LA CONFEDERACIÓN GALLEGA DE PERSONAS CON DISCAPACIDAD COGAMI RECHAZA LA PROLIFERACIÓN DE GASOLINERAS SIN ATENCIÓN DE PERSONAL

Con referencia al informe del Comité Español de Representantes de Personas con Discapacidad (CERMI) , desde COGAMI, el movimiento asociativo de la Confederación Gallega de Personas con Discapacidad  expone:

1/ La apertura de estaciones de servicio desprovistas de personal laboral vulnera los derechos de las personas con discapacidade al ir en contra de la Convención Internacional de los Derechos de las Personas con Discapacidad.

2/ Las estaciones de servicio desatendidas vulneran directamente la Carta de los Derechos Fundamentales de la Unión Europea, incumpliendo los artículos 20, 21 y 26, que garantizan la igualdad de todas las personas y la no discriminación por razón de discapacidad, así como el derecho a que se adopten medidas que garanticen su autonomía y participación en la comunidad.

3/ Desde COGAMI proponemos que las gasolineras abiertas al público deban estar provistas de personal presencial que debe atender, apoyar y auxiliar a las personas con discapacidad que así lo requieran en la reposición de carburante, en caso de que no puedan efectuarlo por sí solas.

4/ Las gasolineras sin servicio de atención al público perjudican la accesibilidad universal y por lo tanto, la atención adecuada de más de un millón y medio de personas con discapacidad que tienen vehículo en España.

5/ La apertura de estaciones de servicio sin atención suponen un caso grave de exclusión en el acceso a los servicios esenciales por razón de discapacidad.

6/ Los modelo de negocio de gasolineras automáticas suponen la creación de desigualdad entre las personas, al no permitir el derecho a la accesibilidad universal, y suponen la vulneración de los derechos fundamentales de las personas.


La Confederación COGAMI, como entidad miembro de la Confederación Española de Personas con Discapacidad Física y Orgánica (COCEMFE), ya se sumó el año pasado a una campaña de recogida de firmas a nivel nacional, en contra de la apertura de estaciones de servicio sin atención. Se consiguió más de 100.000 firmas, de las cuales 5.000 las aportó el movimiento asociativo gallego.

Referencia: 

http://www.cogami.gal/difusion/sala-de-prensa/novas/cogami-rexeita-a-proliferacion-de-gasolineiras-sen-atencion-de-persoal/

Artículos relacionados que le pueden interesar: 
(Pincha sobre el texto)

• POR QUE LA ELEFANTIASIS ES UNA ENFERMEDAD OLVIDADA Y DESATENDIDA

• EXISTE ANGUSTIA ASOCIADA A TRATAMIENTO DEFICIENTE DEL LINFEDEMA - AFRONTAMIENTO PSICOLÓGICO DEL LINFEDEMA

• POR QUÉ EL MUNDO NO ESTÁ TRATANDO UNA ENFERMEDAD TRATABLE COMO EL LINFEDEMA - HACIENDO LA VISTA GORDA A LA ELEFANTIASIS 

