Compression Therapy
Knowledge that Lymphoedema and its' related diseases are treatable is not widely prevalent in India. This is true not only amongst the patients but also among the medical community. A related issue is that most care needs to be delivered by specially trained therapists. However, no such training program is currently available in India. Untreated, the disease has an unrelenting course and leads to complications such as:
Deformity and cosmetic disfigurement
Infection with recurrent attacks of fever
Pain
Possibility of recurrence of cancer or a totally different cancer like Stewart Treves syndrome
Social interaction may be impeded due to odour and drainage seen in some cases. Maggots may supervene
Loss of self-esteem, and possible depression which are difficult to quantify, but are certainly real.
Role of Compression
It is well-established that compression therapy is the cornerstone for treatment of Lymphoedema patients. Compression therapy on the affected limb can reduce the diameter of the blood vessel and pressure and reduces the backflow of blood. Compression can be applied using a number of techniques such as compression bandages, compression garments, compression pumps, Manual Lymphatic Drainage etc. The correct combination of these techniques, which varies on a case-to-case basis, can result in dramatic improvement in limb girth.
Compression therapy is typically applied in two phases: the reduction phase and the maintenance phase.
The reduction phase is the initial phase of treatment. In this phase, the patient is treated aggressively with compression therapy. Compliant patients can see dramatic improvement in their limb size in this phase. This phase can last from anywhere between 5 days to several months.
In the maintenance phase, the patient's limb size is 'maintained' via compression techniques. This phase involves self-management of the condition by the patient. This phase lasts for the rest of the patients life. Compliance in this phase results in a normal, healthy lifestyle with a manageable condition.
Role of Antibiotics During Treatment
Infection in the affected limb can give rise to increasing discomfort, deformity and morbidity. It has been obsrved that this infection can be controlled to a large extent with the use of antibiotics. Use of antibiotics before beginning treatment is highly recommended. Long-term penicillin is the preferred choice.
What We Can Do
We believe that patient education is central in the treatment of lymphoedema. Patients suffering from these conditions require regular examination, counselling, bandaging, compression therapy and pressure garments as well as exercise to help control exacerbation and prevention of complications. The treatment is simple and easily possible, provided some insight as well as technical guidance is available. Being a chronic disorder, there is also a need for constant follow up, absence of which leads to a vicious cycle of infection and increase in deformity. An integrated lymphoedema service ultimately aims to identify patients with swelling early so that treatment is timely and effective and enables patients to remain active and to self-manage their condition. Devices like Intermittent Pneumatic Compression machines as well as special dressing techniques help but have to be performed by trained persons to ensure maximum benefit without complications.
Despite having such a high lymphoedema patient load, India hardly has centres providing a comprehensive lymphoedema service. We believe that there are enough patients to start more clinics in corporate hospitals which will be important not only for management but also early and preventive care for patients who have been treated for cancer, trauma besides a host of other conditions notably leg ulcers.
The treatment for a patient is decided based on a number of factors including the diagnosed indication, the stage of the disease, the shape and size of the limb, etc. Since there is no cure for Lymphoedema, patients have to manage their condition lifelong. We provide a number of treatment solutions to allow the patients to self-manage their condition after the initial reduction.