THE LYMPHATIC SYSTEM OF THE HUMAN BODY We love your lymphatics We - PowerPoint PPT Presentation

THE LYMPHATIC SYSTEM OF THE HUMAN BODY We love your lymphatics We want you to love them too!

THERAPIST QUALIFICATIONS

VODDER ACADEMY IN AUSTRIAN TYROL Recuperating cancer patients attend the clinic for two weeks, soon after their medical treatment, for post-operative treatments, early preventative treatment for Oedema and to learn how to self-treat themselves at home.

OUR SERVICES

HOW MUCH DOES IT COST? TREATMENTS REBATES • Physiotherapy $115/hr • Private Health rebates on Physio/OT/RMT • Occupational Therapy $115/hr • CHP (Chronic Health Plan) up to 5/pa Medicare subsidised treatments for Physio/OT • Remedial/Pregnancy Massage $85/hr for $52.95 (including Sozo) • SozoT esting $55/30 mins • DVA – fully subsidised up to 20/pa • Garment Fitting $55/30 mins • ACAT – fully subsidised up to level of cover • ICWA (Insurance Commission WA)

ROLE OF THE LYMPHATIC SYSTEM • Sewerage System of the body • Fluids - uptake and clearance that can’t get back into th blood vessels • Absorption of fats (long chain fatty acids) • Maintains blood volume • Immune response

WASTE MAINTENANCE • Collects & drains: 2-4L Lymph per day. • 100mls lymph drain from each arm daily = about a ½ cup of tea. • 200-300mls drain from each leg daily = about 1½ cups of tea. • Works at about 20% of capacity.

LYMPH SYSTEM • Superficial and deep • 80% above the muscle 20% deep • 60% cervical • Lymph from the legs, groin, abdomen and left chest, arm and neck drain to left terminus • Lymph form right chest, arm and side of head to the right terminus

IT ALL STARTS IN THE SKIN!

ILV & ANCHORING FILAMENTS

THE FACTORIES – LYMPH NODES • Holds invaders (pathogens) to identify! • Immune response factory • Waste recycling plant • Returns H2O back to blood • Stores insolubles – Ink! • We can’t make new nodes

THORACIC DUCT • Thoracic duct 38-45cms long & 5mm in diameter, largest lymphatic vessel = Super Highway! • Cisterna chyli is a dilated lymphatic sac that represents origin of thoracic duct = Vacuum Cleaner! • Clears the whole of the lower part of the body and upper left quadrant.

LYMPHANGIOGRAPHY

BIO-IMPEDANCE SPECROSCOPY

BIO-IMPEDANCE SPECTROSCOPY (BIS)

Not to be confused with Bio-impedance ANALYSIS (BIA) - often found in gyms etc.

TERMINOLOGY! • OEDEMA = Fluid Retention • ACUTE oedema = Short term (< 3 months) Post op, seromas, fracture, strains, wounds etc. • CHRONIC oedema = LYMPHOEDEMA (> 3 months?) a problem with lymphatic system = OR could be other causes

BEWARE THE CAUSE OF SWELLING! • Lymphoedema: Primary and Secondary • Filariasis • Venous insufficiency, (e.g. varicose veins) • Recurrence of Cancer • DVT • Post operative swelling • Thrombophlebitis • Cardiac Disease (CHF) • Lymphangioma (Pseudotumor) • Renal Disease / Liver Disease • Lipoedema / Lipedema • Hypoalbuminemia • Obesity • Metabolic disorders • Infection – cellulitis, Erysipelas

RED FLAGS • Sudden acute onset • Pain as the principle complaint • Skin colour changes • Collateral veins • Lumps, sores or ulcers • Paraesthesia or neurological signs • History of cancer not recently monitored  Further assessment & investigation needed CT scan, Doppler, biopsy etc. for cause

CELLULITIS • Consensus document: lymphoedema.org.au • Occurs very quickly (24 hours) • Needs immediate intravenous antibiotics

LYMPHOEDEMA • The National Breast and Ovarian Cancer Centre “conservative estimates suggest that 20% of breast, genitourinary, gynaecological, or melanoma survivors will experience Secondary Lymphoedema. • Lymphoedema generally occurs in the first 2-3 yrs after surg or radiotherapy • Risk drops over time - provided no other trauma occurs • At birth, about one person in every 6000 will develop Primary Lymphoedema (Folidi M,E. (2006) • Significant negative impacts: frustration, distress, depression, anxiety, and body image disturbance, financial, productivity…..

INCIDENCE OF LYMPHOEDEMA FOLLOWING CANCERS • Breast Cancer (axillary clearance) 21 - 28% (sentinel node biopsy) 5% • Cervical Cancer 24% • Melanoma 9 - 29% • Prostate Cancer 10 - 60% • Vulvar Cancer 36 - 47% ( Beesley et al (2007) After gynaecological treatment 10% reported diagnosed LO, 15% reported undiagnosed “symptomatic”lower limb swelling.