• ES  INCAPACITANTE Y DISCAPACITANTE EL LINFEDEMA 

• CUAL ES EL MEJOR TRATAMIENTO PARA LINFEDEMA 

• CAMPAÑA INTERNACIONAL DE CONCIENCIACIÓN PARA PROMOVER TRATAMIENTO CORRECTO PARA LINFEDEMA

• CAMPAÑA PARA PREVENIR LA ELEFANTIASIS EN NIÑOS DEBIDO A LINFEDEMA PRIMARIO

• CUIDADO CON NUEVAS TERMINOLOGÍAS QUE DESCRIBEN EL TRATAMIENTO PARA EL LINFEDEMA

• QUE DOCTOR O ESPECIALIDADES MÉDICAS DEBE DIAGNOSTICAR, TRATAR O ESTÁN RELACIONADAS CON LINFEDEMA

• TRAMITACIÓN RÁPIDA PARA EL RECONOCIMIENTO DE DISCAPACIDAD DE NIÑOS CON LINFEDEMA

• GUÍA PROTOCOLO DE LINFEDEMA

• DOCTOR KENNETH GERSHENGORN Y EL CASO CLÍNICO DE MAUREEN DIGAN

• LINFEDEMA EN LA CODIFICACIÓN Y CLASIFICACIÓN INTERNACIONAL DE ENFERMEDADES

• QUE ES FLEBOLINFEDEMA

• POR QUÉ LA MARIPOSA ES EL SÍMBOLO DE LINFEDEMA

• PRECAUCIÓN CON LAS BOMBAS DE PRESOTERAPIA

• PULSERAS Y COLGANTES DE AVISO MÉDICO - INDICATIVOS DE ALERTA MÉDICA

• CONSEJOS PARA VIAJES EN AUTO Y TREN

• CONSEJOS PARA VIAJES EN AVIÓN

• ASISTENCIA PSICOLÓGICA EN LINFEDEMA

• LA ELEFANTIASIS NO ES SOLO FILARIASIS LINFÁTIC 

• ASOCIACIONES ESPAÑOLAS DE LINFEDEMA – DIRECTORIO ACTUALIZADO – ASOCIACIONES DE PACIENTES DE LINFEDEMA DE ESPAÑA – FEDERACION ESPAÑOLA DE ASOCIACIONES DE LINFEDEMA

CUAL ES EL MEJOR TRATAMIENTO PARA LINFEDEMA - Enfermedad Linfático-Vascular Orgánica - Tratamiento de Primera Línea - Elegir un Centro o Unidad de Referencia de Linfedema - Linfedema Primario - Linfedema Secundario - Elefantiasis Linfostática - Filariasis linfática / Podoconiosis - Guías de Mejor Práctica Clínica - Protocolo de Tratamiento - Medicina Preventiva - Estrategias de Rehabilitación - Vía de atención al paciente

El linfedema es una enfermedad de la piel progresiva, desfigurante e incapacitante, clasificada como un trastorno del sistema circulatorio linfático (Enfermedad Linfático-Vascular Orgánica). Los vasos linfáticos son un componente activo e integrante de la respuesta inmunitaria y, en el linfedema, siempre hay una mayor susceptibilidad a las infecciones debido al sistema inmunitario comprometido. Lea sobre qué es una Discapacidad Orgánica AQUÍ. 

El linfedema surge cuando hay una interrupción del flujo linfático (Discapacidad Orgánica), lo que provoca la acumulación de linfa. Está claro que ningún paciente ni su linfedema son iguales, así como tampoco lo son su progresión. Algunos pacientes con linfedema tienen pocos síntomas y pueden realizar con facilidad distintos grados de actividad física, mientras que otros experimentan un aumento de la hinchazón con el mínimo esfuerzo, o incluso sufren distintos grados de discapacidad y complicaciones severas. Lea sobre linfedema y Celulitis Infecciosa AQUÍ.

El tratamiento del linfedema periférico se divide en métodos conservadores no quirúrgicos y métodos quirúrgicos. El mejor tratamiento no quirúrgico de primera línea para linfedema, considerado como el tratamiento Estándar de Excelencia, se conoce como TERAPIA DESCONGESTIVA COMPLEJA (TDC). 

La Terapia Descongestiva Compleja (TDC) está respaldada por una larga experiencia y consiste en un programa de tratamiento que puede aplicarse tanto a niños como adultos y que consta de dos fases: La Fase I tiene como objetivo reducir el volumen del linfedema y, movilizar el aumento del líquido intersticial para normalizar la homeostasis tisular. El objetivo de la Fase II es el mantenimiento y la optimización del éxito terapéutico. 

Para obtener los mejores resultados, se recomienda un tratamiento precoz. La frecuencia y la intensidad de los componentes del TDC en la Fase I y la Fase II deben depender de los grados  y estadio del linfedema y adaptarse a los cambios clínicos. No se recomienda la aplicación aislada de los componentes en la Fase I Inicial, debiendo utilizarse en su totalidad. 

La Terapia Descongestiva Compleja (TDC) es llevada a cabo por un terapeuta que ha recibido formación a nivel de especialista y combina los siguientes componentes:

• Cuidado de la Piel
• Drenaje Linfático Manual (DLM)
• Vendajes Multicapa
• Ejercicio
• Prendas de Compresión
• Educación del Paciente

• Bomba de Presoterapia (es un adyuvante opcional y, sólo se aplica si va acompañado de Drenaje Linfático Manual (DLM) realizado por terapeutas a nivel de especialista).

