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Pinned General Discussion

I Am A Lymphoedema Therapist In Singapore, AMA!

Posted by

Veronica Yap profile picture
Veronica Yap
VIP 36 days & 1h ago


Hello DxD community! I’m Veronica Yap. I’ll be replying to all your comments on Wednesday, 19th December.

Proof:

 Lymphedema Therapist Singapore

Background: I've been a medical healthcare specialist for almost 20 years, and I am now certified in a number of notable areas associated with Lymphatic Disorders. 

We all have a lymphatic system in our bodies. It’s a network of tissues and organs that help rid the body of toxins, waste, and other unwanted materials. This is how our body keep the our fluids in balance and defending us against diseases.

For people with lymphatic disorders, this system becomes blocked and stops functioning normally. When that happens, fluid builds up in your tissue spaces between your muscles and skin. The result of this is chronic swelling. This condition is called Lymphoedema.

If you leave it untreated, it can lead to other complications! While there are no complete cures available in standard medical practice, my team and I have developed a range of integrated therapies that consistently and effectively relieves our patients symptoms.

Through this AMA, I hope to raise more awareness on lymphoedema because early detection and management yields the best outcomes.

Leave a comment below asking me  anything you want to learn about  lymphoedema, e.g. :

  • What causes lymphoedema
  • Who is most at risk
  • Symptoms of lymphoedema
  • Lymphoedema treatment options
  • How does massage help
  • Are there activities that someone with lymphoedema should avoid
  • Tips and tricks for lymphoedema patients 
  • How to choose the best compression garments for yourself
#Singapore Healthcare #Cancer
Comments (62)
Jeeyan Cheng profile picture
Jeeyan Cheng
VIP 36 days & 1h ago

Hi all, I'm Jeeyan, one of DxD's content editor. I'll be moderating this AMA. Veronica will be coming on live on Wednesday, 19 December, from 5:00-6:30 PM to answer all your questions. Feel free to start leaving your questions and comments for her below. 

Hello Veronica, thanks for doing this AMA session! Really appreciate it :) 

My questions for you are: 

1. How common is lymphoedema in Singapore? Do you have any statistics? What's the most common demographic category you see at your practice? 

2.Why do you think there so little healthcare professionals specialised in the management of lymphatic disorders in Singapore? (or is this a worldwide problem) 

3. Is lymphoedema a preventable condition? 

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 22h ago

Hi Jeeyan,

Thank you for having me on your AMA session. It's a great privilege.  I hope this session will be useful to all concerned about this topic. To answer your questions:

1) We do not have any official statistics here, some suggestions from Singapore breast surgeons guess it to be about 30% but they don't track the patients further, because I found some who developed lymphedema up to 20 years post treatment.  At the British Lymphology Society they have suggested 20% among breast patients and Australia Breast Cancer Foundation suggested it is at 30%.  They used to only pick up the incidences first 3 years from their post treatment, but soon found that patients can develop lymphedema at anytime of their lifetime post treatment now.  However numbers this doesn't cover other lymphedema development from gynae, prostate, lymphoma, sacroma, melanoma or thryoid cancer etc... It would be great to have a census of some sort to find out our rate of post cancer lymphedema issues by the singapore cancer society, because they have the most diverse groups of patients, just to use their members as a sample. 

The most common referral I get is from breast cancer, however their lymphedema stage is usually not as far in development as the ones from pelvic cancer.  However, I think it is still important that the breast patient gets this level of support from their practitioners which is encouraging, in referring them this early. Therefore more than 50% of my post cancer lymphedema cases are breast patients, either with chest back or arm swelling. The more complex lymphedema cases are usually lower body cases from pelvic patients. Latest research papers hows that the risk for lower body cases are much higher than the upper body cases, so I do hope these patients gets referred for some form of prevention awareness program soon after their treatment.

