hormones gushing through a teen's
body causes
the lymphedema to go from latent to active. Has your teen or tween
experienced
any "out-of-the-blue" swelling? Was there an infection or injury that
caused a limb to swell that did not return to normal.
Remember, I am not a doctor and these are just personal observations
from my own
experience. I hope this helps, and as I said if any parent has
additions or
differing symptoms, I would greatly appreciate your input. Maybe
together we can
build a database of symptoms so these wonderful children can get
treatment
sooner.
Factors that will determine treatment
1. Related medical conditions and your child's health. There are a number of hereditary syndromes associated with primary lymphedema and treatment for those conditions will need to compliment the treatment for lymphedema.
2. To extent of the lymphedema. Considerations include if it is in one or both legs, one or both arms or if genital swelling is involved.
3. The stage of the lymphedema. Usually children, due to age present with Stage 1 and as such it is much easier to treat successfully.
4. Your child's ability to tolerate certain procedures, therapies and/or medications.
5. Your child's overall prognosis. Again the consideration for this will include any related conditions.
6. Parents preferences
7. Age of your child
Treatment of Children's Lymphedema
As with adults with lymphedema, the preferred method today of treating limb (arm and or leg) is through decongestive therapy. After undergoing therapy, your child will be fitting with the appropriate compression garments and you as the care giver will be taught compression wrapping and how to care for the garments.
I strongly suggest (plead) with parents do not let a doctor perform debulking or reconstructive limb surgery on your child. It is almost never needed except in the most severe and otherwise untreatable situations.
For genital lymphedema, male or female the standard treatment is still surgery. However, new massage techniques are and have been development (with support garments) that I feel will be more successful and less risky than the surgical techniques.
Because of the concern and risk of genital lymphedema, I also strongly suggest that parents not allow the use of compression pump devices on their child. They have been shown to cause genital lymphedema and also damage the existing secondary lymphatics.
Another concern is that you and your child will need to learn proper skin care. This will help prevent dryness, cracking and open areas that could lead to infection.
Complications of Children's Lymphedema
Because of the age, the complications involved with children's and pediatric lymphedema are not so severe as with long untreated adult lymphedema. They do include however
1. Risk for cellulitis, related infections
2. Weeping wounds, breaks in the skin
3. Spreading lymphedema. Often legs may be involved initially and later the hands, arms or genital will become involved.
4. Complications involved with bandaging such as blisters, rubbed sore spots, rashes and other skin conditions.
5. There also may be pleural effusions or lung edema although this is not typical in children
Cellulitis
Acute Cellulitis is one of
the complications of
lymphedema. The patient may not be aware of the source of the etiology.
Sometimes it may be a cut, mosquito bite, open wound or other infection
in the
body.
The first sign is increased or different quality of PAIN involving the
lymphedema limb. The patients often describe this as a "flu like
symptom or
an ache" involving the Lymphedema arm or leg. This is usually followed
by
sudden onset of ERYTHEMA(redness, red streaks or blotches) on the
involved limb.
The HYPERTHERMIA(lymphedema limb becomes warm, hot) will follow and the
patient
may experience the CHILLS and even HIGH FEVER.
Long
term Prognosis for Children's Lymphedema
It is not possible with certainty to guarantee what lymphedema will or will not do as a person ages. Much of the long term outlook rests of the severity of the condition, complications that arise and other related medical conditions.
However, by having your child diagnosed early and by learning about and insisting on the proper treatment techniques you can keep the condition under control and your child can look forward to a long, active and enjoyable life - despite the lymphedema.
Stages of Lymphedema
Stage 1 (mild) - Upon waking in the morning the
limb or
affected area is almost a normal size. The tissue is still in a
"pitting
stage" ( when pressed by a finger the area indents and holds the
indentation).
Stage 2
(moderate) - The tissue is "non-pitting" (when pressed by a
finger the tissue bounces back without leaving an indentation). The
tissue has a
spongy consistency.
Stage 3
(severe) - The tissue at this stage is hard (fibrotic) and will be only
slightly responsive to the touch. The swelling is almost irreversible
and the
limb is very large and swollen. Infections are possible at any stage of
lymphedema but occurrence becomes greater as stages progress. A swollen
limb,
left untreated, becomes hard (fibrotic) and full of lymph fluid which
is high in
protein and a perfect medium for bacteria and infections.
Be sure to check through our entire page - updates. Information at the bottom on wrapping a child's arm and leg, special tips for children with lymphedema, massage treatment techniques for children and more
Also, come join us at our Yahoo support group
Children with Lymphedema
http://health.groups.yahoo.com/group/childrenwithlymphedema/
Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com
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Here is an
excellent article I ran across about children with lymphedema.
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Frequently Asked Lymphedema Program Questions
Q: My child's feet suddenly swelled. Does this mean she has lymphedema?