Después del tratamiento inicial (Fase 1), que incluye todos los componentes y que se aplica diariamente y dura varias semanas, se pasa luego al tratamiento de mantenimiento (Fase 2), consistente en compresión mediante una media o manga elástica de baja elasticidad, cuidado de la piel, ejercicio y el Drenaje Linfático Manual (DLM) según sea necesario. En esta segunda fase que es de larga duración, al paciente se le enseña auto-vendaje de mantenimiento, auto-cuidados básicos de la piel, y la práctica de ejercicios. Lea sobre que país tiene la mejor cobertura sanitaria pública para el tratamiento de linfedema AQUÍ. 

El éxito de la Terapia Descongestiva Compleja (TDC) depende de que debe ser administrado por un terapeuta certificado con experiencia. La terapia TDC se considera segura, sin embargo los pacientes deben consultar con su médico antes de comenzar el tratamiento. Las indicaciones, las contraindicaciones y la aplicación de medidas terapéuticas individuales dependen de varios factores: el Grado del linfedema al inicio del tratamiento, las comorbilidades, la edad del paciente y las circunstancias individuales del mismo. 

El fracaso de la Terapia Descongestiva Compleja (TDC) debe confirmarse sólo cuando el tratamiento intensivo no quirúrgico, se haya realizado en una clínica especializada en el manejo del linfedema periférico y, dirigido por un linfólogo clínico experimentado. Lea sobre los signos, síntomas  y complicaciones del linfedema AQUÍ.

De ninguna manera debe este tratamiento altamente especializado ser sustituido, debido a los posibles efectos secundarios graves, por tratamientos para la reducción de edemas llevados a cabo por personas no especializadas. La reducción agresiva del edema puede causar daños en la piel y los vasos. 

La terapia de compresión aislada sin Drenaje Linfático Manual (DLM) de las extremidades, sobre todo en pacientes con linfedema que también afecta a los cuadrantes del tronco, puede causar el desplazamiento del edema y aumentar la hinchazón en la raíz de la extremidad, e incluso puede provocar linfedema genital.

AVISO IMPORTANTE

El linfedema (Enfermedad Linfático Vascular Orgánica) se debe a un drenaje linfático deficiente que provoca enfermedad de la piel, caracterizada por una hinchazón y un engrosamiento anormal de la piel y tejido conjuntivo subcutáneo. El linfedema no es sólo un problema de hinchazón localizada, sino una afección que puede afectar a múltiples sistemas, estructuras y funciones corporales, dando lugar a una serie de síntomas y complicaciones físicas, fisiológicas y psicosociales. Lea sobre los síntomas y complicaciones del linfedema AQUÍ.

El Linfedema es una enfermedad crónica y progresiva debido a una disfunción linfática. El tratamiento clínico del linfedema no es ni un tratamiento cosmético ni estético. El tratamiento del linfedema es para controlar su avance y aliviar los síntomas relacionados con la disfunción del sistema circulatorio linfático. 

Para prevenir y evitar problemas graves asociados al tratamiento, como el posible desplazamiento del edema a zonas previamente no afectadas cuando se aplica la terapia de compresión para la reducción del volumen, los pacientes deben recurrir a terapeutas altamente especializados con experiencia. 

La cualificación profesional y la instrucción impartida a distancia en línea no son lo mismo que la instrucción práctica en directo en la formación clínica y la certificación de los terapeutas del linfedema, similar a todos los demás programas de formación en rehabilitación, medicina y cirugía, y especialmente para desarrollar las habilidades manuales necesarias para tratar una enfermedad tan compleja como el linfedema.

Los pacientes deben igualmente tener un especial cuidado a la hora de elegir un Centro Multidisciplinar de Referencia de Linfedema, ya que no todos los países o centros de referencia proporcionan las mismas opciones de tratamiento. La mejor elección es un centro de referencia que aplica la Terapia Descongestiva Compleja (TDC), que está reconocida como el tratamiento Estándar de Excelencia para el linfedema.

• Lea sobre cuales son las principales funciones del Drenaje Linfático Manual AQUÍ.

• Lea sobre cuales son las importantes diferencias entre los dos principales protocolos de tratamiento para Linfedema AQUÍ. 

• Lea sobre cuales son las estrategias para la aplicación de tratamientos de bajo coste para el linfedema AQUÍ.  

QUE ES LA ELEFANTIASIS / MITOS Y REALIDADES

REFERENCIAS

(Pincha sobre los textos para leér los artículos científicos)

SOCIEDADES CIENTÍFICAS

• German Scientific Society Guideline: Diagnostics and Therapy of Lymphoedema.

