Originally published in September-October 2004 icon
An effective treatment for lymphoedema, a frequent and distressing side-effect of some cancer surgery
By Marie-France Bewley
Doctor NW is an American archaeologist who lives in Rome and comes to Oxford, every summer to study and write. She first approached me in the summer of 2001 at my clinic in Abingdon, as she felt flooded with water. Her left leg was so badly swollen that I wondered whether I could help her at all.
Doctor NW’s Story
"In early January I was operated on to remove a cancerous tumour in the inguinal lymph nodes, and surgery was followed by radiation therapy.
"Both the surgery and the therapy resulted in considerable swelling in the operated leg, due to a build-up of lymph fluid. My surgeon explained that this fluid would eventually find another path to drain and that I would have to wait for that to happen.
"My specialist doctor took no interest in the problem, except to advise me to take aspirin to reduce the danger of thrombosis.
"Months passed with no improvement and the situation appeared to be worsening rather than improving. On some mornings. I could hardly bend my leg enough to put on a stocking and the swelling was so bad that I had considerable difficulty even in putting on a shoe. Walking was often painful, and climbing stairs very difficult.
"Accidentally. I read in a newspaper about a similar problem and learned the name for this condition: lymphoedema. I turned to the internet to see what I could learn.
"After telling my specialist doctor I had discovered from the internet that compression stockings and lymphatic drainage massage could be beneficial according to doctors at the Churchill Hospital, he admitted that there was a special Lymphoedema Clinic there and agreed to refer me. While waiting a further two months until they could see me, I was provided with a list of lymphatic drainage practitioners in the area by the Clinic.
Within weeks, I saw a marked improvement
"I immediately contacted Marie-France Bewley, who fortunately was able to schedule me for regular massages, initially daily and eventually weekly. She also advised me to purchase a compression stocking, provided me with a specially composed oedema gel to use every evening, and suggested I see a nutritionist who had devised a special diet for the problem.
"Within weeks, I saw a marked improvement. The Lymphoedema Clinic at the Churchill Hospital fitted me for special compression stockings and checked my progress after one month. Now, three months after my first massage with Mrs Bewley, my leg has returned to almost its normal size and the texture of the skin is again normal. I have regained considerable flexibility in the leg as well, and am hoping to return to yoga or pilates exercise classes in the next month, something that was inconceivable three months ago.
"I realise that, if I had not happened to learn that there was help for this condition, it might have continued to worsen, without hope of improvement on its own. I was shocked to realise that doctors ignore the seriousness of this condition, even when they are aware that there is help for it."
I explained to Dr. NW. the complexities of the lymphatic system, the three distinct and progressive stages of lymphoedema, the two phases of Complex Decongestive Therapy [CDT (1. reduce lymphoedema 2. remove lymphoedema and avoid reaccumulation of fluid and decrease fibrosis), and the four classical elements of CDT (Skin Care, MLD, Compression Therapy, Breathing and Exercise Therapy). I wanted her to understand the whole picture and the necessity of total compliance on her part if we were going to achieve any results. We worked joyfully as a team for three months, at the end of which her leg had returned to almost its normal size, the texture of the skin was normal, and she had regained considerable flexibility.
I was very aware that I was sitting on a time bomb, and to enhance the speed of her recovery I used the Advanced Reflexology Technique (ART) devised by Antony Porter, at the end of each treatment.
I gave her the excellent Lymphoedema Support Network’s leaflets and advised her to join them
I gave her the excellent Lymphoedema Support Network’s leaflets and advised her to join them. I lent her three of my many videos on the lymphatic system and its pathologies all superbly produced by the Dr Vodder School of North America
I reminded Dr.N.W. of the general precautions:
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Avoid temperature extremes (hot baths, hot showers, solarium, Turkish baths, saunas, burns)
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Avoid infections (insect bites, vaccinations, venipunctures, acupuncture on the affected limb, pet scratches, skin punctures and ruts, venography, and lymphography)
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Avoid blunt traumas (lifting heavy objects, blood pressure measurement, tight clothing [especially bra straps, rings, watches and bracelets.)