A: Many things, including abdominal masses, venous problems, and
rheumatologic
disorders, can cause immediate or rapid swelling of the feet. An
appropriate
medical exam and evaluation is necessary before a physician can rule
out
competing causes and begin considering a diagnosis of lymphedema.
Q: How is congenital lymphedema diagnosed in a child?
A: First, our medical staff takes your child's medical history and
performs a
physical exam. Depending on the results, the staff may schedule your
child for a
lymphoscintigraphy, an imaging test that allows physicians to view your
child's
lymphatic vessels. During a lymphoscintigraphy, a radiologist will
inject a
small amount of a radioactive tracer in your child's foot or hand, then
use a
special camera to view your child's lymphatic vessels. The radiologist
can then
make an accurate diagnosis, classifying your child's lymphedema by
type:
hyperplasia, hypoplasia, or absence of lymphatics. In some cases, the
medical
staff may order additional X-rays and imaging tests for further
clarification.
Q: My child has a rheumatologic disorder that periodically causes her
limbs to
swell. Yet she also experiences limb swelling that does not seem
related to her
rheumatologic flare-ups. Could she have congenital lymphedema?
A: Our lymphedema team has evaluated several children who have
inflammatory
conditions, yet develop swelling at times when their arthritis does not
appear
to be active. After evaluation, we have determined that some, but not
all, of
these children also have congenital lymphedema.
Q: My child has congenital lymphedema. What sort of therapies will you
use to
treat her?
A: The medical team will create an individualized treatment plan for
your child.
The typical treatment plan involves avoiding infection in the affected
limb(s)
and using special garments, bandaging, or a Reid sleeve to provide
compression
to the affected limb(s) when your child stands. If those interventions
are not
adequate, the medical team may use lymphatic drainage techniques to
stimulate
the lymphatic circulation and help the affected limb(s) move extraneous
lymph
out of the limb. The medical team may also recommend the use of a
gradient pump,
a technology that our physicians have used with reasonable success over
the past
few years.
Q: Will my child need a special diet?
A: In general, children with lymphedema have normal digestive tracts
and renal
systems, and therefore do not need to follow special diets. Some
children with
lymphedema have a problem digesting protein, and physicians sometimes
treat this
condition by administering short-chain fatty acids. By and large,
however,
children with lymphedema eat the exact same foods as their peers.
Q: Should my child exercise? Will it help?
A: We encourage all of our patients to play sports and be active. If
your child
wears a compression garment while engaging in normal physical activity
or
playing sports, the exercise will encourage excess lymph to flow out of
her
affected limb(s) and back into her general lymphatic circulation. If
your child
exercises without wearing a compression garment, however, her exercise
will not
have any effect on her lymphatic flow.
KidsHealth.org
http://www.nemours.org/no/faq/faq1812.html
http://kidshealth.org/faq/lymphedema.html
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TOP TIPS FOR CHILDREN WITH LYMPHEDEMA
Children with Lymphedema Yahoo Group
http://health.groups.yahoo.com/group/childrenwithlymphedema/
It's always going to be different for every child, but things that
1.
Not being too cautious.
It helps my son's confidence if he can do
the things his friends are doing, so let them take a few risks if you
can
2.
Keeping skin in good
condition. We Aqueous cream night and morning -
in the UK you can get a huge tub on prescription. You can also use
it to wash with if skin gets dry. We also put emollient in the bath
3. Going swimming - like a gentle all-over massage
4. Trampolining (for lower limb LE)
5. Using SLD (simple lymphatic drainage) between MLD sessions
6.
Sharing info with your
child's teacher/school. As well as knowing
what to do if your child gets hurt, teachers can help in other ways.
For instance, my son was worried about other kids looking
at/commenting on his big leg/support hosiery in PE. His teacher
explained to the whole class about LE and why he wears a stocking.
The other kids took it all on board and don't make an issue of it any
more
7.