2) Its a worldwide shortage problem with very little professionals in lymphedema specialization, perhaps due to the nature of the work, which means the patient is always on an ongoing treatment of some sort and not possible to fully discharge them, or perhaps it is due to the lack of awareness about lymphedema being part of mainstream treatment, or poor recognition from the hospital management, but it is not a compulsory study subject for onco physios or OT, it's an elective specialization.

There is no universal standard of practice.  Politics between schools makes it hard to decide for the therapists on where to study. The schools that teach this subject charges a lot of money and competition between schools makes the passing criteria very stringent and tough for the students with constant bi-annual reviews, while it could be a good thing to have tough standards, but it could be discouraging to the students, at the same time, the Singapore therapist who this subject typically doesn't have any form of education support from their hospitals or employers with finances or time.  They have to dig out of their personal income and consume their annual leave for the classes, I tried my best to seek sponsorship and funds for these classes but its still a large amount of their salary, and yet they will not have any recognition for the certificates they attain from this training unfortunately. So the ones who go for the training are truly passionate about this subject to have sacrificed so much. I want to take this moment to encourage them for their efforts to improve themselves despite the challenging environment. It would be great to have a Singapore association body to set up the standards of lymphedema prevention in post care and recognize the studies of these therapists.

3) Yes established lymphedema is highly preventable and treatable at the baby stage of swelling which can occur anytime from post surgery, the therapist can coach the patient into self management, which can do a lot for the patients post quality of life.  After it has past the latent stage (stage 1) and moved into stage 2 (where it is visible difference lymphatic failure) there is no other way out except through a life time of constant management. You can keep the patient in the 'invisible' mode for a good many years of their life if they learn to self manage and understand their trigger risk well.

Anonymous
34 days & 20h ago
Is it safe for me to go to the gym if I suffer from lymphoedema?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 18h ago

In the old books, they have always recommended patient not to lift heavy weight or do strenous exercise, but it was found that non exercise patients have more lymphatic problems. Yes you can exercise in the gym and I encourage all my patients to be active, but you need to make sure your muscles are well conditioned.  Work with a personal trainer, I taught my trainer about my lymphatic condition by giving him materials concerning my situation and told him my triggers and limitations. He designed something effective for me to build muscle and core strength.

You can start with light exercises and move on to heavier exercises.  Under my care in my clinic, I have several marathon runners, who has lymphedema but still maintain their lifestyle, you will need to have a good discipline and control strategy because you will have workout stress induced swelling, most of these swellings are easily manageable with cold therapy, self treatment and compression garments. Let me know if you need further information, but definitely find a lymphedema therapist who can help you design a self care routine with your post workout and a personal trainer to work with.

Anonymous
35 days & 16h ago

Is Lymphedema debilitating?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 21h ago
Thank you for the question, it can be debilitating at the later stage when it is harden and heavy and tends to get repeated infections, you will constantly feel flu like symptoms and fatigue.  Mobility and sensation is affected when it is developed into stage 3 and 4.
Anonymous
35 days & 16h ago
How can massages help with lymphoedema?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 21h ago
The right massage can be very useful for lymphedema. The type of massage cannot be turning the skin red or bruise them.  It helps to break down the proteins and fibrosis.  Remember than lymphedema is a skin deep problem and not muscle deep, pressing hard and increasing circulation is only helpful for vein issues and not lymph issue.  It would be useful to identify the swelling nature whether it is venous or lymphatics to begin with the right direction.
Anonymous
35 days & 16h ago
Can lymphoedema kill you?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 21h ago
No death was linked directly to lymphedema so far. Although it can create opportunities for multiple infections called cellulitis (not to be confused with lumpy fat deposit).
DangDang
34 days & 22h ago

How much does lymphoedema therapy cost? How many sessions on average do people usually need?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 21h ago

