I have secondary lymphoedema in both legs but a year ago my right leg got worse and although I have gone to class 2 compression tights it’s no better, in fact it seems to be getting worse. At my local lymphoedema clinic in November I was given a six week course on a Lymph Assist machine. They said it wouldn’t reduce volume but soften up the leg and this unfortunately was the case – softer but the same size.
I would like to reduce the volume of the leg and then use bandaging/ wraps to keep it less swollen. I’m sure I’ve read in the LSN magazine about people using compression pumps or something called Hivamat? Presumably this is different from Lymph Assist if they reduce the volume? I would be grateful for any information/ ideas. I realise any reduction won’t be permanent and that I might have to keep using a pump plus continue to wear compression tights.
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caroline111
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Hi Caroline, Pneumatic compression pump is a tool in the lymphoedema treatment arsenal, it’s not used instead of compression. A high quality pump attempts to simulate Manual Lymphatic Drainage (MLD) to move congested lymph out of the effected limb. However, without proper patient preparation for 5-10 minutes before every single pump session then using a pump can cause complications in the long term. The most common complication is Lymphoedema ‘spreading’. Preparation for a pump session includes lymphatic diaphragmatic breathing to stimulate drainage to the thoracic duct which is the main lymphatic drain back to the heart. Diaphragmatic breathing should be repeated after every pump session.
Many lymph therapists and nurses are not keen on pumps because they can lead to problems when a patient doesn’t utilise it properly, and in conjunction with all the other conservative treatment measures eg therapeutic compression, lymph friendly exercises/physio exercises, sensible eating and weight management (as excess weight adds huge stress on the lymphatics), meticulous skin care, etc.
Limb volume reduction won’t be achieved with a pump, only Complete Décongestive Therapy (CDT) eg bandaging, lymph drainage, and fresh measured compression garments will effectively reduce limb size. Sustaining reduced volume will only occur if daily self treatment is adhered to. Using a pump correctly can help with this
You refer to Hivamat which is a device that delivers Deep Oscillation Therapy (not a pump). The Hivamat DOT device is the larger unit used in clinic/hospital settings whilst the smaller DOT device for home and portable use is called the Personal. DOT is a completely different technology than a pump to undertake lymph drainage, and to address/prevent fibrosis.
Pumps are large/bulky while DOT Personal is a light and portable. Some NHS clinics have DOT Personal devices available on loan. Check with your clinic. DOT is German technology that has been used in Lymphoedema & Lipoedema treatment on the Continent for decades. PhysioPod UK brought DOT to the UK ten years ago. It’s widely used with very good results.
I’ve had a DOT Personal device for nearly 7 years, and a compression pump for 5 years. The Personal set me back 2k and the pump 5k Sterling. I got the market leading pump with the most clinical data behind it, including independent clinical research.
I have the luxury of having both modalities. Personally, if I had to choose only one modality I would forgo the pump and stick with DOT as I find it has benefits over the pump.
To find out more about DOT contact Julie and Mary at PhysioPod UK which is the official UK distributor of DOT. They are lovely and extreme knowledgeable about DOT for Lymphoedema. physiopod.co.uk
Only consider reputable pump brands such LymphaPress, Haddenham LymphFlow, etc (speak to your lymph clinic).
then you can access their fab special offer from Compression Therapy UK : free 14-day trial of Lympha Press with no obligation to purchase from 1-31 Jan 2022. Contact: naomi@compressiontherapyuk.com
LymphaPress is the international market leader in specialist compression pump for Lymphoedema. The free trial is a brilliant way to see how you get on with a LymphaPress at home.
Not all pumps are created equal. Don’t go cheap or you risk having irreversible complications. It’s always advisable to ensure the pump garment/trousers comes up to your waist, rather than the pump garment stopping at the top of the legs. LymphaPress does come up to the waist. Take care, Catherine x
As mentioned by CCT67 above I have the Physiopod DOT device which I bought about 2 years ago. I use it first thing most mornings for about 10 minutes to facilitate my SLD/exercise routine, just before I put my stocking on. I'm pleased I bought it.