Doing things to
make LE less of a bind and helping them feel a bit
more in control. Things like choosing own colour of stockings, having
a few hours without the stocking sometimes (maybe if they want to
stay in pyjamas in the morning at the weekend), choosing a favourite
story to take along to MLD, having time off school for MLD instead of
going after school, having a special day together when you go to the
clinic - like going to a film or having lunch out
Special Thanks to member and mom Katherine
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Lymphedema Program for Children
http://www.nemours.org/no/aidhc/svcs/div2007.html
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Compression Garments/Wraps for Pediatrics
E
Lymph Notes Archive
http://www.elymphnotes.org/
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How Parents and Children Cope with Lymphovenous Disorders
Lymphovenous Canada
http://www.lymphovenous-canada.ca/chil_hsc.htm
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JoVi PAK PRODUCTS - Children
http://www.jovipak.com/custom.shtml
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The Treatment of Pediatric Lymphedema
E Lymph Notes Archive
http://www.elymphnotes.org/detail.asp?ci=37&it=IPI
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Treating Pediatric Lymphedema
http://lymphedema.articleinsider.com/73873_pediatric_lymphedema.html
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National Network
for Child Care
COPING WITH ILLNESS
http://www.nncc.org/Health/coping.illness.html
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The Impact of
Disability on Children's Self Concept
http://www.aare.edu.au/99pap/joh99515.htm
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Adolescent Chronic Illness
- A Qualitative Study of
Psychosocial Adjustment
http://annals.edu.sg/pdfJan03/OlssonCA.PDF
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NATIONAL LYMPHEDEMA NETWORK
Questions and Answers
Q: I am interested in learning more about treating infants six
months of age
or younger. I am looking for input regarding materials used for
compression with
special attention give to the needs of infants, which includes not
restricting
movement, the ability to adjust the compression for infant's small and
more
fragile body, etc. Also, I am interested in guidelines for when to
start using
compression bandages and garments, and if the compression is different
from what
you would use with an older child. I hope to hear from everyone who has
experience treating infants. (Jane Reinsch, MA, PT)
A: Treating and understanding patients under six months of age is very
difficult. I have treated a number of infants and found them to be a
great
challenge. It is very important that you work closely with the
pediatrician and
make sure that you have an excellent understanding of the patient's
medical
history (besides the lymphedema). Parent compliance is crucial in the
case of
infant care; their interest and involvement in treating the child daily
is key.
There are mixed philosophies regarding how best to treat infants: some
clinicians say you need to wait until the child is four or five years
old.
Others, like myself, believe that if the child is healthy, go ahead and
start
the CDP. At this young age, however, it is not advisable to do the
lymphoscintigraphy — even though we do not necessarily know how much of
the
patient's body is involved — since it sometimes shows up in one limb
initially, but may progress over the years as the child develops. This
is also
what makes it difficult to treat infants.
Manual lymph drainage should not do any harm if performed properly and
with a
little lighter touch. Massaging the baby and teaching the parents how
to do the
basic movements can also create a lifetime bond that can be very
healing and
supportive for both the child and the parents (there are studies to
support
this).
Light bandaging or use of a customized Reid sleeve is beneficial as
well. A
custom garment (Jobst, Barton-Carey) also works and, of course, helps
to protect
the skin from trauma. IMPORTANT: Make sure that the parents clearly
understand
the concept of CDP and that they take the child in for regular visits
with the
therapist or pediatrician.
Note: This, of course, is my own opinion. I invite other clinicians to
respond
to this question and to share your experience with infants.
http://www.lymphnet.org/question0797.html
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What
Is Cellulitis?
What Causes It?
http://kidshealth.org/kid/health_problems/infection/cellulitis.html
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How Do I
Know if I Have It?
What Will the Doctor Do?
http://kidshealth.org/kid/health_problems/infection/cellulitis_p2.html
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http://lymphedema.articleinsider.com/73887_treatment_for_pediatric_lymphedema.html
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A retrospective study of the
effects of the Lymphapress pump on lymphedema in a pediatric population.
Hassall A, Graveline C, Hilliard P.
Department of Rehabilitation Services, The Hospital for Sick Children,
Toronto,
Canada.
We studied the effects of the Lymphapress pump (LP; Global Medical
Imports,
Digby, NS, Canada) retrospectively on 16 children with primary or
secondary
lymphedema of the upper or lower extremities by measuring the volume
and
circumference of the limbs before and after treatment. We reviewed
medical
charts for data on age, sex, length of disease process, grade of
lymphedema,
frequency and duration of treatment, and pump pressures used. We
recorded
changes in limb size before and after pumping in terms of the mean
percentage
difference between the affected and unaffected limb at both time points
to allow
for growth of the child and the extremity. On volumetric measures,
thirteen
(93%) of the subjects showed a clinical trend towards sustained
maintenance or
reduction in size of the lymphedematous limb(s). The reduction in the
pump
pressure at start of the treatment to that required to maintain the
size of the
limb was statistically significant (p = 0.0036). Fourteen (88%) of the
subjects
had no complications directly attributable to the pump, whereas two had
complications that were probably unrelated to LP. Overall, there was a
clinical
trend towards reduction or maintenance of the lymphedematous limb size
in
children using LP without notable adverse sequelae.
PMID: 11783593 [PubMed - indexed for MEDLINE]
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Clinical heterogeneity in lymphoedema-distichiasis with FOXC2
truncating
mutations. Children's Lympehdema
Erickson RP, Dagenais SL, Caulder MS, Downs CA, Herman G,
Jones MC,
Kerstjens-Frederikse WS, Lidral AC, McDonald M, Nelson CC, Witte M,
Glover TW.
Angel Charity for Children-Wings for Genetic Research, Steele Memorial
Children's Research Center, University of Arizona Health Sciences
Center,
Tucson, AZ 85727-5073, USA. erickson@peds.arizona.edu
BACKGROUND: Hereditary lymphoedema-distichiasis (LD) is an autosomal
dominant
disorder that classically presents as lymphoedema of the limbs, with
variable
age of onset, and extra aberrant growth of eyelashes from the Meibomian
gland (distichiasis).
