Integrative Treatment for all Types of Lymphoedema
Lymphoedema is a collection of lymph fluid in the body tissues especially in extremities and genital organs; here the normal flow of the lymph is obstructed or reduced resulting in the collection of lymph in the extremities.
Lymph is the normal body fluid that is present in tissue and circulates through the lymphatic system. This unilateral movement of lymph through the lymphatic system is done by contraction of muscles and gentle pumping action from the lymphatic vessels themselves. The fluid is filtered through lymph nodes and then eventually drains back to the blood system. Lymph from right side of head and neck, right upper limb and right part of chest passes through a vessel known as right lymphatic duct and joins right sub clavian vein. Lymph from rest of the body area drains through thoracic duct and joins left sub clavian vein. They finally drain to heart through superior vena cava. Lymph flows in one direction towards the blood system and there are tiny valves in the lymphatic channels which aid in this one way flow. When lymph load is increased, fluid accumulates in tissues lymphoedema develops.
In primary lymphoedema, the lymphatic vessels themselves often appear to be abnormal. They can be very poorly developed (hypoplastic) or not developed at all (aplastic). The tiny valves in the lymphatics may also be faulty. The reason for the occurrence is not entirely clear, but genetic abnormalities have been identified in some patients. Primary lymphoedema can be divided into three main groups.
- Congenital onset primary lymphoedema-the odema which is seen in childhood
- Post-pubertal primary lymphoedema-the oedema develops after puberty (known as lymphoedema precox)
- Adult onset primary lymphoedema- oedema develops after the age of 30-35 (lymphoedema tardum)
Secondary lymphoedema is caused by damage of the lymphatic vessels due to any reason. Lymphatic Filariasis, Pdoconiosis, surgery, radiation, chemotherapy, accidents and injury are the commonest reasons causing secondary lymphoedema.
Cancer and Radiotherapy
After certain types of surgery (breast cancer surgery, lymph node dissection for melanoma, atype of skin cancer) the lymph nodes are intentionally removed to reduce the risk of cancer spreading to the other parts. In some patients the development of cancers themselves can lead to lymphedema. This is because sometimes the tumour cells also affect the lymphatic vessels and block them. This can also occur after radiotherapy which sometimes damages lymphatic vessels.
Lymphatic Filariasis is a parasitic and infectious disease that is caused by (Wuchereriabancrofti and Brugiamalayi) thread-like filarial nematode worms which are also known as â€œmicrofilaria. Lodging in the lymphatic system these worms damage the lymph nodes or causes the dilatation of the lymphatic vessels and impair the flow of the lymph. The adult worms live for 5-7 years in the lymphatics, producing millions of immature microfilariae (minute larvae) that circulate in the blood. The patients usually present with symptoms like painful swelling on the one / both legs, arms & scrotum, along with fever and redness of the affected part. The skin also becomes much thickened and with overhanging folds which can resemble the foot of an elephant. Filariasis is the most common form of secondary lymphoedema worldwide. IAD offers a Filarial parasite treatment using various approaches and it is one among the primary destinations for filariasis treatment in India.
LF is caused by a microscopic worm that spread from person to person by the bite of infected mosquito. The microscopic worms pass from the mosquito through the skin, travel to the lymph vessels and grow into adults. An adult worm lives for about 5-7 years. The adult worms then release millions of microscopic eggs called microfilariae, into the blood. People with the live filarial worms in their blood can give the infection to others through mosquitoes. The microfilaria damage the lymph nodes and lymphatic vessel by which flow of lymph fluid is impaired and cause massive lymphoedema (elephantiasis) of the legs, arms, breast, genital area . There are no symptoms in the early stage of infection after receiving mosquito bites. This stage can last for several years. As the disease progresses the skin becomes much thickened and with overhanging folds resembling the foot of an elephant. Previously lymphatic Filariasis treatments in India and cure for lymphatic filariasis were rare and difficult. Since 2005 new treatment methods are made available by IAD at Kasaragod, Kerala with high success rate. The elephantiasis treatment method varies based on the condition of the patient. Including ayurveda treatment for lymphatic filariasis, IAD offers an integrative approach to this condition.