FISIOPATOLOGÍA

• lymphedema.
• Biology of Lymphedema
• Lymph vessels: the forgotten second circulation in health and disease
• Lymphatic Vessel Network Structure and Physiology
• Lymphatic System Flows
• Organ-specific lymphatic vasculature: From development to pathophysiology.
• The lymphatic vascular system: much more than just a sewer.
• The unresolved pathophysiology of lymphedema.
• Lymphedema: A Practical Approach and Clinical Update.
• Coagulation in Lymphatic System.
• Regulation of immune function by the lymphatic system in lymphedema.
• Oxidative stress in chronic lymphoedema.
• Regulatory T Cells Mediate Local Immunosuppression in Lymphedema.
• Hemostatic properties of the lymph: relationships with occlusion and thrombosis.
• Secondary lymphedema: Pathogenesis
• Gastrointestinal Lymphatics in Health and Disease
• Intestinal lymphangiectasia in adults
• Role of the lymphatic vasculature in cardiovascular medicine
• The lymphatic vasculature in disease
• Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema.
• The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review
• Peripheral Edema

COMPLICACIONES CUTÁNEAS

• The lymphatic system and the skin. Classification, clinical aspects, and histology.
• Lymphedema and cutaneous diseases.
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.
• Serum Immune Proteins in Limb Lymphedema Reflecting Tissue Processes Caused by Lymph Stasis and Chronic Dermato-lymphangio-adenitis (Cellulitis).
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.

COMPLICACIONES INFECCIOSAS

• Lymphatic Flow: A Potential Target in Sepsis.
• Infectious complications of lymphedema.
• Acute inflammatory exacerbations in lymphoedema.
• Inflammatory Manifestations of lymphedema.

CELULITIS / DERMATOLINFANGIOADENITIS

• Cellulitis.
• Clinical features, microbiological epidemiology, and recommendations for the management of cellulitis in extremity lymphedema.
• Challenges of cellulitis in a lymphedematous extremity.
• Diagnosis and management of cellulitis.
• Cellulitis risk factors for patients with primary or secondary lymphedema.
• Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg.
• Prevention of dermatolymphangioadenitis by combined physiotherapy.
• Erysipelas: a common potentially dangerous infection.

TUMORES

• Malignant tumors as complications of lymphedema.
• Lymphedematous areas: Privileged sites for tumors, infections, and immune disorders.
• Lymphedema-related angiogenic tumors and other malignancies.
• Lymphedema: an immunologically vulnerable site for the development of neoplasms.
• Lymph stasis promotes tumor growth
• A retrospective analysis of Stewart-Treves syndrome in the context of chronic lymphedema.
• Stewart-Treves Syndrome

DOLOR

• Congenital lymphedema complicated by pain and psychological distress: case report
• Lymphatic Pain in Breast Cancer Survivors
• Does Manual Lymphatic Drainage Have Any Effect on Pain Threshold and Tolerance of Different Body Parts?
• Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer
• Quality of life in patients with primary and secondary lymphedema in the community

TRATAMIENTO

• Treatment of limbs lymphedema.
• Nonoperative treatment of lymphedema.
• Lymphedema: From diagnosis to treatment.
• Lymphedema-clinical picture and therapy.
• Physiotherapeutic rehabilitation of lymphedema: state-of-the-art.
• Diagnosis and management of lymphatic vascular disease
• Effective treatment of lymphedema of the extremities.
• Lymphoscintigraphic aspects of the effects of manual lymphatic drainage.
• Intensive Treatment of Lower-Limb Lymphedema and Variations in Volume.
• Effectiveness and safety of Complete Decongestive Therapy of Phase I.
• Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities.
• Effects of Phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer-related lymph edema.
• Does lymphoedema bandaging reduce the risk of toe ulceration?
• Study of 700 referrals to a Lymphedema Program.
• Worldwide assessment of healthcare personnel dealing with lymphoedema.
• Földi M, Földi E. Földi’s textbook of lymphology for physicians and Lymphoedema therapists.
• Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients
• Visualization of Accessory Lymphatic Pathways, before and after Manual Drainage, in Secondary Upper Limb Lymphedema Using Indocyanine Green Lymphography
• The risk of genital edema after external pump compression for lower limb lymphedema.
• The management of genital lymphoedema
• The management of deep vein thrombosis in lymphoedema: a review.
• Lymphedema-associated comorbidities and treatment gap.

