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Can fibrotic skin be broken down and reduced?

Hi,

I have what's coming up to stg 2 lymphedema, with the hard (fibrotic) skin. I am working on getting compression stockings and then doing MLD.

However, one thing which is not clear: Can compression stockings and MLD (with the hivamat 200, as a therapist near my work provides this) break down the hard tissue? Also, are high strength compression stockings sufficient for a stg 2 LE? As therapists recommend bandages (which I wore after an op for vein ablation), but could barely walk in this! And with bandages, you need to walk around like normal e.g. go work etc, which I would not manage! Also, therapists recommend foam pads etc.

I did have one MLD out of curiousity (no hivamat) and found it amazing. My my trousers felt looser and my shoe slipped right on (slight foot swelling, but after the op I mentioned, not LE).

Thanks

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Hi Girdip

I’m not surprised to hear your positive experience of MLD, it’s so effective, even more so with the Hivamat. The Hivamat helps to break down fibrosis as it provides electrostatic Deep Oscillation that works through skin, connective tissue, subcutaneous fat, muscles, blood and lymph vessels to a depth of 8cm. You can read more here: physiopod.co.uk/clinical-ef...

I have my own Hivamat (the portable Personal version) and my MLD therapist issues the Hivamat. The fibrosiis was very thick/hard in my legs before using the Hivamat and I therefore had no sensation in the acute fibrotic areas. After several Hivamat treatments the tissue had softened and I started to regain sensation. Deep Oscillation is also a good preventative in the formation of fibrosis. The Foeldi Klinic in Germany (the only Lymphoedema hospital in the world) has used the Hivamat in LE treatment for many years. It’s also used at Wittlinger LE Klinic in Austria. Deep Oscillation was developed in Germany in the 70’s and is used by many Foeldi and Vodder trained MLD therapists in the UK.

Compression garments do not break down fibrosis, that is not their function. Compression garments and bandaging for Lymphoedema is different than what you had after your vein ablation (if what you had is anything like what they put on my legs after a similar op). If you have stage 2 LE I would presume you have been or will be fitted with made-to-measure flat-knit garments that are specific for Lymphoedema management. They are very different to circular-knit hosiery which is used for venus difficulties. Sometimes in early stage LE the circular-knit over the counter garment will provide sufficient compression but not for more advanced LE. The Class of compression determines the strength of the garment, and an experienced MLD therapist accustomed to fitting flat-knit garments will advise on the class of compression you need. Are you under a local Lymphoedema Clinic? Compression advice and fitting is usually the main service provided at LE clinics. Ask your GP to refer you if not already. This is a useful garment explanation:

mylymph.com/2017/08/02/flat...

It sounds like you may have been advised to have Complete Decongestive Therapy/CDT which includes a course of bandaging, using short-stretch bandages specific to Lymphoedema CDT. Engaging in CDT will reduce limb volume, wearing garments afterward to maintain the reduction. Another option if you don’t want to do CDT is to explore compression wraps with your therapist/LE specialist nurse. The Haddenham Easy Wrap is low profile and can be worn under clothing more easily than some of the other wrapping systems.

In addition to MLD its also important to engage in drainage promotmg exercise (swimming is superb as water provides natural compression), and to undertake 2-3 times daily Simple Lymphatic Drainage/SLD on yourself. You may find this link useful, it’s probably the best SLD instruction on the web as the therapist explains the ‘why’ not only the ‘how’

youtube.com/playlist?list=P...

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Thank you very much for a helpful post. I see my practise nurse at GP to get stitches out for the vein ablation,and she, or the pharmacy lady, can measure me up. I am seeing the london lymphedema clinic on Wednesday to get measured up, advice, assessed, etc. I am self-funding this as this is a big priority for me and I have lost time due to wrongful diagnosis and GPs who are not very good at dealing with LE!

I don't mind wearing stockings and I understand they can get take some getting used to, both in terms of wearing and putting on, but one specific question I have: If I get a full leg length stocking (my LE is knee to ankle) with a moderate to high compression, would this make bending my knee difficult?

I also saw Prof Mortimer who was/is great and diagnosed LE, but I am taking initiative to get some active management happening!

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Where are you GurdipS111 ?

Yes, a combination of MLD and treatment with DOT (deep oscillation therapy using Hivamat) will reduce fibrosis - it may take several treatments if the fibrosis is long term/chronic.

Compression stockings after a period of compression bandaging is standard Decongestive Lymphatic Therapy. Compression bandaging is different to post-vein ablation bandaging. Persevere - it’s worth it!

