Today was my first visit to the Physiotherapist who specialises in Lymphoedema, as the doctor will now allow me to wear a compression stocking or to have bandaging done. The infection now seems to be gone, I finished my antibiotics today so I can now have Manual Lymph Drainage, MLD, as there is no more fear of spreading the infection. I can hardly believe that it is a month since my surgery, that I am now back on track at last, though I would say I am about two weeks slower getting to this stage than what had been expected. I was very anxious about my appointment today as I needed to feel I was moving forward, that I was able to make some kind of progress otherwise ones brain feeds on doubts!
My physio started the session by examining both my legs, the incision in my neck, and then the knee. Were there any problems with movement of my neck and shoulders? What was the range of movement for my knee? Where was fluid collecting? Neck and shoulders were moving fine, no problems and healing well. I can nearly bend the knee to 90 degrees, this is improving every day, it is also getting easier to get up and down the stairs each day. The major issue is the Lymphoedema and fluid retention in the leg, mainly around the knee and lower thigh but to some extent all over from the waist and down the left leg. This is due to the lack of movement for three weeks, infection and the surgery. I guess to be expected but hard to cope with……
Today we did a full set of measurements of both legs, the first since last year when being assessed for the surgery. The measurements now are not at their best but with a bit of work these will improve. The physio also did an L-dex measurement. This is done using a special machine that measures the fluid in the good and bad limb. This will give us an accurate guide re the reduction of the Lymphoedema in the left leg post surgery. To obtain the reading an electrode is placed in the top of each foot and on my right hand, these are connected and the readings taken, it takes a couple of seconds and you feel nothing… One of the easiest tests!!!
To explain this better here are some quotes below from the L-Dex web site plus link to this info…
“The lymphedema index (L-Dex) is a measurement system used to aid in the clinical assessment of unilateral lymphedema of the arm or leg (swelling occurring in only one limb.)
ImpediMed L-Dex devices are the first cleared medical devices using low frequency impedance. They have been developed to help your doctor or physio detect the onset of lymphedema before feelings of heaviness or visible swelling occur. The devices produce a lymphedema index (or L-Dex) value that can help determine if you are building up excess fluid in your at-risk limb. The test takes only minutes to perform. It is painless and gives an immediate result.
Why Have an L-Dex Measurement?
L-Dex measurements are a quick, non-invasive and sensitive method for aiding in the clinical assessment of lymphedema of the arm or leg
L-Dex measurements can help your healthcare professional accurately monitor lymphedema whether in the early (hidden) or late stages.
L-Dex measurements made each time you see your healthcare professional can help them:
–Better clinically assess the early stages of lymphedema.
–Show you how any treatment or management is working.
How Does it Work?
The electrical signal travels through the fluid surrounding the cells which make up the muscle and tissue of the arm or leg. The amount of this fluid increases as lymphedema develops. Increased fluid means the electrical signal will travel more easily through the arm. An L-Dex device compares how easily the electrical signal travels in the unaffected versus the affected (or at-risk) arms and generates an L-Dex value from this comparison.
What Does an L-Dex Value Mean?
The L-Dex value indicates the difference in the amount of fluid in the unaffected limb versus the affected limb.
L-Dex values are displayed against a normal “healthy” range.
L-Dex values greater than 10 or an increase of 10 L-Dex units may be indicative of lymphedema.
L-Dex values indicative of lymphedema should decrease as a result of therapy.”
My L-dex reading today was 7.5 for good leg and 34 for bad leg!!! Not sounding so good but this is a measurement we can work on and reduce. For those of you who have had lymph nodes removed due to surgery this is a reading you can have done to detect if Lymphoedema is occurring in the hidden stage. On a positive note because it is a build up of fluid rather than fibrous tissue this can be reduced by the use of MLD and the compression stocking and or complex bandaging if needed.
At the end of today’s session the physio and I decided we would try to put on my existing compression stocking. We checked the measurements for ankle, calf and thigh and they were all good. Problem was no measurement for knee, however when we put it on it went over the knee well and felt quite comfortable, not sure if this is because my knee is still quite numb or it really is comfortable! Today the physio suggested leaving it on for a few hours then removing it to check knee incision is ok. Tomorrow when I put the stocking on I am to put a padded dressing over the incision, to protect it against friction from the stocking when walking, although it is looking good the area is still sensitive and needs to be treated with care. I am using pure vitamin E oil on both scars and they are healing well. I am to see the physio again next Monday and I will have another MLD and check the progress. I hope this works as otherwise I will have to have the complex bandaging and I really feel I would like to get moving more than this allows. Over the weekend I will continue self massage and exercises to help the drainage, and will wish that Monday brings positive results that the leg is shrinking!
Today was also a big mile stone as I drove my car for the first time since surgery… Yeh… Freedom!!