Thank you for your question, there is no real standard charge in Singapore, the prices ranges from the heavily ubsidized services at public hospital to private hospitals and clinics, I can only say the average is about $120-200 per session for private therapist, without material cost.  It is hard to estimate the session until we see the patients and it also depends on home care compliance. Textbooks standards recommends10 sessions of intensive meaning several times a week for 2 weeks until reduction and home care standards are achieved and then patient gets into a home program with supervision by the professional at less intervals, but like I said again, this is just a blind suggestion and it could well be fewer or more, the patient needs to be assessed professionally and the treatment plan will be mapped out by your therapist according to their presentation and stage of swelling, because there are 4 stages of it. Needless to say, the higher your staging the more intensive will your sessions be and the fewer compression options will be left. So please see your therapist sooner than later.

yina soh
34 days & 22h ago

how do i find out if i am at risk of lymphoedema?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 21h ago

Hi Yina,

Your therapist can do the risk assessment for you, and if you have very little lymph nodes affected your risk is very very low. Let me know if you need further help.

Natnuro
34 days & 22h ago

my aunt has lymphoedema, does that mean that i have it too? what about my mother as my aunt is her sister. i am 30 and my mom is 60. but we don't seem to exhibit any usual signs?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 21h ago
Thank you for your question, it all really depends on the nature of why your aunt developed lymphoedema.  Is it genetic or caused by some form of trauma? If it is genetic, you may have some risk but not show it until some form of trauma or stress in your body push it to the surface.  Trauma such as accidents and injury or surgery to the lymph nodes can cause secondary lymphoedema to express itself. I have genetic lymphedema issues but non of my family members have it so far, and I do hope it stays this way, but I do make sure everyone knows the signs and risk to ensure their good health. Many of my primary lymphedema patients like myself is an isolated incidence. So genetically inherited lymphedema doesn't always affect everyone in the family like the books suggests. Please let me know if you need any assistance or referral.
Darlene Qiao
34 days & 22h ago

where can i go to find treatment for lymphoedema? is it just therapy? do hospital have a department for this condition?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 21h ago
Hi Darlene, you can find a therapist at the hospitals in the rehabilitation units normally, in most general hospitals now, we have someone in their unit, the biggest teams are at SGH and KKH.  The therapist will collect your measurements and baseline, do both correction therapy and fitting you for a proper and appropriate compression garment when the limb or area is decongested, They will also do home care coaching, where they will teach you risk management self management and monitoring. Please let me know if you have any trouble and I can make a referral for you to the right therapist in the hospital you are visiting.
Wei Sheng
34 days & 22h ago

Are all places that provide lymphoedema therapy private clinics? my uncle has lymphoedema and he has commented that it's a very expensive condition to manage.. Do you happen to know if there are any sort of healthcare subsidies a patient can tap on? 

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 21h ago

Hi Wei Sheng,

Yes it is unfortunately true that lymphoedema is an expensive problem, it needs constant care and management with compression garments and bandaging as well as proper supervision. Learning how to do home care is very useful to help the family with cost savings, some of the helpers I coached does such an excellent job managing their patients at home, I only see them for data collection, garment fitting and monitoring their texture and infection risk.  Some of my patients achieve such excellent self management I can see them once in 3 months. Compliance and acceptance of the issue is always a challenge.

There are hospitals that offer lymphoedema treatment, the patient can get the same class of subsidy they have for their treatment at the hospitals. The patient can get their oncologist to refer them to the rehabilitation department for help.  The lymphedema therapist are usually found in the Oncology Physio/Occupation Therapist areas.  Please let me know if you have any issues, I can help you with getting connected.

Anonymous
34 days & 20h ago

Is it safe to travel overseas through plane when I have lymphoedema?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 18h ago
Yes you can travel overseas safely.  You need to make sure you have good effective compression garments made and fitted prior to your flight or prolong bus journey. Otherwise you can do self bandaging before flight and remove your garment and bandages only when you have arrived at your hotel/home. Flight pressure and prolong stagnant position causes swelling to get worse, so you should walk around a bit and stretch as often as you can.  Schedule for yourself to have time to rest for a day and to manage your post flight swelling with your self treatment and garments or bandages.  I do not recommend a hectic and rushed schedule because it doesn't help your lymphatic if your body is stressed and hurried.
Meow
34 days & 20h ago

