TENS unit to help move lymphedema?
Has anyone used a TENS unit to help move fluid away from lymphedema areas? Mild stimulation?
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I've never heard anything about using one for that. Will be looking forward to what anyone knows. Have an eye appt tomorrow so will stop in and see if I can talk to my LE guy about the idea. I'm thinking it wouldn't do anything as the problem is the lymph nodes that are no longer there.
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Hi,Kicks!
Thanks for responding so quickly! My thoughts are, that the mild stimulation would be almost like a brushing massage, therefore helping movement of fluid.
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Hello, SN, and welcome to bc.org
!Have you tried TENS for your lymphedema? If so, what was your experience?
The massage needed to move lymph fluid (Manual Lymph Drainage, or MLD) is very different from simple nerve (or even muscle) stimulation. The lymph vessels lie close to the skin, between the skin and the muscles, so gentle massage strokes are enough to activate them. The activation is specific to the way lymph moves through the lymph vessels. The vessels are not simple tubes like a blood vessel or a garden hose (which is how I usually picture them), but are made up entirely of tiny sections called lymphangions that have valves at both ends to allow lymph to move forward and keep it from back-flowing. The theory behind MLD is that it gently stretches these teensy lymphangions, which causes the fluid to move forward. So MLD is both gentle and directional -- unlike TENS stimulation. MLD must place this gentle, directional pressure on the lymph vessels themselves, not just in their general vicinity, in order to create flow.
I just reread that and it sounds like I made it up, but I didn't, honest!
Who knew the nearly invisible lymph system was this complicated?! Getting lymphedema was the hard way to find all this stuff out, for sure, but it is pretty fascinating, yes?
Be well,
Binney0 -
Binney, That's a wonderful, crystal clear description of how the lymph moves. Thanks so much for being so descriptive! But now that you've explained the one-way flow via the lymphangions with valves at both ends to prevent backflow, I simply have to ask a follow up question, something I've been wondering about lately.
My understanding of the lymphatic system is that the vessels move lymph upward from the upper half of the trunk, toward that huge lymph-vessel convergence point near the clavicle. Yet we can use MLD to move lymph from say, the trunk area just under the armpit, nudging it downward toward the inquinals. How can that work if the lymphangions only permit the lymph to flow south-to-north? Apparently I've misunderstood something. Can you clarify or correct my thinking?
This question came to me after I watched all of Joanne Rovig's wonderful explanatory videos posted on the Northwestern Lymphedema website. She clearly shows using MLD to nudge lymph downward from under the axilla, but I think she also shows that the body moves lymph upward within a quadrant. Do you see why I am confused?
Carol
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Thanks! As soon as I saw this post about video on lymphedema I was on the website in less than a minute. I have had so many conflicting instructions from therapist that I didn't know which way to go. Gotta go watch this video! Thanks again.
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Good question, Carol, and to dove-tail, how do we select our 'flow pattern" to encourage drainage? Do we know how to locate those lymphangions? Going to watch the videos also-
Chris in NM
Diagnosis 1: 4-2008, IDC, left, 1.5cm, Stage 1, grade 2, 0/1 nodes, ER+/Pr+, HER2-; lumpectomy, SNB, 26 rads, tamoxifen
Diagnosis 2: 12-2011, IDC, right, <1cm, stage 1, grade 2, 0/1nodes,ER+/PR+, HER2-; BMX, complete hysterectomy, anastrozole, LE in both arms
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Chippewa, the Rovig videos are highly credible, unlike some pop-culture vidoes you can find on youtube about lymphatic massage. But MLD is individual to our needs, so a good therapist will tailor the method to our own LE issues and available pathways. For example, I have a bodacious abdominal scar that runs about 70% around my lower trunk from my diep reconstruction. That limits what I can do to nudge fluid to the inquinals, because it doesn't move well under scars. So watch the Rovig videos knowing that there's not really a one-size-fits-all approach. There's a full length Rovig video available from the NLN store (lympnet.org), about $60 if you're not a member. I've heard good things about it, if you want to see a complete demonstration of MLD. But again...your own needs may call for a variation.
But no kidding, it's frustrating when you get conflicting instructions. My therapist actually gave me instructions, including printed drawings, showing movement of fluid up when she really wanted me to move it down. She didn't realize that error until weeks later, after I had been following the instructions to the letter. I asked about it, after being confused about direction choices, otherwise the wrong instructions would not have been discovered.
Carol
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Carol, I think I understand your question, and I believe the confusion comes from our assumption that all the fluid being moved is in the lymph vessels. But in fact it's in the tissues (which is the source of the swelling), and we're trying to move it to areas where it can be taken up more readily by lymphatics that are not compromised, then moved to the nodes and eventually back into circulation. (And at the same time MLD is stimulating those little angions to keep things moving so the whole system can handle more when it's picked up).
My mental picture always get in the way of grasping all this and I keep trying to revise it so it's more accurate. What I imagine is hose-like tubes running in neat parallel lines from point A (fingertips, say) to point B (the axilla), but it's nowhere near as neat as that. The tissue in each quadrant is a watershed, but fluid in the tissues can be induced (with MLD) to cross the line into an adjacent watershed area, where it can be taken up. The reason my therapist gives me for moving fluid DOWN my trunk is that my scars are going to block it from going UP. Above the scars I do, in fact, move the fluid north (so to speak!)