I trialled a LymphAssist pump from Huntleigh at my lymphoedema clinic. I didn't buy one as I didn't think it had any effect on my swelling. When people claim significant reduction of swelling by using a pump I suspect it's because they don't have adequate compression garments.
I feel my custom made flat knit stocking plays the major role in controlling my swelling but getting the correct fit is critical and and can take a lot of trial and error to achieve, albeit worth the effort in the long run.
Hi Perido Thank you for your reply. I'm beginning to think I need even more compression but also I'm interested in hearing about your device. Do you feel the Physiopod reduced swelling?
Before I put my stocking on in the morning I perform a routine which takes about 25 minutes and includes a bit of strength training for my arms/legs/core, diaphragmatic breathing, cycling my legs in the air, rotating my feet in the air and SLD (10 minutes) using the Physiopod. At the end of this routine the swelling in my lower leg is slightly reduced (I check regularly by measuring) and softer. The Physiopod alone doesn't perform miracles in reducing swelling but for me its value is to enhance and facilitate the SLD part of the routine; I think the Physiopod is more effective than hands for SLD, albeit I use my hands to do the very first part of the SLD on my armpits, torso and abdomen then use the Physiopod on my leg. When I was doing all my SLD manually my hands and wrists would ache so I'm pleased to have the Physiopod to help prevent that happening.
It also depends what kind of person you are. Some might like to relax for the best part of an hour while a pump does it thing but I would rather be moving around doing my exercises/SLD along with the Physiopod. Also the Physiopod is versatile and I can use it to work on specific areas of swelling which I feel need more attention - at the moment that's my buttock.
One way of experiencing deep oscillation therapy (DOT) is via a MLDUK registered therapist - some use the Hivamat to deliver MLD massage. The website is mlduk.org.uk which unfortunately seems to have an error on it at the moment. If you call Physiopod I think they will be able to advise you how to find such a therapist.
The Physiopod sounds good and I'm inclined to go down that route. I'm also going to look at wraps. I've had lymphoedema for 10 years and I suppose I've been lucky that until recently it has been very stable. I'm now getting my head around all the various devices, possible treatments etc and feel almost as if it's a new problem for me. Thank you for your advice and info.
I have a wrap for my lower leg - after wearing it for a day I get a reduction in the size of my ankle and calf beyond what I can achieve with exercise and SLD. The effect lasts for a day or two albeit I don't take a break from my usual routine which includes wearing compression.
I’ve been using the PhysioPod for over a year and definitely recommend it. Importantly, rather than using the standard settings you can get a program that is designed specifically for you and is set to different frequencies. I use mine for 20 mins each day at bedtime after some SLD but you need to be aware that the machine doesn’t work well if you are hot. In these cases I revert back to my trusted paint roller and boar hair brush to carry out SLD, that’s normally after I have showered.
With regards to the compression pump, I have just finished the trial of the Lympha Press from Compression Therapy UK. I was impressed with the high standard of the equipment but didn’t see any significant results, mainly because my Lymphoedema is at an early stage. The main dilemma for me was the cost versus benefit at this moment in time which is difficult to evaluate within a 2 week trial period. That said, you have nothing to lose by taking up the Compression Therapy UK trail offer and Naomi is very helpful and understanding.
Haddenhams also offer a trial for their Lymph Assist pump so it might be good to contact them to discuss.
I have to admit my SLD has not been perfect which is crucial to effective treatment with the PhysioPod and Compression Pumps. It’s something I’m improving on but unless you clear the lymphatic ducts before use then the outcomes from either piece of equipment could be counterintuitive.
I think the Physiopod doesn't work so well when it's hot because skin can get a bit sweaty - I think a bit of talc (or cornflour) can resolve the problem.
In terms of improving SLD one thing I recently learnt was about breathing. I was taught to do 5 deep breaths at the beginning and end of a SLD session. Recently I've heard it's important to ensure to get good movement in the diaphragm (diaphragmatic breathing) and that a strong exhalation is especially important.
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