Can the swollen areas caused by lymphoedema be cut out?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 18h ago

Hi Meow,

Typically that is not recommeded, because lymphoedema is sensitive to infection and healing is very slow and tedious, the patient having undergone surgery for the lymphatic area has to be aware that healing will be 3 times slower than others because their immunity response on the affected area is different. In the past we used to have debulking surgery done but it has to be done and only available to the entire lower limb of the patient only and not on any smaller area or parts of the body.  Surgery to a small area will increase lymphatic failure to spread to a bigger zone due to increase in swelling from post surgery inflammation. The post surgery scar will add on to transport obstruction stress of an already compromised system.

Anonymous
34 days & 22h ago

how does lymphoedema occur? is it genetics? 

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 18h ago
Lymphedema has two main types of trigger.  One is called primary lymphedema which has a genetic inheritance, the other is called secondary lymphedema which is caused by accident, injury, surgery or diseases to the lymphatic system.
Sriiiii
34 days & 22h ago

does lymphoedema only happen to people who have cancer? i read that people who went for cancer treatment have a high chance of getting it

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 18h ago

Hi Sriiii,

No it doesn't occur only to post cancer patients but yes people who had cancer surgery have a higher chance of developing lymphoedema depending on the extent of the surgery.  Therefore post surgery lymphoedema awareness and risk management is essential to preventing lymphoedema from developing and to defend the remaining lymphatic structures of the body.

10101Shaz
34 days & 22h ago

can drinking too much alcohol cause people to develop lymphoedema? cause some websites say that it causes blood vessels to expand so the fluid to leak into the other parts 

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 18h ago

Hello Shaz,

Thank you for your question, unfortunately I have no information about this phenomenon, so I cannot comment, I have not met anyone so far with alcohol induced lymphoedema.

However, one can develop obesity lympoedema due to the excessive weight because the lymphatics manages the fats and water system of the body and if you have excessive weight due to the physical inertial and size and weight of the physical structures, the pressure of the body will destroy the lymphatic collectors and cause lymphatic failure and swelling which usually starts at the lower body due to gravity.

Anonymous
34 days & 22h ago

what are the different stages of lymphoedema?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 17h ago

There are 4 typical stages of lymphoedema progression

Stage 1 Latent stage, at this stage lymphatics capillaries shows some incompetency and some heaviness starts to show up towards the end of the day, when you rest it dissolves and it only shows up with pressure and stress. It may not appear everyday, so it is normally highly manageable with some self drainage therapy and a ccl1 compression garment. Exercise and keep fluids moving with daily activities, eating well and resting well is important for your lymphatic health. I highly recommend swimming or pool walking for non swimmers, because it helps to remove fluids with hydrostatic pressure and also the cool water comforts the lymphatic inflammation.

Stage 2 is established lymphoedema, the patient will have bigger or smaller subtle swelling, but it is obvious by now texture of the affected tissue can feel dough like and this stage requires professional intervention because you have a good chance at restoring the tissue behavior and stabilize the progression.  You will feel heaviness and weight on the affected area with some numbing some times, achy and soreness when it is inflammed.  It goes down in size when you sleep but pops back up by the afternoon.  See your lymphoedema therapist have your treatment and the therapist will coach you on self management and prescribe garments to you, wear your compression garment daily now to reduce the size, modify the swelling and also prevent any further developments.

Stage 3 is the texture change stage.  Usually patients will start to struggle with this stage because the lymphedema will have fibrosis impact on it, sometimes infections will start by this stage.  Bed and night rest doesn't give much reduction now, patient feels tired and fatigued from the weight and movement starts to get compromised. The patient will need to do corrective intensive with the therapist now and will need compression bandaging to decongest the limb, to get a size reduction, it needs to be carried out frequently, because the refill rate is quite high due to even bigger lack of lymphatic function.  Patient's home care therapist will include wearing compression bandages until the limb is suitable for compression garment, at this stage only flat knit customized garment are suitable.