PRENDAS DE COMPRESIÓN

• A study of the advantages of elastic stockings for leg lymphedema.
• Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement.
• Medical compression stockings for chronic venous diseases and lymphedema: Scientific evidence and results of a patient survey on quality of care.
• Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic edema: a randomized controlled trial protocol.
• Compression Therapy Is Cost-Saving in the Prevention of Lower Limb Recurrent Cellulitis in Patients with Chronic Edema.
• Occupational leg edema-use of compression stockings.

DISCAPACIDAD

• Disability and lymphedema.
• Lymphedema and employability.
• Worse and worse off: the impact of lymphedema on work and career after breast cancer
• Functioning in lymphedema from the patient's perspective using the International Classification of Functioning, Disability and Health (ICF).
• Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors
• Postural Stability in Patients with Lower Limb Lymphedema
• Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema

DISFIGURACIÓN

• Adjusting to disfigurement: processes involved in dealing with being visibly different
• Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments
• Quality-of-life and body image impairments in patients with lymphedema
• Association of lower extremity lymphedema with pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancers

CALIDAD DE VIDA

• The impact of lower limb chronic oedema on patients' quality of life
• Quality of life in patients with primary and secondary lymphedema in the community
• Evaluating the effect of upper-body morbidity on quality of life following breast cancer treatment.
• Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study
• The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema

IMPACTO PSYCHOSOCIAL

• Psychosocial Impact of Lymphedema.
• Associations between chronic disease, age, and physical and mental health status
• A network analysis of psychological flexibility, coping, and stigma in dermatology patients
• 'Abandoned by medicine'? A qualitative study of women's experiences with lymphoedema secondary to cancer, and the implications for care
• People are neglected, not diseases.
• Chronic edema/lymphoedema: under-recognized and under‐treated.
• Lymphatic Medicine: Paradoxically and unnecessarily ignored.
• Medical education: a deficiency or a disgrace.

LINFEDEMA PEDIÁTRICO

• NORD: Rare Disease Database - Lymphedema
• Medical management of lymphedema.
• Primary lymphedema in childhood.
• An approach to familiar lymphedema
• Pediatric Children Lymphedema
• Primary Lymphedema French National Diagnosis and Care Protocol (PNDS).
• Lymphatic filariasis: an infection of childhood.
• Lymphatic filariasis in children: clinical features, infection burdens and future prospects for elimination.

FILARIASIS / PODOCONIOSIS LINFÁTICA

• Podoconiosis: Clinical spectrum and microscopic presentations.
• Podoconiosis: A Possible Cause of Lymphedema in Micronesia.
• A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis, and leprosy.
• The impact of acute adenolymphangitis in podoconiosis on caregivers.
• Neglected tropical diseases and disability-what is the link?
• Locomotor disability in bancroftian filarial lymphoedema patients.
• Neglected patients with a neglected disease?
• Neglected tropical diseases and mental health: a perspective on comorbidity.
• People are neglected, not diseases.
• Addressing Inequity: Neglected Tropical Diseases and Human Rights.
• Neglected Tropical Diseases, Conflict, and the Right To Health.

SISTEMA VASCULAR SANGUÍNEO 

• Peripheral Edema
• Phlebolymphedema
• Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management
• Role of the lymphatic vasculature in cardiovascular medicine
• Communication between lymphatic and venous systems
• Phlebopathies and occupation
• Phlebopathies and workers
• Evidence of health risks associated with prolonged standing at work and intervention effectiveness
• Leg edema formation and venous blood flow velocity during a simulated long-haul flight

WHAT IS THE BEST TREATMENT OPTION FOR LYMPHEDEMA - Organic Lymphatic Vascular Disease - First-line Treatment - Choosing a Lymphedema Expert Reference Centre - Primary Lymphedema - Secondary Lymphedema - Lymphostatic Elephantiasis - Lymphatic Filariasis / Podoconiosis - Best Practices Management Guidelines - Treatment Protocol - Patient Care Pathways - Preventive Medicine - Rehabilitation Stratagies

Lymphedema is a progressive, disfiguring, and disabling disease of the skin, classified as a functional, immune, and lymphatic circulatory system disorder (Organic Lymphatic Vascular Disease). The lymphatics are an active and integrated component of the immune response, and in lymphedema, there is always an increased susceptibility to infection due to the compromised immune system. Read about what is an Organic Impairment HERE. 