Other major reported complications include cardiac defects, cleft
palate, and
extradural cysts. Photophobia, exotropia, ptosis, congenital ectropion,
and
congenital cataracts are additional eye findings. Recently, we reported
that
truncating mutations in the forkhead transcription family member FOXC2
resulted
in LD in two families. METHODS: The clinical findings in seven
additional
families with LD, including the original family described by Falls and
Kertesz,
were determined and mutational analyses were performed. RESULTS:
Distichiasis
was the most common clinical feature followed by age dependent
lymphoedema.
There is a wide variation of associated secondary features including
tetralogy
of Fallot and cleft palate. The mutational analyses identified
truncating
mutations in all of the families studied (two nonsense, one deletion,
three
insertion, and one insertion-deletion), which most likely result in
haploinsufficiency of FOXC2. CONCLUSIONS: FOXC2 mutations are highly
penetrant
with variable expressivity which is not explicable by the pattern of
mutations.
PMID: 11694548 [PubMed - indexed for MEDLINE]
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Pediatric Chronic Illness Resources
http://www.cfw.tufts.edu/rrviewtopics.asp?topicid=124
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Brave Kids - Helps for Children with chronic, life-threatening illnesses or disabilities
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Directory - Pediatric Chronic Illness Conditions and Diseases
http://search-info.com/search/engine/index/Health/Conditions_and_Diseases/Chronic_Illness/Pediatric/
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| Physiotherapy results in a baby with congenital lymphedema: a follow-up study |
| Türkan Akbayrak1, İlkim Çıtak1, Funda Demirtürk1, Mintaze Kerem2, İnci Akarcalı1 |
| Departments of 1Connective Tissue Manipulation and 2Pediatric Rehabilitation, Hacettepe University School of Physical Therapy and Rehabilitation, Samanpazarı, Ankara, Turkey |
|
Akbayrak
T, Çıtak İ, Demirtürk F, Kerem M, Akarcalı İ. Physiotherapy results in
a baby with congenital lymphedema: a follow-up study. Turk J Pediatr
2002; 44: 349-353.
Physiotherapy results of a 6.5-month-old baby with congenital lymphedema in the lower limbs are presented İn this study. Her motor developmental level and reflexes were evaluated and test results did not show any abnormal findings. Assessment of limb volume included circumferential and volumetric measurements, and photographs showing the changes in macroscopic view are presented. The physiotherapy program consisted of manual lymphatic massage, remedial exercises, multilayered inelastic compression bandaging, meticulous skin care and education of parents. The treatment lasted for 2.5 months, five days per week. Evaluations were done immediately after treatment and six months after treatment. The evaluations showed reduction in swelling after the treatment and this reduction continued during the follow-up period. It can be concluded that this physiotherapy program reduces the swelling in a baby with congenital lymphedema. Further studies are required in order to see the effectiveness of this therapy program in a greater number of subjects. |
http://tjp.dergisi.org/summary_en.php3?id=17
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New Day: Infant Massage Classes
Massaging your baby is a
great way to start a loving
relationship that will affect them their whole life. It’s an ancient
tradition
in many cultures and is now being rediscovered in the West. There is
evidence
that shows that a loving, touching, nurturing contact between caregiver
and
infant has a positive impact in their development. Infant massage is
one of the
easiest and most pleasant methods of providing early positive
interaction.
The Importance of Bonding - Infant massage includes the critical elements of bonding- eye-to-eye contact, skin-to-skin contact, smiling and other facial expressions, soothing sounds and cuddling. The quality of closeness between parent and child is enhanced and a massage may provide a wonderful way to stay in touch with your growing child. Some of the benefits of massaging your baby are:
http://www.aomc.org/affiliates/NewDay/infantClass.asp
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WHAT
DO YOU DO IF YOUR BABY HAS LYMPHEDEMA?
By Silkie
I have been searching every where to try and get information for our
mums
And I am shocked, There is no help. I have been thinking what I would do
As a Mum.
I am a Mum with lymphedema, I could not sit and wait, till my chilld
was 3
I would do simple routine with my baby.
1) In the bath I would always stroke the infected limbs upwards away
from the
fingers or toes. Playing and laughing making a game of it as we went
along .
2) Never run dry a limb that has swelling pat and it must be thoroughly
dry all
the little creases in the limb take extra care with, Particular
attention to
between toes and fingers. The least tiny break in the skin can cause
bad
infection
3) Nail care. Toe nails always cut straight across keep them short as
possible.
If one caught on something and tore it could set of infection.
4) I would use a cream (non scented) on the limb paying attention to
toes or
fingers
all the time remember work up not down the limb and soft as a babies
breath,
stroke the cream up the limb even if only a few strokes let this be a
fun thing,
your preparing you little one for a routine that he/she will have to
follow for
life.
