Making strides in Lymphoedema treatments

Our two Lymphoedema Clinical Nurse Specialists, Helen Treleaven and Terri Lightfoot are both members of the South West Forum for Lymphoedema.  The forum covers the South West, including Bath and Gloucestershire, and meets four times a year to discuss policies, procedures and best practices.

Helen and Terri had recently attended a Level 1 Myofascial Release Course, aimed at ‘Post-Operative Breast Cancer Complications’ at the Christie Hospital in Manchester.  Subsequently both were invited to present at the recent South West Forum meeting to share their knowledge and explain how the course had changed their practices.

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Helen talks about their presentation to the South West Forum;

“We started off explaining about the course and how it had involved anatomy and physiology of the breast and what happens to our tissues when we undergo surgery, and then 2 and ½ days of very hands on practical work exploring where our tissue tension starts and stops in conjunction with scar tissue. We learnt how to release this scar tissue and improve range of movement (ROM).

Both myself and Terri talked about patient case studies and how, by incorporating this technique into our treatments, we have improved quality of life, reduced pain and discomfort, improved ROM and general wellbeing. As a result of our presentation, the South West Forum have asked for course details as they would be very interested in attending the course and having such an excellent treatment option.

We have both been very fortunate in that we have been accepted on the Level 2 course, incorporating the head and neck, pelvic, thorax, shoulder, abdomen, back, sacrum and thigh, so we will be able to treat the whole body.”

What it means for our patients

Helen then reflected further on what Terri and she had already put into practice, as well as their aspirations for their Level 2 course;

“Since undertaking the Level 1 course, I would say that every patient that I have seen since May for breast oedema has benefited (bearing in mind I can see 4 – 5 patients a day just for breast oedema), so the impact in clinic has been huge for both the patients and myself, particularly in terms of:

  • reducing patients pain
  • reducing the amount of analgesia required
  • improving range of movement by releasing their scar tissue

This could be enabling them for the first time to do up a bra without help, wash their own hair and dry/straighten their hair – all very normal for us, but this has a profound effect upon patients.  This is demonstrated by patients informing me that they are feeling ‘back to normal’ or getting ‘back to normal’ for the first time since having surgery. They feel their quality of life has improved to the point where their confidence is growing and they feel able to take part in family activities with reduced pain.  By releasing scar tissue patients have found they are contributing more at work and at home, so this gives them a greater sense of purpose in life and self-worth.

For my clinic it has enabled me to move patients appointments further apart, which allows me to see more patients and gives me greater movement in my clinical diary for urgent referrals.”

What it means for our clinics

Helen explains what benefits further training could mean;

“Undertaking Level 2, which covers the relationship between the thorax/shoulder and the head/neck and masticatory system, abdomen, back, sacrum and thighs in relation to the pelvic function, would allow myself and Terri to treat the whole body.  This is particularly important as we are finding we are having increased referrals for head and neck cancers with significant scar tissue, and also gynaecological cancers.  These cancers have large operation sites with huge scars around the groin, effecting mobility to the point where sitting down is hard to do and significantly increases the risk of genital oedema.  All of this has a huge detrimental effect upon quality of life and general well-being.

By enabling us to both treat our patients with a combination of MLD (Manual lymphatic Drainage) and MFR (Myofascial Release) we can improve our patients outcome of treatments as mentioned above, but also by being trained to treat the whole body we would be offering the same service irrelevant of what cancer they had.  More importantly it shows other providers that as a hospice team we are we are broadening and expanding our skill set and knowledge and improving patients lives.

The Level 2 course could potentially enable us to expand our clinic even more by allowing myself and Terri to move away from ‘simple lymphoedema’ by training other staff to manage this (i.e. 6 monthly reviews and using the Intermittent Pneumatic Compression), which would allow us both to increase our caseloads without detriment to patient care and also we would be expanding our community reach.”

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