Lymphedema arises when there is a disruption of lymphatic flow (Organic Impairment), leading to the buildup of lymphatic fluid. It is clear that no patient or their lymphedema is the same and neither is its progress. Some patients with lymphedema have few symptoms, and can easily do different degrees of physical activity, while others feel the strain, experience increased swelling with minimum effort, or even suffer varying degrees of disability and severe complications. Read about lymphedema and Infectious Cellulitis HERE. 

Therapy of peripheral lymphedema is divided into conservative non-operative and operative methods. The best first-line non-surgical treatment for lymphoedema, considered the "Gold Standard" treatment, is known as "COMPLETE DECONGESTIVE THERAPY (CDT)". 

Complete Decongestive Therapy (CDT) is backed by longstanding experience and generally involves a two-stage treatment program that can be applied to both children and adults and consists of two phases: Phase I is aimed at reducing lymphedema volume and mobilizing the increased interstitial fluid to normalize tissue homeostasis, and the aim of Phase II is maintenance and optimization of the therapeutic success. Earlier treatment is reported for the best results. 

The frequency and intensity of the components of CDT in Phase I and Phase II should depend on the clinical edema findings and Stage of the lymphoedema and be adapted to clinical changes. The isolated application of single components in Phase I is not recommended, and thus should be used in its entirety. 

Complete Decongestive Therapy is undertaken by a therapist who has undergone training at the specialist level and who combines the following components:

• Skin Care
• Manual Lymphatic Drainage (MLD)
• Multilayer Bandages
• Exercise
• Compression Garments
• Patient Education

• Compression Pumps (this is an optional adjuvant, and must be accompanied by Manual Lymph Drainage (MLD) conducted by therapists at the specialist level)).

After the initial treatment (Phase 1), which includes all the components and is applied daily and lasts several weeks, the next step is the maintenance treatment (Phase 2), which consists of compression by low-stretch garments, skin care, continued exercise, and MLD as needed. In this second phase, which is long-term, the patient is taught self-bandaging for maintenance, basic self-care of the skin, and exercise practice. Read about which country has the best public healthcare coverage of lymphedema HERE. 

The success of Complete Decongestive Therapy (CDT) depends on it being administered by an experienced certified therapist. CDT is considered safe, however, patients should consult with their physician before beginning treatment. Indications, contraindications, and the application of individual therapeutic measures depend on several factors: the stage of lymphoedema at the start of treatment, comorbidities, the age of the patient, and the patient’s individual life circumstances. 

Failure of Complete Decongestive Therapy (CDT) should be confirmed only when intensive non-operative treatment in a clinic specializing in the management of peripheral lymphedema and directed by an experienced clinical lymphologist has been unsuccessful. Read more about the signs, symptoms, and complications of lymphoedema HERE.

In no way should this highly specialized treatment be replaced, due to the possible serious side effects, by edema reduction treatments carried out by non-specialists. Aggressive reduction of swelling can cause skin and vessel damage, Isolated compression therapy of the extremities, particularly in patients with lymphedema also affecting the quadrants of the trunk, may cause displacement of edema and increase swelling at the root of the extremity, and may even lead to genital lymphoedema. 

IMPORTANT NOTICE

Lymphedema (Organic Lymphatic Vascular Disease) is due to impaired lymphatic drainage resulting in skin disease, characterized by persistent swelling, and abnormal thickening of the skin and subcutaneous connective tissue. Lymphedema is not just a localized swelling problem, but a condition that can affect multiple body systems, structures and functions, leading to a range of physical, physiological and psychosocial symptoms and complications. Read about the symptoms and complications of lymphedema HERE.

Lymphedema is a serious chronic and progressive disease due to lymphatic dysfunction. The clinical treatment of lymphedema is neither a cosmetic nor an aesthetic treatment. The treatment of lymphedema is to control its progression and alleviate the symptoms related to dysfunction of the lymphatic circulatory system. 

To prevent and avoid serious complications associated with treatment, such as the possible displacement of edema to previously unaffected areas when compression therapy is applied for volume reduction, patients should use highly specialized and experienced therapists. 

Professional qualification and instruction delivered remotely online are not the same as live hands-on practical instruction in the clinical training and certification of lymphedema therapists, similar to all other rehabilitation, medical, and surgical training programs, and especially for developing the necessary manual skills to treat a disease as complex as lymphedema. 