Always up the limb one- way don’t bring your hand back down the body in
contact with the skin just upward stroke.
If there is any change in colour or reddening of skin stop this has to
be so
soft it does not change colour of the skin.
5) I am not suggesting you wrap but might be fun to get baby used to
you
handling the limb by pretending to. May be while your wrapping round do
a
nursery rhyme
the round a round the garden one something like that just all the time
getting
your baby used to the touch and feel of you doing these things.
6) I would always have the limb covered wither with long sleeves or
pants again
you will be helping you baby get used to having something on the limb
at all
times
7) Remember extreme Heat and cold are bad for lymphedema try to avoid
at all
times.
8) Always have some form of footwear on if the legs are infected
remembering
that the limbs can swell and a tight fitting shoe can not only rub the
skin
maybe causing an infection but also damage the development of baby’s
feet.
9) Exercise is good for the limb. I have to do a foot exercise lying
down I
point my toes to the ground then back up again at the ankle. I lift my
leg
keeping it straight from the bed as high as I can, I try to draw my
knees up to
my tummy.
Little thing like that could be fun.
10) I did a bonding yoga massage with my daughter, I found the best
place was on
the floor. My legs in a diamond shape with big blanket over them and my
daughter
between my legs she was comfortable, we really had lots of songs
giggles fun.
11) Baby’s bottom . I would be extra careful changing often, remember
one tiny
break in skin can allow an infection to start.
These are just my own thoughts on how I would try to deal with lymph if
I had a
baby
Let us hope you get help. But like one or two of our Mums have been
told leave
it to little. It must be agonising, if nothing else I would try to get
my child
used to the touch and feel of what is after all going to be their every
day
routine.
You may have your own ideas of how to Help your baby somwe things you
have tried
all ready If you have weather successful or not let us know lets get
some
personal experience together for others the positives and negatives.
Lets keep this information coming in. That way mums can find it and do
what they
think best but there are ideas to help
Silks
.................
Additional information:
Children with Lymphedema
http://www.lymphedemapeople.com/thesite/lymphedema_children's_pediatric.htm
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Tips on Wrapping a Lymphedema Leg
One of the best posts on how to wrap a leg...from LLLymphedema2@yahoo.com
Since you have the swelling in the feet (and toes), it is probably
lymphedema,
perhaps compounded with lipedema. The traditional bandaging technique
is with a
stockinet, then some artiflex (cotton padding), and lastly, the
bandages. I
bandage directly over the skin. The padding is supposed to even out if
you
should constrict some part of the bandaging, causing the lymph not to
flow, but
the bandages are really not like rubber bands -- properly spaced and
overlapped,
they will not cause constriction -- and the artiflex is a pain. The
stockinet is
just another thing to wash and dry. I went to www.bandages.com
and found that they have new bandages that are thick enough to be used
without
layering (e.g. the stockinet and padding). Perhaps this is the way to
go, or
perhaps you want to bother with stockinets and padding. If you were
seeing a
therapist, they would also use foam instead of artiflex (just cotton
padding).
Some pictures of bandaging look absolutely monstrous. My so called
therapist
used some foam, etc., but I soon discovered that the leg went down more
without
it. The pad is supposed to "spread" the compression so there is no
binding -- but what really happens is all the elasticity of the
bandages goes to
compressing the FOAM -- not compressing your leg. A little compression
trickles
down to the actual leg, but my experience was that the swelling went
down better
without the extra stuff. However, since this is against tradition, you
should at
least be aware if any part of your leg feels too tight, and, if so redo
the
bandages (which is at least an hour for two legs -- and bandages that
were OK
while you were up and around can suddenly become too tight in the
middle of the
night -- which means you have to get up and do it again.) Anyway, with
or
without stockinet and padding, here is one technique for bandaging:
materials (1 large leg not grossly larger than normal (I am 5'9" and
the
calf measure is 21" and I have wide, swollen feet - if you are
substantially larger, you may need more)
optional: stockinet, artiflex, foam
required:
1 roll 1" professional strength masking tape.
1 ea 3" strip of heavy padding around the ankles
1 ea 1" x 5m medi-rip
2 ea 8 cm. x 5 m short stretch bandages
1 ea 10 cm x 10 m short stretch bandages
1 ea 6 cm x 5 m short stretch bandages.
Double for 2 legs, if you are very much larger than me, add another 1
ea 10 cm.
x 5 m short stretch bandage for each leg.
I sit on my bed and have a low table I can rest my foot on, but two
chairs will
work also (one to sit on and one to put your foot on).
Wrap the 3" strip of heavy padding (or chock pads) around the ankles.
The
figure 8's you are making around your foot and from the foot onto the
leg will
tend to bind right at the intersection of the foot and leg (where the
90"
turn is made. This is the only place padding is essential. Secure it
with
masking tape. Secure all the bandages after they have been wrapped with
masking
tape. Cut a lot of 5" strips of masking tape and have them ready. Stick
them on the edge of the table, or a windowsill, or something.