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Hi,

I am in London. I am seeing the lymphedema clinic this week to discuss everything mentioned in here, get measured up, other advice such as SLD and exercise, and then order stockings on advice.

I don't mind wearing stockings and my (secondary) LE is below my knee to ankle. One worry is if I had full length stockings, will the compression make it difficult to bend my knee? When I got bandaged after my vein ablation, the bandage was so thick and tight I could barely bend my knee! I must be able to have the same of range of movement.

Also should add that in the mornings the majority of swelling and hard skin has gone so while I am a bit late at treating this (Rubbish doctors!), I am happy that I can make a difference!

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Don’t compare post-ablation with lymphoedema management - completely different, as you will find out at the clinic. Lymphoedema compression garments are made to measure, so that they move with you to aid drainage and give containment.

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Thanks. One question I have, with this treatment of stockings and MLD with hivamat, what are realistic expectations? All of the swelling to go? I know this is not a cure as it does not cure the underlying problem (the blockage) thus I need to keep wearing a stocking to prevent swelling again (but maybe a smaller one if the leg gets smaller).

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You will always have lymphoedema, but the lymphoedema clinic will teach you how to manage it. Compression will maintain it. MLD/Hivamat/skin care/exercise will soften and often reduce it. If it has been caused by the vein ablation, the compression may, over time, be reduced as your limb recovers.

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Well I had leg LE prior to surgery, but swelling of my foot after a phlebectomy in the same op. Not sure if that is LE or a regular edema?

When you say always have lymphoedema, do you mean the condition being chronic or always some swelling even at the best of times?

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Long term/chronic - but with good care, manageable!

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Indeed! I don't have measurements of my calfs, but visibly, the right is larger. No pain or loss of range, but I read on another thread that above a certain size, compression garments won't achieve limb reduction but maintain the current volume? Is this true? And if so, the only thing that can help with reduction is MLD and/or Hivamat or surgery (which I am not looking at, and has its own risks).

Sorry, I'm a bit anxious.

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Don’t get anxious - stop reading (😉) - take all your questions (write them down if necessary) and discuss them with the lymphoedema specialists at the clinic.

Now take a slow deep breath and greet the week with a smile.

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Ha when I say anxious, I mean eager. I have no pain or loss of mobility so I want to nip this in the bud (although LE can't really be nipped in the bud) asap! Also, stockings are like an insurance policy so they will be provide immense peace of mind. Yes lots to ask and talk about!

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Hi Gurdip ,

I have never heard of the Hivamat can you please tell me the cost of it and we’re I can buy one .

Many Thanks

Barb

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You can find more information about Hivamat here- physiopod.co.uk

They are not cheap, and if you are not a therapist, you will need to be taught how to use one by a therapist.

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Thank you Lenora

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Get in touch with Mary/Julie via the email address posted by Lynora. They are the lovely owners of PhysioPod UK, the only UK distributers of deep oscillation therapy.

The personal size/portable version that I have now costs about £2500. It’s gone up in price substantially over past 3 years and will continue to. The Hivamat is closer to £10k and is a clinic/hospital size. Some Lymphies are buying the smaller personal model by way of getting a no interest credit card or low interest bank loan.

There are some videos that Julie and Mary can provide that show how to use it on yourself. And some LE clinics are familiar, as are some private MLD therapists.

Great to hear you’ll be at St George’s LE clinic for proper garment fitting/advice as pharmacists do not know about LE garments (sadly rather useless in that regard).

To answer your question re knee bending - a thigh garment will allow some bending of the knee. Circular knit are more stretchy while flat-knit less so but much more effective for more advanced LE. One option is getting one knee and one thigh garment to wear when knee bending isn’t essential.

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Can't thigh length stockings have a whole for the knee cap? I guess that may compromise the compression of the entire stocking/

I will be going to the London Lymphedema Clinic which is independent.https://www.thelymphoedemacliniclondon.co.uk

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No, compression garments do not have holes - as I explained above, you will be measured and fitted with a garment that will give you full use of your limb.

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Ok thanks, will see what happens.

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You can ask for a knee functional zone JOBST... Goodluck 👍🏽

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Fantastic responses and advice I can add that Kinesiology is also brilliant on fibrotic tissues applied correctly.. Good luck and don’t be anxious. Like Lynora said take a deep breath and don’t read too much. Every person is different and unique and respond differently with various treatments. Take notes and ask your therapist to write everything down for you as it might be too much to take on at one go... Deep breathing helps stimulate your Lymphatics so is singing and my favourite Laughter Yoga....! 😂🤣

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