Patients should also take special care when choosing a Multidisciplinary Expert Center of Reference for Lymphedema, as not all countries and centers provide the same treatment options. The best choice is a center of reference that provides Complete Decongestive Therapy (CDT”, which is recognized as the Gold Standard treatment for lymphedema.

• Read about what are the principal functions of Manual Lymphatic Drainage HERE.

• Read about what are the main differences between the two principal lymphedema treatment protocols HERE. 

• Read about what are the strategies for the implementation of low-cost treatment options for Lymphedema HERE.

WHAT IS ELEPHANTIASIS / MYTHS AND FACTS

REFERENCES

(Click on the texts to read the research articles)

SCIENTIFIC SOCIETIES

• German Scientific Society Guideline: Diagnostics and Therapy of Lymphoedema.

PATHOPHYSIOLOGY

• lymphedema.
• Biology of Lymphedema
• Lymph vessels: the forgotten second circulation in health and disease
• Lymphatic Vessel Network Structure and Physiology
• Lymphatic System Flows
• Organ-specific lymphatic vasculature: From development to pathophysiology.
• The lymphatic vascular system: much more than just a sewer.
• The unresolved pathophysiology of lymphedema.
• Lymphedema: A Practical Approach and Clinical Update.
• Coagulation in Lymphatic System.
• Regulation of immune function by the lymphatic system in lymphedema.
• Oxidative stress in chronic lymphoedema.
• Regulatory T Cells Mediate Local Immunosuppression in Lymphedema.
• Hemostatic properties of the lymph: relationships with occlusion and thrombosis.
• Secondary lymphedema: Pathogenesis
• Gastrointestinal Lymphatics in Health and Disease
• Intestinal lymphangiectasia in adults
• Role of the lymphatic vasculature in cardiovascular medicine
• The lymphatic vasculature in disease
• Lymphoscintigraphic abnormalities in the contralateral lower limbs of patients with unilateral lymphedema.
• The Prevalence of Lower Limb and Genital Lymphedema after Prostate Cancer Treatment: A Systematic Review
• Peripheral Edema

CUTANEOUS COMPLICATIONS

• The lymphatic system and the skin. Classification, clinical aspects, and histology.
• Lymphedema and cutaneous diseases.
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.
• Serum Immune Proteins in Limb Lymphedema Reflecting Tissue Processes Caused by Lymph Stasis and Chronic Dermato-lymphangio-adenitis (Cellulitis).
• Lymphedema and subclinical lymphostasis (microlymphedema) facilitate cutaneous infection, inflammatory dermatoses, and neoplasia: A locus minoris resistentiae.

INFECTIOUS COMPLICATIONS

• Lymphatic Flow: A Potential Target in Sepsis.
• Infectious complications of lymphedema.
• Acute inflammatory exacerbations in lymphoedema.
• Inflammatory Manifestations of lymphedema.

CELLULITIS / DERMATOLYMPHANGIOADENITIS

• Cellulitis.
• Clinical features, microbiological epidemiology, and recommendations for the management of cellulitis in extremity lymphedema.
• Challenges of cellulitis in a lymphedematous extremity.
• Diagnosis and management of cellulitis.
• Cellulitis risk factors for patients with primary or secondary lymphedema.
• Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg.
• Prevention of dermatolymphangioadenitis by combined physiotherapy.
• Erysipelas: a common potentially dangerous infection.

TUMOURS

• Malignant tumors as complications of lymphedema.
• Lymphedematous areas: Privileged sites for tumors, infections, and immune disorders.
• Lymphedema-related angiogenic tumors and other malignancies.
• Lymphedema: an immunologically vulnerable site for the development of neoplasms.
• Lymph stasis promotes tumor growth
• A retrospective analysis of Stewart-Treves syndrome in the context of chronic lymphedema.
• Stewart-Treves Syndrome

PAIN

• Congenital lymphedema complicated by pain and psychological distress: case report
• Lymphatic Pain in Breast Cancer Survivors
• Does Manual Lymphatic Drainage Have Any Effect on Pain Threshold and Tolerance of Different Body Parts?
• Lymphedema therapy reduces the volume of edema and pain in patients with breast cancer
• Quality of life in patients with primary and secondary lymphedema in the community

