Soothing The Pains Of Sufferers

People with painful, swollen limbs may no longer have to suffer in silence, as Pauline Torode reports

IT'S unusual to have a clinic in Guernsey specialising in something that most people have never heard of but lymphoedema is a condition that can happen to anyone. The lymphatic system acts as a highly efficient filter that helps the body to fight infection and disease. Lymphoedema starts with an unusual feeling of heaviness, stiffness and a dull ache in an arm or leg, usually with some swelling and redness on the skin. T hese are the typical symptoms, caused by a buildup of lymph fluid in the tissues. Although the condition cannot be cured, it can be controlled. The good news for Guernsey patients is that there are two enthusiastic women working in a modern surgery to provide practical and emotional support for the disease. Practice nurse Heather McGhee and physiotherapist Nicola Norman at the Longfrie Surgery have routine general appointments, but their speciality is treating lymphoedema. Demand for their expertise is increasing slowly, replacing their general practice time with occasional visits to patients at home for palliative care.

Mention of the lymph nodes may bring to mind breast cancer where some of the cells have been destroyed by the lymphatic system, while others may not have been affected. Therefore surgeons will often remove some of the nodes at the time of the operation to check whether cancer cells are present to help prevent the spread of the disease. Only a third of men and women with lymphoedema referred to the clinic are cancer patients. Swelling of the arms and legs can happen at any time, from childhood to old age. Those born with an under-developed lymph system have primary lymphoedema; while those whose condition is as a result of surgery, accidents, burns or anything else that is invasive to the body, including radiotherapy, have secondary lymphoedema.

The genetic link for people affected is still being researched, but, in Heather and Nicola's opinion, this has long been a neglected condition as far as British-trained doctors are concerned.

Most of the research and expertise in the last 60 years has been centred in Europe. England has lagged behind, but gradually doctors have begun to identify the symptoms and recognise regimes of treatment. As a result Heather and Nicola have seen referrals increase.

For some of the more severe cases they might need to see the patient each day, for specialised massage or compression bandaging. Their aim, however, is to show the patient how to do their own gentle massage to keep the swellings under control. In those rare cases where gross lymphoedema has resulted in huge legs with folds of hardened skin, very intensive therapy is required.

'The extreme of this condition is elephantiasis, which is common in Africa where it is caused by infected mosquitoes. A lesser form can occur when the lymph vessels become restricted and don't work as effectively and if that person has an insect bite or knocks their arm or leg, any minor trauma can set it off,' said Heather.

This can particularly apply to men and women soon after breast cancer surgery, or who subsequently damage the arm on the affected side. This can result in lymphoedema as much as 20 years later.

'We advise patients who have had breast surgery not to have injections, blood taken or any form of constriction on that arm, to avoid tight clothing or jewellery and to take care cutting nails or underarm shaving. This can contribute to the condition and should be avoided. 'Once the surface of the skin is broken, it allows infection in,' said Nicola.

There is no magic wand that these two women can wave to cure the condition, but in most cases they can reduce and control the swelling and make it more comfortable. For many people the swellings can be easily managed with daily self-massage and wearing a compression sleeve or stocking that encourages the lymph fluid to move back up the affected limb. No two patients have identical problems and most will have only mild symptoms that can be treated and tolerated with no more than discomfort rather than pain.

The Patient

Betty Le Blond was once a most active woman, a non-driver who walked everywhere especially when her her children were young. In those days, dancing was a pleasure she shared with her husband, John. Now anything more than a short stroll is out of the question, Betty, 65, suffers from lymphoedema in her left leg, a condition that developed soon after two operations for artery replacement a couple of years ago. 'When I was 621 fell up the stairs and damaged my leg. In the hospital the doctors discovered that I had a blockage of some sort,' she recalled. Eventually, after many tests, she was given an artificial artery from groin to knee.

Despite physiotherapy and wonderful care from an extended surgical and nursing team, Betty's leg was swollen, red and painful when she was referred to Nicola for specialised treatment that was to continue indefinitely on a weekly basis.

'Nicky's massage keeps me out of hospital, there's no doubt about that,' she said.

One daily antibiotic tablet keeps infection at bay and, in addition, Betty has a supply of teatree oil, recommended by Nicola, to treat the cracks and fungal growth of athlete's foot that seem to occur prior to the start of an infection. Despite this regular care, Betty needed four sessions in hospital this year, each time for about a week for intravenous antibiotic treatment. Nicola noticed that Betty's hospital admissions coincided with her own holidays when she was unable to provide the Thursday massage appointments.

'There was a definite correlation between the dates and it has been reassuring to see that our treatments have been the central factor in keeping Betty out of hospital  which is the cheaper option for the States and far more comfortable for her,' said Nicola.

She has taught Betty how to do gentle self-massage, starting at the sides of her neck and working down the body through the important lymph sites. Betty does this every morning. Prescribed cream to gently massage into the skin completes the treatment, and Betty uses a footstool to keep her leg up when she is not moving around.

'I have to be careful not to lift heavy things or to bump my leg and I wear good flat shoes and tights. I can't wear socks or a compression stocking because of the artery operation on my upper leg. I can't walk too far and I usually don't go out on my own; I just go along at my own pace.'

Lymphoedema is a swelling caused by a build-up of lymph fluid in the tissues.

Between two and four litres of strow-coloured lymph are moved around the body every day, maintaining the balance of fluid in the body and fighting infection by cleaning and filtering protein, tissue debris, infection and, in rare cases, cancer ceHs. The main lymph nodes are situated in the groin, the neck, and throat, under the arms, at the back of the knees and in the elbows

(Reproduced courtesy Guernsey Press and Star)

Article dated 10 December 2004

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