First hold all the bandages so that you are drawing from the bottom of
the
bandage cylinder (the bandages rolled up are a cylinder), not the top.
A little
experimentation will show you that this is much easier.
Start with the 1" medi-rip (it is a self cohesive bandage, but looses
some
of the self cohesion with laundering). Use this tiny bandage to bandage
along
the toe line. That is, make the same arc that the joints of the toes to
the feet
make. Do not bind the toes. If you can, wrap each toe with it, but I
find that
this binds the toes and hurts, so I leave my toes unwrapped, even
though they
swell, but if you start with the larger short stretch bandages, there
will be a
half moon that swells even more (Since if you make a straight circle
from just
below the little toe to just below the big toe, this will leave some
area of
foot not bandaged and the lymph will be pushed into this area, and it
will be
worse than before. The little 1" medirip can be wrapped in a curved
path
that covers all of the foot. Overlap this 1" medirep by 1/2 and
continue
winding it around your foot until you get to the end of the arch, then
take it
up diagonally over the top of the foot, and you will still have enough
bandage
to wrap again just under the toe line again for a few wraps. The medi
wrap has
strands of elastic in an otherwise cotton strip, so pull the medirip
tight (that
is the elastic is extended, but not to the point of discomfort).
When you wrap the bandages, pull a bit at the end of each circle, but
do not
stretch them too hard, or with constant tension as far as they will
stretch. You
want them to exert a little spring, but don't strangle your legs. If
you get
them too tight, it will hurt, and you must undo your wrapping and redo
it (a big
pain). If you don't stretch them a little, they won't have much
compression. Of
course, it's always the bottom bandages on the feet that hurt, so you
have to
unwrap the whole deal to get to them.
Next,step 2 take a 8 cm. x 5 m short stretch bandage, and start at the
tip of
the foot, but do not bind any toes, and since you already have the
medi-rip,
allow a little breathing space to make sure you don't bind toes. Then
wind
around your foot overlapping the bandages by about 1/2 to 2/3 (I
probably
overlap 2/3) until you have gotten almost to the leg (your foot should
be at a
90 degree angle to the leg, and for me this is 2 or 3 wraps), then go
around the
heel itself, and, as you come off the other side of the heel, take the
bandage
diagonally up on the top of the foot to just below the top of the first
wrap
(just under the bottom of the big toe), go around the bottom of the
foot, and
then bring the bandage back around the ankle just above the heel, then
around
the ankle, and back up diagonally across the top of the foot just like
before,
overlapping 1/2 to 2/3 of the previous path. This will make large
figure 8s.
Continue with the figure 8's each layer a little higher around the
ankle, until
you again are wrapping just in front of the leg (no more space to do
another
figure 8) and use the rest of the bandages going in straight circles
(not figure
8's) around the ankles.
Next,step 3 take the second 8 cm x 5 meter short stretch bandage, and
start at
the base of the leg (around the ankles), go around once or twice, to
anchor the
bandage, then on the next turn go down around the bottom of the foot
close to
the heel, and then around the bottom of the foot and then over and up
around the
leg, then continue making figure 8's up the leg overlapping by about
2/3. To
make a figure 8 around the leg, on one side of the front of the leg,
the bandage
is going uphill (or towards your knee), then it goes more or less
straight
around the back of the leg at the high end of the 8, then goes downhill
(or
towards the foot), as you come across the front of the leg again, then
more or
less straight across the back of the leg at the low end of the 8 and
then up
again for the next figure 8. On me, this bandage is finished just about
at the
beginning of the calf (a little above the bottom of the muscle -- it
would be
ideal if this bandage ended just before the muscle begins, but it will
be a bit
different for everyone depending of how much they overlap and how large
their
leg is.
Next,step 4 do figure 8's with the 10 cm x 10 m bandage. Begin at the
bottom of
the leg with the beginning of the bandage facing upward, so the first
direction
is in a downward direction, (the end pointing up) coming around and
then going
up again. The 10 cm x 10 m bandage should take you up to just below the
knee,
but if the legs are very large, you may need another 10 cm. bandage.
Each course
of the figure 8 should overlap a little less or evenly, but not more
than the
previous course. The more you overlap the greater the compression, and
you must
always have less compression proximally (towards your heart) than
distally
(towards your toes).
Finally,step 5 take the last 6 cm. x 5 meter short stretch bandage and
start at
about mid calf or a little higher, and wind in straight circles until
just below
and as close as possible to the knee. This last bandage gives
compression over
the tops of the top 8's where there is not as much overlap, and sort of
holds it
all up, as the circumference of the leg is actually smaller at the knee
than at
the mid calf (doesn't slide down because a smaller circle would have to
slide
over a larger circumference of the leg).
I have been complemented on my ability to wrap, but It is hard to know
if a
novice can make much sense of my directions -- but I tried. Look at
some
photographs of the bandaging while you are at www.bandages.com.