PRIMARY LYMPHOEDEMA • A congenital condition where there is an abnormality of the development of the lymphatics.

BIS FOR PRIMARY LYMPHOEDEMA

LIPEDEMA FAT deposits under the skin not recognised by Lysosomes (not a lymphatic issue) Affects 11% of women (probably underestimated due to lack of diagnosis Congenital, but cause uncertain

BIS FOR LIPEDEMA

SECONDARY LYMPHOEDEMA • Trauma and tissue damage • Venous disease • Immobility and dependency • Factious – self harm • Infection such as cellulitis • Obesity • Filariasis

BIS FOR SECONDARY LYMPHOEDEMA

SYMPTOMS OF LYMPHOEDEMA STAGES • Stage 0: Latent, patient at risk, may have subjective complaint (heaviness), no visible oedema. Now detectable by BIS - provided there is a baseline, reversible . • Stage I : Soft pitting oedema present, subsides on elevation, reversible , negative Stemmer’s sign. • Stage II : Firm, non pitting oedema present, rarely reduces on elevation, positive Stemmer’s sign. Late stage II: There may or may not be pitting as tissue fibrosis evident. Treatment – reduction & management . • Stage III : Tissue fibrotic (hard) and pitting is absent, management, significant skin changes: (hyperkeratosis elephantiasis, lymphangiectasia, papillomatosis, lymphorrhoea) Treatment – reduction & management .

STAGES OF SECONDARY LYMPHOEDEMA

HOW DO WE FIX IT? COMPLEX DECONGESTIVE THERAPY • Manual Lymph Drainage (therapist / pumps) • Compression (Bandaging / Wraps / Sleeves) • Exercise (Walking / Hydrotherapy) • Skin Care (Moisturise / protect / treat wounds) EARLY INTERVENTION!!!

EARLY INTERVENTION – LYMPHATIC REDIRECTION TRAIN THE LYMPHATIC SYSTEM TO FLOW IN A DIFFERENT DIRECTION! • The body can grow new vessels but it can’t replace nodes! • Uses the body’s anastomoses • Uses highly hypoallergenic lymphatic tape - Curetape (form of Kinesiotape) • NO scientific evidence BUT now we can track with BIS • Plenty of anecdotal evidence and Sporting injury observations

SPORTING INJURIES WITH TAPING

SPORTING INJURIES WITH TAPING

EARLY INTERVENTION – LYMPHATIC REDIRECTION • What does it entail? • Baseline BIS • 6 treatments – Manual lymph drainage & taping Fill up the anastomoses Tape body to encourage lymph to flow to other nodes • BIS in 3 – 6 months • Self-care education • Compression sleeve for flying

EARLY INTERVENTION – LYMPHATIC REDIRECTION

BIS FOR SECONDARY LYMPHOEDEMA

BIS FOR SECONDARY LYMPHOEDEMA – FOLLOW UP 5 MONTHS

WHY ARE SCARS IMPORTANT? • They can • We can • Restrict movement • Perform MLD/MSTR • Adhere to organs/deeper tissue • Use Low Level Laser (LLL) • Cause seromas • Use Physiokey (neurostimulator) • Block superficial lymph flow • Use taping • Look unsightly • 28 Feb 12 Mar 18 Apr 20 May

WHAT IS CORDING? Axillary web syndrome Lymphatic cording • Incidence varies among the few reports • Associated with pain and limitation in in the literature ROM shoulder • Definite clinical entity following axillary • Most authors show resolution in 3 surgery for breast cancer months (Tilley et al 2009) • Treatment - Scar work - Laser -Taping - Exercise

SCARS & CORDING

FAILURE LYMPH SYSTEM • Load is greater than ability of LVS to manage • Progressive accumulation of fluid + inc. concentration- leads to more inflammation • Reduced oxygen levels • Inc. distance between blood and lymph vessels • Normal cells in tissues not dong what they should • Excessive fat deposition where slow/poor flow

INCREASED RISK • Prior damage-e.g. hip joint, frozen shoulder, soft tissue injury • Blood vessel disease • Thyroid disease-makes large sticky molecules- which attract fluid-myxoedema • Inflammatory events • Lipoedema

RISKS TRANSPORT CAPACITY REDUCTION • Surgery, radiotherapy • Fibrous tissue • Body mass- excess fat • Immobility or lack of activity • T oo much pressure on a small area - e.g. bra, underwear too tight

RISKS INCREASE LOAD • High capillary BP • Injured blood vessels • Weak capillaries and blood vessels • Infection • Sunburn • Heating of skin • Poor quality skin care • Not warming down after strenuous exercise

RISK ASSESSMENT - ARMS

RISK ASSESSMENT - LEGS