Stage 4 is elephant static.  The limb is extremely big and heavy now. Tissue texture is harden and fibrotic by now with lots of loblues and folds, infections can happen a few times a year now, immunity health is low, every infection with lymphoedema cellulitis, hardens the tissue and can cause fibrosis scar deposits in the area increases the complexity of the lymphoedema. Every infection requires a hospital stay for intravenous antibiotics.  Quality of life will be impacted. Mobility is limited due to the weight and size of the affected limb, a lot of activity cannot be easily done, even a simple thing like getting on the bus, my patient needed some people to push her up the steps each time.  It is still possible to correct this, but it has to be aggressive treatment and the option is intensive professional care. Some of my european schools have lymphoedema hospitals for patients to check into for therapy twice a day and exercise and diet planners for up to a month depending on the case.  For my elephantisis cases I use their helper to enforce 24/7 bandaging at home between visits so it cuts the cost down and I reduce sessions once I see them maintaining the reduction and for these patients they can only sometimes fit for lower leg garment if they can bend their knees, otherwise, they no longer have much compression garment options due to their irregular shape and size, they can only be bandaged all the time.  I put them on a strict diet program along with some light walking if they can still manage walking at this stage because it speeds up their reduction.

Adam
34 days & 22h ago
what are the complications that can happen if you just ignore it?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 16h ago

Hi Adam,

Lymphedema tends to progress if you just ignore it because the swelling leads to further obstruction to the lymphatic transport leading to a larger area of lymphatic failure resulting in denser and more protein infused fluid which leads to a fertile area for infections for that area from any common cold bacterial. It tends to get complication even if management is insufficient. Some patients with a stable swell that doesn't change are happy to live with a big arm or leg if it doesn't bother them if it doesn't progress, its all good and choices by the patient to refuse treatment, however, if it progresses and deteriorates, it becomes necessary to have more intensive and complex treatment in order to rein in the issue.

In the early stage managing it could be very minimal lots cheaper and simple, I recommend not to let it slip and progress if that is possible.

Anonymous
34 days & 22h ago

you mentioned that there's no cure for lymphoedema in your description. does that mean that once you develop it you will never be able to fully recover and will have to live with it for the rest of your life? 

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago

Yes I'm sorry to say, unfortunately, at this point in time, after much research around the world, from early days until now in the past 50 years of known research, it still remains a mystery that we can't solve, neither drugs, nor surgery or alternative methods could provide a firm solution to free the lymphedema patient from constantly needing to care for it.  Yes you might live with it in latent stage controlling it at it's baby stage (like I did for the last 20 years) and for the rest of my/your life or live with higher constant management in bandages all the time in the later stages of development. The practitioners can help reduce and improve, but there is no end point in management until the day comes, so far, but we live in hope of that answer.

That's why if we know any patient with a possible risk of developing lymphoedema, we need to provide enough awareness to prevent that.  To allow them to develop without knowledge and information that this might happen to them is an unfair treatment in my opinion.

Atiqah_Jane
34 days & 22h ago

how does compression garments help in managing lymphoedema

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago

Hi Jane,

Compression garments are prescribed to assist in the lymphatic transport from light circular knit garments for light swell to heavy flat knitted fabrics custom made to their specifications for heavy fibrotic. This is important to restrict and resist the fluids from filling up under the skin and also to soften scaring and fibrosis from protein rich lymphatics that tends to change the texture to something firmer and more doughy.

Jackson Yap Shun
34 days & 22h ago

do you know if TCM can help with lymphoedema?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago

So far there are patients who goes on TCM herbal drinks which is helpful, however, we do not recommend any form of hard pressure massages that can turn the skin red or bruise the skin or acupuncture on the affected limb as this will trigger cellulitis.  Heat treatment in hot bath and using infra red lamps. I have received patients who had done these treatment and it promoted advancement of their lymphedema development into the next stage or triggered recurring infections, then its too late for regrets.