Hmmm. So much for crystal-clear.
Sorry!
Binney0 -
Binney, OK, so-- the fluid moves through body tissue, much as water runs through a sponge? If one end of the sponge is blocked, I can run my hand over the top of the sponge, applying gentle pressure, moving the fluid to the other end of the sponge to find open and available lymph vessels that will take the fluid I away from the sponge.
I thought with MLD we were moving lymph already inside the superficial lymphatic vessels, but no--we are moving the interstitial (between cells) fluid before it even gains entry to the lymphatic vessels? Honestly, I thought all the body's fluids were in pipelines. Not to sound stupid, but what's 'containing' the interstitial fluid? Does my sponge analogy in any way resemble what's holding the lymph before it moves into the vessels?
Sigh...can you tell I majored in French and not science???
Carol
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Carol, MLD moves fluid through the tissues AND stimulates the lymph vessels to contract and move fluid and pick up more too. At least that's what they theorize. And yes, the sponge is a good image. Lymph goes into the tissues on purpose to gather garbage and then retreats back into the lymph vessels where it transports the garbage to the nodes. If it can't get back in, we swell. It can't get back in because the lymph vessels have been overwhelmed because of the trauma back at Node Central.
But even that is not the whole picture, because even the lymph vessels can swell when things get far enough along, and then the little valves on the angions won't close completely and we get backflow and very sluggish flow that it harder to move even with MLD and compression garments (since it's essentially a valve malfunction, not just a pumping or take-up malfunction--did that make sense?!) Hopefully none of us get to that point, because we're all going to take really good care of ourselves and work at keeping the fluid moving and the swelling down.
Frankly, all of this makes me very angry that our doctors don't take this condition seriously. Our lymph system is pervasive and crucial, and--darn it!--ours is broken. And they're trying to tell us it's all in our heads, or we don't need to take precautions, or there's no real treatment for it. There was a recent article published by researchers that was titled something like "By gum! The Lymph System IS Important After All! How 'Bout That!" (I'm being sarcastic, but you get the idea. I'll go see if I can find it and post it here). I almost cried when I saw it. WELL, YEAH, YOU DUMMIES! D'YA THINK?!
Okay, end of rant. Better get down off this soapbox before the altitude makes my arms swell.
Binney0 -
Here's the article I was talking about. Didn't get the title quite right, did I?
(emphasis mine):The new era of the lymphatic system: no longer secondary to the blood vascular system.
Choi I, Lee S, Hong YK.
Source:
Department of Surgery, Department of Biochemistry and Molecular Biology, Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California 90033.
Abstract:
The blood and lymphatic systems are the two major circulatory systems in our body. Although the blood system has been studied extensively, the lymphatic system has received much less scientific and medical attention because of its elusive morphology and mysterious pathophysiology. However, a series of landmark discoveries made in the past decade has begun to change the previous misconception of the lymphatic system to be secondary to the more essential blood vascular system. In this article, we review the current understanding of the development and pathology of the lymphatic system. We hope to convince readers that the lymphatic system is no less essential than the blood circulatory system for human health and well-being.
http://www.ncbi.nlm.nih.gov/pubmed/22474611
Well, duh!
Binney0 -
Thank you, Binney. You should send the authors a note suggesting an appropriate subtitle!
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Binney - love the links to the article... and your ending on your last post!
As for TENS - here is my professional opinion... LOL... one thing about doing electrical stim on an arm that has had an axillary dissection is that chances are there is some decreased sensation as well. TENS is generally utilized for pain, although if you turn it up high enough, you can get a muscle contraction. The issue with a TENS unit is that in an area where there is decreased sensation as well as decreased fluid movement is that the patient may be at risk of getting an electrical burn. Someone with intact sensation would most likely feel the unit long before it could be turned high enough to inflict a burn, but not so much when the sensation is not intact - which could be directly from the surgery itself (I personally have diminished sensation down the back of my arm since my axillary dissection) OR it can be from the lymphedema itself, depending on how severe it is. If it were my patient, I would not use TENS... or any E-stim on the affected limb... nor would I use ultrasound... MLD, wrapping, lymphedema specific clearing exercises and even kinesio taping are your best choices here. If you are looking for a device to utilize at home, maybe look into the flexitouch. Just my 2 cents here... LOL... Binney, you let me know if I encouraged anything that I shouldn't have!
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Thanks, Nordy.
Absolutely clear about the treatments of choice. Perfect! The Flexitouch is useful as a replacement for self-MLD (as long as you clear your nodes yourself first) for anyone who can't do it themselves (like me because I'm bilateral and wear out before I can do a thorough job of it). Heat is contra-indicated for LE anyway, since it draws lymph to the area, but the thought of burning somebody with it is kinda ghastly.
Thanks for that!Be well,
Binney0 -
Joe Zuther just posted this on his blog: The Science Behind Manual Lymph Drainage. Interesting, yes?!
Binney
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Yes i am currently having this treatment for breast lymphedema and it is working !! .
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