Cellulitis or Filarial fever is a common soft tissue infection affecting the lymphoedema patients. Most commonly this occurs in the lower leg but can develop anywhere in the body. In severe infections, the inflammation can spread to the lymphatic vessels (lymphangitis) and cause damage. Frequent inflammatory episodes lead to swelling because of scarring (damage) around the lymphatic channels and will have the following symptoms.
- Pain and tenderness.
- Warmth of the affected region.
- Erythema (redness).
- Increased swelling.
- Local lymphadenitis (infection of lymph nodes).
Integrative Treatment for All Types of Lymphoedema
IAD has a wide range of services including Ayurveda treatment for Lymphedema and it is recognised as one of the primary places for Lymphoedema treatments in India. The patient participates in pre-treatment counselling sessions to understand the details of the disease and treatment. Preliminary patient details will be documented by a counsellor before the team of doctors examine the patient and record the status of the disease. Doctors, nurses and compression therapists will discuss and decide on treatment. Before starting treatment girth and volume measurement of the affected limb will be recorded. This will be repeated on 7th and 14th day or on the day of discharge. In general, the treatment will be for 15days or 21 days according to the condition of the patient. Complicated limbs with ulcer, maggots, fever episodes, recent ADLA (medical term for acute fever) or cellulites and large sized limbs initially require 3-4 weeks of treatment. These treatment procedures are mainly aimed to drain the lymph blocked in the legs or affected parts.
- Skin wash:Meticulous washing and drying of the affected limb.
- Phanta:The process of soaking the affected limb in herbalized solution to heal microscopic ulcers.
- Yoga exercises:Asanas and pranayama to facilitate the lymph flow carried out in two sessions and will be trained to the patients by our staff.
- Massage (Indian Manual Lymph Drainage):This process helps to drain the accumulated lymph and also helps to absorb medicated oil into the skin.
- Compression:The affected limb is bandaged in a figure of 8 method; compression will improve the muscle pumping & thus facilitate lymph drainage.
- Swedhana: The patients with hardened limbs showing non-pitting oedema (organized limbs) will be treated with swedhana therapy (Ayurvedic steam treatment also called Nadisweda). Here the herbalized steam is passed through a pipe directly over the lymphoedematous legs.
- Home care training:The patient will have to spend 1Â½ hours daily to do the self-care procedures at home. IAD gives required training to the patient and a care taker from the family on the above protocol, to ensure the continuity of treatment when patient returns home. If the patient follows all the instruction given during the training period, the reduction rate will be significant. By continuing the integrative treatment recurrent fever episodes can be easily controlled and limb size can be reduced thus improving their Quality of Life. IAD has a proven history of successfully treating over 2800 cases in lymphoedema and the institution is now a renowned name in the field of Lymphoedema treatment in Kerala as well as in India.
Please read a WHO publication that mentioned that IAD is a lead centre for
Lymphoedema in the world
- Macdonald JM, Geyer MJ (Eds). Wound and lymphedema management. World Health Organization; 2010. pp. 63-83 http://apps.who.int/iris/bitstream/10665/44279/1/9789241599139_eng.pdf
- Doctors and scientists in IAD have written more than 45 research papers on treating lymphoedema. To access the link please click here http://www.iad.org.in/publications/list-publications-lymphoedema/
Cost Estimation for Treatment
Treatment cost will depend on the duration of the treatment and the size of the limb. As the patients attend the pre-treatment counseling the girth measurement will be taken, cost estimation software uses this measurement to give the approximate cost of treatment. The patient can also send the photo of the affected limb taken from anterior, posterior, medical and lateral aspects to email@example.com before the arrival. This will help in estimating the approximate cost and duration of the treatment. Please click on our photo gallery to understand the position for taking photo.
Blood, urine and discharge from the wound will be tested to initiate appropriate treatment. Physical fitness and circulation to limbs through Ankle brachial pressure index will also be determined. Photo of the affected part will be documented. If you have done any tests recently please bring them along with you
Periodic follow-ups are done generally at 30 to 45, 90 and 180 days to ensure the continuity of the self-care. Follow-up dates will be given during discharge. Patients are requested take prior appointment for follow-up visit. Patients have to spend a day for follow up. Follow-up counseling will be done during each follow up visits. The treatment procedures practiced by the patients at home are also cross checked during this secession. The bystander who was trained on treatment procedure should accompany the patient in order to re-educate the treatment procedure.
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