Similarly for a patient who had done a spa hot wraps on their affected limb, she developed into a stage 2 swelling with infections the day after the wraps, worse still was the issue with her package and non refund clauses.  So i would caution, I'm not against anyone but so long as any practitioner and well meaning person understand this trigger friendly condition and I support visiting them because they know how to be cautious and what to lookout for.

Ey_qbae
34 days & 22h ago

what happens during a lymphoedema therapy session? is it just massages? are there physical exercises too?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago

Hello,

The therapy sessions involves measurement and data collection, mapping out a treatment and frequency plan according to the patient's presentation, MLD treatment and use of any other lymphatic management devices and bandaging, garment prescription after the decongestion and reshaping is phase completed, home care coaching on self management, and self monitoring. Advise on exercises is briefly recommended, we recommend them to follow a professional trainer or fitness instructor for more detailed instructions so that its safely carried out.

RelenaW
34 days & 22h ago

These treatments are so time consuming.. I have to take time off work and to travel for frequent therapy sessions. Is there anything I can do on my own at home to help with my condition? Are there anything there I should avoid doing?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 17h ago

Hi Relena,

Yes they are very time consuming and tedious I agree. You should have your therapist coach you on self management, bandaging and wear your compression garment diligently during the day, you can bandage at night or fit for a night compression garment (these are padded garments but expensive) Do you self massage and self bandaging, these are the two most effective method.  I think swimming is the best friend of lymphatic problems and exercise by using your muscles and vessles to pump out the other fluid load of the body. 

In my sessions with my patients, I explain to my patients what is their troubled spot and what should they watch for and I map out their treatment strategy either for reduction or maintenance and I make videos on the patients smart phones for self management drainage steps and self bandaging steps for their home care program. You can ask your current therapist to do the same for you. If you are able to produce results with good home care, your therapist should cut down your sessions, this way you are more independent and have better time management.

You should avoid anything hot with lymphedema, onsen, hot spa, hot sauna, hot baths, infra red lamps.  Avoid acupuncture and hard massage on the affected area, blood pressure cuffs on the affected limb. Traveling without your compression garment. Weight management is important, increase weight will increase lymphatic loading. Inappropriate compression wear that is not suited for lymphoedema or prescribed by a well trained therapist also causes lymphoedema to harden when I found those patients, they are usually wrongly fitted, so if your common sense tells you something is off with your garment, you should seek your therapist's opinion.  That being said not all therapist are trained in compression garment management, because this was not a compulsory study subject for us, I trained for it separately in Germany to become a specialist in compression wear.  If you need any further advise please let me know.

Fian
34 days & 22h ago
How to choose the right compression garments? Must they al be custom made?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago

Hi Fian,

Not all patients need custom made garment, your therapist should be able to fit you and recommend the right fabric and compression pressure according to your stage of swelling. I'm strict and I will only recommend ready made garments to non developed to those who developed at below 2 cm difference, if they have further circumference difference, I would do the decongestive therapy to change their shape texture and size before fitting them. At this point we might need to customize if they no longer fit into a ready made garment.

However Asians are very small petite ladies, if they don't fit into a ready made garment because it is too gappy, then we will custom make one in a light texture and lycra like fabric just to give them enough support.

My patients are mostly given depending on their swelling stage ccl 1 to ccl 2 compression on upper limb and ccl 1 to ccl 3 on lower limb.

The more comfortable the garment is the more compliant the patient will be. So we have lots of brands to select the best fabrics that suits our patient's profile.

Anonymous
34 days & 20h ago
How do I help my sister who has lymphoedema
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago
You can arrange for her to get support from a lymphoedema therapist, they will start with assessing her stage of swelling. Her doctor can recommend her to the hospital rehabilitation unit that has a trained lymphoedema therapist, if you need more help let me know, I am happy to direct you to the right people.
Jack
34 days & 20h ago
How do I stay fit if I have lymphoedema?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago

Hi Jack,

You can still exercise and eat well and sleep well, lymphoedema doesn't need to impact your activity levels, if you have not exercised for a long time, then you need to slowly build it up so that your lactic acid waste from the muscle soreness doesn't upset the lymphoedema too much.