You don't see to many photographs of the figure 8's, but they give more
compression and stay up better, and bind less. You will get the general
idea of
winding up the leg, and overlap by looking at the photographs, however.
It may
seem complicated to follow my directions (I tried to be clear), but the
real
technique is not very hard at all.
The new thick bandages that do not need padding (padding is included)
are :
KomprimED. They are located on the bandagesplus web site under
bandages, then
under two way stretch bandages. I think you should start with these, as
the
padding may be more important for someone who is just beginning
bandages. This
is much simpler than all those stupid layers.
*Soft and comfortable directly on patient's skin
*Thicker texture avoids application of foam and padding in many cases
*Suitable for lymphedema and venous ulcers
*Patient-friendly application requires less layers
*All bandages are short-stretch/low stretch
KomprimED 4cmx5m
Other wise, the standard short stretch bandages are rosidal or
comprilan. I use
rosidal. The medi-rip is under the section
cohesive bandages on page 2 under the more general category bandages.
...............
Special Thanks to: Linda
--------------------------------------------------------
SELF MASSAGE FOR CHILDREN'S ARM LYMPHEDEMA
Children with Lymphedema Yahoo Group
http://health.groups.yahoo.com/group/childrenwithlymphedema/
SELF MASSAGE FOR THE UPPER EXTREMITY
- Massage slowly, approx. one cycle per second
- Massage gently, approx. the pressure when stroking a cat
- Use the entire surface of the hand when massaging. Avoid digging in
with your fingers.
- Perform the entire massage in the sequence as specified in this
handout.
SEQUENCE OF MASSAGE
1. Apply circular motions to both sides of the throat, in the
triangular space just above the collarbone. Repeat 25x (I was told to
do in sets of 5)
2. Apply circular motions to both underarms. First to the uninvolved
side, then to the involved side. Repeat 25x each side.
3. Glide the hand across the from the involved underarm to the
univolved underarm, in this direction only. Repeat 10x
4. Apply circular motions to the groin of the involved side pumping in
an upward direction. Repeat 25x
5. Glide the hand from the involved underarm to the groin on the same
side of the throat, in this direction only. Reapeat 10x
6. Glide the hand from the involved shoulder to the same side of the
throat, in this direction only. Repeat 10x
7. Glide the hand from the elbow to the shoulder in three patterns:
a. from the front of the upper arm
b. from the back of the upper arm
c. from the inside of the upper arm in a spiral motion to the
outside of the shoulder
8. Apply circular motion to the front & the back of the elbow.
Repeat
each side 25x
9. Glide hand from the involved wrist to the elbow, first to the front
side, then to the backside.
10. Glide hand from the base of the fingers to the wrist, in this
direction only. If the fingers are affected (Mia's are), massage each
finger individually from the fingertip to the base. Repeat each 10x
The BEST advice the LT gave me was ~ stroke Mia as if softly petting a
cat. That is the easiest way to understand how much pressure to
use/not to use.
Hope this helps!
Stephanie
Courtesy of:
--------------------------------------------------------
WRAPPING A BABY'S LIMBS WITH LYMPHEDEMA
Children with Lymphedema Yahoo Group
http://health.groups.yahoo.com/group/childrenwithlymphedema/
--------------------------------------------------------
Primary
lymphedema of the genitalia
in children and adolescents.
Ross JH, Kay R, Yetman RJ, Angermeier K.
Department of Plastic Surgery, Cleveland Clinic Foundation, Ohio, USA.
PURPOSE: Congenital lymphedema is a rare disorder that may result in
disfiguring
edema of the male genitalia. We reviewed our experience with 5 cases to
advance
our understanding of this challenging problem. MATERIALS AND METHODS:
Four boys
with significant lymphedema underwent excision of the involved
subcutaneous
genital tissue and coverage with local skin flaps. Two boys in whom
this
approach failed later underwent complete excision of the involved
subcutaneous
tissue and skin, and coverage with split thickness skin grafts. The boy
with
minimal edema was observed. RESULTS: Two of the 4 boys who underwent
subcutaneous genital tissue resection and coverage with local skin
flaps are
markedly improved, although 1 requires further revision. In the other 2
boys
treatment failed, necessitating repeat genital tissue excision and
grafting.
While there have been no recurrences in the grafted areas, each patient
has
required additional operations to manage recurrent edema in adjacent
tissues of
the perineum and inguinal region, and in 1 significant contraction of
the
grafted skin developed. Mild genital lymphedema in the remaining
patient has
remained stable during 10 years of followup. CONCLUSIONS: Congenital
lymphedema
of the genitalia is a challenging problem. Recurrences requiring
multiple
operations are common. We recommend expectant management of mild cases.
In more
severe cases excision without grafting should be attempted. While skin
grafting
may be the most definitive solution, it does not prevent recurrence in
adjacent
regions, and it carries the risk of skin contraction. Skin grafts
should only be
used when other techniques have failed.