Had the doctor started her treatment with me this year, I would have given her Chris Woollams" book, Everything you need to know to help you beat cancer, the very best book I have ever read for prevention or "cure"
for cancer. She was deeply distressed by the condition of her skin, as no aqueous cream she tried made any difference.
I introduced her most successfully to the highly specialised skincare range that as a clinical aromatherapist I have created for lymphoedema patients. There is a choice of hypoallergenic organic carrier oil creams, Aloe Vera and seaweed gels, lotions, pure blends of essential oils to nourish the skin, stimulate lymphatic flow, prevent and combat bacterial, fungal and viral infections, heal the burns of radiotherapy, and speed up scar and wound healing. In my formulas, I take into account whether the patients are pregnant, suffer from high blood pressure, epilepsy, or kidney problems. I always insist on a skin patch test.
The common factor to all the formulas is that they are anti-depressant to help the patients to cope with the feeling of anxiety, anger, frustration, and even despair. I took Dr. N.W. to the Oxford Physiotherapy Centre where very experienced physiotherapists taught her Pilates with great benefit. Lastly, I taught her Vertical Reflex Therapy (VRT) as devised by Lynn Booth, as she found it extremely difficult to perform correctly on herself the Simple Lymph Drainage (SLD) Techniques.
The hardest thing for this or any other lympboedema patient to accept is the fact that oedema is a chronic condition which will worsen unless treated quickly.
In Dr.N.W.’s condition, the surgery and radiotherapy had destroyed and damaged lymph vessels and lymph nodes in the groin area.
The whole legs drain into the inguinal nodes of the groin area, and the lymphatic fluids have nowhere to go.
The lymphatic vessels are made of segments which dilate and contract and push the fluids against gravity and pour it back into the venous system. Manual lymphatic drainage stimulates the contraction and pulsation of the lymphatic vessels, and moves the lymph to functional areas. Bandaging prevents the reflow in the vessels by using a decreasing pressure from foot to groin. Different pressures are used at different stages of lymphoedema, from exquisitely light to extremely strong.
The Three Stages
STAGE 1 (reversible): the lymphatic system is overburdened, a protein-rich soft swelling develops in the affected area. It can be indented by applying pressure; when the affected arm or leg is raised the swelling recedes on its own accord.
STAGE 2 (spontaneously irreversible): the swelling is now characterised by the presence of excess collective tissue, fibrosis and sclerosis have developed, indentations can no longer be produced by applying pressure, raising the limb no longer reduces the swelling.
STAGE 3 (lymphostatic elephantiasis): the swelling is extreme, the skin is hardened and shows wart-like growth. Sometimes large bulges are present. The risk of wound inflammation is high, and the skin is vulnerable to the development of deep, poorly healing wounds.
Fortunately, Dr.N.W. came at the second stage. Had she come at Stage 3, I would have referred her to the Dr. Vodder Clinic in Austria, which is the best and cheapest in the world (from my own experience) and offers an intensive residential treatment with the four components of CDT
In Lymphoedoma. time is of the essence. Wasted time doth waste the body.
Useful Contacts
Manual Lymphatic Drainage UK Ltd
PO Box 14491
Glenrothes
Fife, KY6 3YE
Scotland
Email: [email protected]
Web: http://www.mlduk.org.uk
The Lymphoedema Stupport Network
St Luke’s Crypt
Sydney Street
London
SW3 6NH
Tel: 020 7351 44S0
Fax: 020 7349 9809
email: [email protected]
web: http://www.lymphoedema.org/lsn
Marie-France Bewley
160 Oxford Road
Abinqdon
Oxfordshire.
0X14 2AF
Tel: 01235 555932
email: [email protected]
web: http://www.mfbewley.org.uk
The Summertown Clinic
362 Banbury Road
Oxford
OXZ 7PP
Tel: 01865 558561
email: [email protected]
web: http://www.summertownclinic.co.uk