Anonymous
34 days & 20h ago
How do I get my jeans to fit? Should I visit a tailor?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago
Yes if you have issues with clothes, we do recommend you see a tailor stretch materials are useful.  That's the best person.  There are also shoes for lymphoedema patients most recently launched.
Anonymous
34 days & 20h ago
How do I make my condition less embarrassing and sightly?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago
It really depends on where your condition is located and I'm assuming you are referring to a lymphoedema swelling. Clever clothing and fashion will mask a lot and distract attention.  I wear batik printed compression full panty hose and people think its leggings  for fashion, I wear long flowy dresses and fluttering sleeves to hide my arm, (cause the garments are warm in this weather, I choose light fabrics) since I swell on one side of my face chest, arm and leg, I use make up on my face to do contours and clothes that can cover and colorful compression garments that matches makes people think that it's part of my hippie gypsy fashion sense. :)
Anonymous
34 days & 20h ago
Does undergoing treatment for cancer increase my risk of contracting lymphoedema?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago
It's not always true, it depends on the type of cancer treatment necessary, the amount of lymph nodes affected or dissected and what else needs to be done. There are many other reasons that trigger lymphoedema besides cancer treatment.
Anonymous
34 days & 20h ago
I have had lymph nodes removed at my right leg, do I need to worry about the disease occurring at other parts of my body?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 15h ago

I'm sorry I'm not sure what is the nature of the disease, perhaps you could be more specific? If you are talking about the lymph nodes infection that caused it to be removed from your leg, and whether it will occur somewhere else, this is a question only the surgeon who done the history of your treatment can answer.

Lymphoedema can only affect the area that had lymph nodes removed, if the rest of the body is free of any genetic lymphoedema issue.

Anonymous
34 days & 17h ago
The recommendation is to wear compression sleeve for my arm during the day. Can I wear it at night instead ? Is there a lot of difference whether I wear it at night compare to day? What is the best outcome you’ve seen for patients with second lyumphema after breast cancer treatment?
Veronica Yap profile picture
Veronica Yap
VIP 34 days & 14h ago

The compression garment is designed for day time activity and resistance of swelling pressure, and the compression is knitted as such.  I have not seen your swelling so I do not know if you can only wear it at night only.  However for the patient who has stage 1 swell, it is best to wear it during the day because the activities during the day increases the lymphatic load.

These day compression sleeve cannot be worn at night because your gravity pressure is different when you lie down and it will be obstructive to your lymphatic flow and create more lymphatic failure. There are suitable night compression garment that are usually less pressure and looser fit and fluffy due to the sponges inside. But this garment is expensive and I only recommend them to patients who doesn't have reduction during their night rest.

Best outcome I have seen for post breast stage 1 lymphoedema patient is that we managed to get them stable enough to cheat without their sleeves for hours to some days. Those are very few because of their personal discipline and super compliance, they gotten their reward, they have some freedom and such independence.  However they all started with very intensive work and we work as a team to ensure the results.

Best outcome for a stage 2 lymphoedema who is a foreigner, she has reduced herself into a stage 1 swelling.  She made me super proud of her compliance. In fact she visits me once a year for intensive reduction sessions, so far, we made more progress than we thought possible.

I hope this encourages you, don't give up and don't feel frustrated, it can happen to them you can also get the results, are you determine enough?

Anonymous
34 days & 16h ago

is there a specific type of cancer that causes lymphoedema more than the others?

Veronica Yap profile picture
Veronica Yap
VIP 34 days & 14h ago
There are some research comparing upper and lower limbs and it was found that lower limb patients developed quicker and sooner and more percentage than upper limb.  It was suggested that the number of lymph nodes remove was the main reason, or the weight of the person.  It was not a firm answer because there is not enough studies. There were no other comparison studies, that I have found so far that is meanful.
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