MedLine
-------------------------------------------------------------------
Surgical
management of congenital
lymphedema in infants and children.
Fonkalsrud EW.
Of 67 children and infants with lymphedema, 28 had the congenital type.
Congenital lymphedema appears during the first few weeks of life,
frequently
involves more than one extremity, and enlarges at a slower rate than
general
body growth. The swelling usually becomes less pronounced with age, and
no
specific therapy is required in two thirds of the patients. Seven of
the 28
children had swelling of the upper extremities and a generalized
lymphangiopathy
syndrome. Subcutaneous lymphangiectomy was performed on ten of 28
patients who
had moderate to severe swelling. Those with hand and arm involvement
were
particularly benefited; however, operations on the dorsum of the foot
produced
hypertrophic scars in one third of the cases. The operation is deferred
until
after age 2 years to permit optimal technical repair and to identify
those
patients whose conditions will improve spontaneously.
Pub Med
===================================================
Lymphedema People
Support Groups
-----------------------------------------------
Children
with Lymphedema
The time has come for families, parents, caregivers to have a support
group of
their own. Support group for parents, families and caregivers of
chilren with
lymphedema. Sharing information on coping, diagnosis, treatment and
prognosis.
Sponsored by Lymphedema People.
http://health.groups.yahoo.com/group/childrenwithlymphedema/
Subscribe: childrenwithlymphedema-subscribe@yahoogroups.com
......................
Lipedema
Lipodema Lipoedema
No matter how you spell it, this is another very little understood and
totally
frustrating conditions out there. This will be a support group for
those
suffering with lipedema/lipodema. A place for information, sharing
experiences,
exploring treatment options and coping.
Come join, be a part of the family!
http://health.groups.yahoo.com/group/lipedema_lipodema_lipoedema/?yguid=209645515
Subscribe: lipedema_lipodema_lipoedema-subscribe@yahoogroups.com
......................
MEN WITH LYMPHEDEMA
If you are a man with
lymphedema; a man with a loved
one with lymphedema who you are trying to help and understand come join
us and
discover what it is to be the master instead of the sufferer of
lymphedema.
http://health.groups.yahoo.com/group/menwithlymphedema/
Subscribe: menwithlymphedema-subscribe@yahoogroups.com
......................
All
About Lymphangiectasia
Support group for parents, patients, children who suffer from all forms
of
lymphangiectasia. This condition is caused by dilation of the
lymphatics. It can
affect the intestinal tract, lungs and other critical body areas.
http://health.groups.yahoo.com/group/allaboutlymphangiectasia/
Subscribe: allaboutlymphangiectasia-subscribe@yahoogroups.com
......................
Lymphatic
Disorders Support Group @ Yahoo Groups
While we have a number of support groups for lymphedema... there is
nothing out
there for other lymphatic disorders. Because we have one of the most
comprehensive information sites on all lymphatic disorders, I thought
perhaps,
it is time that one be offered.
DISCRIPTION
Information and support for rare and unusual disorders affecting the
lymph
system. Includes lymphangiomas, lymphatic malformations,
telangiectasia,
hennekam's syndrome, distichiasis, Figueroa
syndrome, ptosis syndrome, plus many more. Extensive database of
information
available through sister site Lymphedema People.
http://health.groups.yahoo.com/group/lymphaticdisorders/
Subscribe: lymphaticdisorders-subscribe@yahoogroups.com
......................
All
About Lymphedema
For our Google fans, we have just created this online support group in
Google
Groups:
Homepage: http://groups-beta.google.com/group/All-About-Lymphedema
Group email: All-About-Lymphedema@googlegroups.com
......................
Lymphedema
Friends
http://groups.aol.com/lymphedemafriend
If you an AOL fan and looking for a
support group in AOL
Groups, come and join us there.
================================================
Join us as we work for lymphedema patients everywehere:
Advocates for Lymphedema
Dedicated to be an advocacy group for lymphedema patients. Working towards education, legal reform, changing insurance practices, promoting research, reaching for a cure.
http://health.groups.yahoo.com/group/AdvocatesforLymphedema/
| Subscribe: | AdvocatesforLymphedema-subscribe@yahoogroups.com |
Pat O'Connor
Lymphedema People / Advocates for Lymphedema
================================================
For information about Lymphedema
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For Lymphedema Personal Stories
http://www.lymphedemapeople.com/forum/forum.asp?FORUM_ID=7
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http://www.lymphedemapeople.com/thesite/lymphedema_wound_care_revised.htm
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http://www.lymphedemapeople.com/thesite/lymphedema_exercise_excercises.htm
For information on Infections Related to Lymphedema
http://www.lymphedemapeople.com/thesite/lymphedema_types_of_infections.htm
===================================================
Lymphedema Glossary
http://www.lymphedemapeople.com/forum/topic.asp?TOPIC_ID=247
===================================================
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