We learn how lymphatic system mapping and associated draining technique is changing lives of lymphoedema patients.
What is lymphoedema?
It occurs when a patient is unable to adequately drain lymph fluid and can arise spontaneously (primary lymphoedema) or result from another disease, condition, or post-surgery (secondary lymphoedema).
While the exact prevalence of the condition is unknown, WHO estimates that worldwide 1-2% of the population suffers from chronic lymphoedema. CANSA estimates that this could translate into 1,3 million people in SA suffering with some form of lymphoedema.
Physiotherapist, Allison Dendy, the first person in Africa to qualify in lymphoflouroscopy mapping, has successfully treated more than 80 patients at her practice in Midrand, Gauteng.
Lymphofluoroscopy is a technique which provides the ability to visualise a person’s lymphatic architecture and drainage pathways in real time.
Allison is passionate about teaching the technique to other physiotherapists and educating patients and healthcare professionals about lymphofluoroscopy mapping, which can be used on both primary and secondary lymphoedema patients.
The mapping is used in combination with a new, more effective manual lymph drainage technique, called “Fill and Flush” (Flouroscopy Guided Manual Lymph Drainage, or FG-MLD), a specialised technique which dynamically targets compromised drainage areas and drains the lymph fluid into normally functioning areas of the body.
Pretoria patient shares her story
Pretoria dentist, Albie Enslin, is one of Allison’s patients whose quality of life has changed dramatically since undergoing lymphofluoroscopy.
She was diagnosed with primary lymphoedema in her right leg at age 19 and struggled for years to manage her condition. She already met Allison in 2012, when she required more intensive treatment and new compression garments for her condition, before continuing with her local physiotherapist in Pretoria.
“When someone mentioned to me last year that Allison was providing fluoroscopy to her patients, I decided that I would move heaven and earth to have it,” Albie says.
Like many during the pandemic, finances had become somewhat restricted, but she and her husband decided to prioritise the procedure and she received it in August last year.
Albie describes seeing how her lymph fluid behaved in her body in real-time, as “a combination of awe, excitement, and disappointment.” Disappointing, because it revealed that surgery wouldn’t be an option for her, and also, to see for herself where lymph was clogged and unlikely to ever be fully decongested, and that she had few drainage paths.
“But overall, I felt a lot of excitement. We found pathways that weren’t standard in the human body, which showed that my own body was adapting and modifying to create new pathways to drain the fluid. It was also a great relief to have precise information on how to proceed with treatment from that moment on.”
Radical improvement in quality of life
Albie is unequivocal about the impact on her quality of life after the mapping. “Whereas I used to need two physiotherapy sessions a week, since the mapping and being taught the Fill and Flush technique, I’m down to one in every six weeks to three months.”
Self-care at home was also extremely strenuous prior to the mapping procedure. “It was a big job, trying to get comfortable while straining in awkward positions to reach my lower limb and I would end up with aching shoulders. It also took about an hour, which I would have to fit in before my two children woke up, or between work, or before I went to bed at night. Now, it takes me all of five minutes, because I know exactly where to concentrate my massage, and I can see it works from the dramatic improvement in my condition.”
Albie encourages people with lymphoedema to do everything they can to have the procedure. It costs around R8 000, and although ironically, the procedure will save medical schemes money through a reduction in the need for professional lymph drainage massage, it’s not yet covered by medical schemes. “Do whatever you can, whatever you have to, to get this treatment!” is her impassioned advice.
She adds that overall management of lymphoedema can be supported with a good diet (the ketogenic diet has worked extremely well for her), and in addition to exercise, support from family members plays a vital role in coping with lymphoedema.
In her case, in addition to her own, upbeat personality, the committed support from her husband, parents and physiotherapists have been pivotal to her managing to control the emotional ups and downs that come with the condition.
MEET THE EXPERT – Allison Dendy
Allison Dendy first qualified in the treatment of lymphoedema in the USA, in 2004, and has been running a successful practice with ongoing training in this field. She qualified in FG-MLD and lymphofluoroscopy mapping techniques in the UK and launched the Lymphoedema Training Academy (LTA Africa) in 2019, where she offers training in the techniques to health professionals.