TREATMENT

• Treatment of limbs lymphedema.
• Nonoperative treatment of lymphedema.
• Lymphedema: From diagnosis to treatment.
• Lymphedema-clinical picture and therapy.
• Physiotherapeutic rehabilitation of lymphedema: state-of-the-art.
• Diagnosis and management of lymphatic vascular disease
• Effective treatment of lymphedema of the extremities.
• Lymphoscintigraphic aspects of the effects of manual lymphatic drainage.
• Intensive Treatment of Lower-Limb Lymphedema and Variations in Volume.
• Effectiveness and safety of Complete Decongestive Therapy of Phase I.
• Therapeutic Efficacy of Complex Decongestive Therapy in the Treatment of Elephantiasis of the Lower Extremities.
• Effects of Phase I complex decongestive physiotherapy on physical functions and depression levels in breast cancer-related lymph edema.
• Does lymphoedema bandaging reduce the risk of toe ulceration?
• Study of 700 referrals to a Lymphedema Program.
• Worldwide assessment of healthcare personnel dealing with lymphoedema.
• Földi M, Földi E. Földi’s textbook of lymphology for physicians and Lymphoedema therapists.
• Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients
• Visualization of Accessory Lymphatic Pathways, before and after Manual Drainage, in Secondary Upper Limb Lymphedema Using Indocyanine Green Lymphography
• The risk of genital edema after external pump compression for lower limb lymphedema.
• The management of genital lymphoedema
• The management of deep vein thrombosis in lymphoedema: a review.
• Lymphedema-associated comorbidities and treatment gap.

COMPRESSION GARMENTS

• A study of the advantages of elastic stockings for leg lymphedema.
• Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement.
• Medical compression stockings for chronic venous diseases and lymphedema: Scientific evidence and results of a patient survey on quality of care.
• Impact of Compression Therapy on Cellulitis (ICTOC) in adults with chronic edema: a randomized controlled trial protocol.
• Compression Therapy Is Cost-Saving in the Prevention of Lower Limb Recurrent Cellulitis in Patients with Chronic Edema.
• Occupational leg edema-use of compression stockings.

DISABILITY

• Disability and lymphedema.
• Lymphedema and employability.
• Worse and worse off: the impact of lymphedema on work and career after breast cancer
• Functioning in lymphedema from the patient's perspective using the International Classification of Functioning, Disability and Health (ICF).
• Unilateral upper extremity lymphedema deteriorates the postural stability in breast cancer survivors
• Postural Stability in Patients with Lower Limb Lymphedema
• Disability, psychological distress and quality of life in breast cancer survivors with arm lymphedema

DISFIGUREMENT

• Adjusting to disfigurement: processes involved in dealing with being visibly different
• Quality of Life in Cancer Patients with Disfigurement due to Cancer and its Treatments
• Quality-of-life and body image impairments in patients with lymphedema
• Association of lower extremity lymphedema with pelvic floor functions, sleep quality, kinesiophobia, body image in patients with gynecological cancers

QUALITY OF LIFE

• The impact of lower limb chronic oedema on patients' quality of life
• Quality of life in patients with primary and secondary lymphedema in the community
• Evaluating the effect of upper-body morbidity on quality of life following breast cancer treatment.
• Functionality and quality of life of patients with unilateral lymphedema of a lower limb: a cross-sectional study
• The effect of complete decongestive therapy on the quality of life of patients with peripheral lymphedema

PSYCHOSOCIAL IMPACT

• Psychosocial Impact of Lymphedema.
• Associations between chronic disease, age and physical and mental health status
• A network analysis of psychological flexibility, coping, and stigma in dermatology patients
• 'Abandoned by medicine'? A qualitative study of women's experiences with lymphoedema secondary to cancer, and the implications for care
• People are neglected, not diseases.
• Chronic edema/lymphoedema: under-recognized and under‐treated.
• Lymphatic Medicine: Paradoxically and unnecessarily ignored.
• Medical education: a deficiency or a disgrace.

PEDIATRIC LYMPHEDEMA

• NORD: Rare Disease Database - Lymphedema
• Medical management of lymphedema.
• Primary lymphedema in childhood.
• An approach to familiar lymphedema
• Pediatric Children Lymphedema
• Primary Lymphedema French National Diagnosis and Care Protocol (PNDS).
• Lymphatic filariasis: an infection of childhood.
• Lymphatic filariasis in children: clinical features, infection burdens and future prospects for elimination.

LYMPHATIC FILARIASIS / PODOCONIOSIS

• Podoconiosis: Clinical spectrum and microscopic presentations.
• Podoconiosis: A Possible Cause of Lymphedema in Micronesia.
• A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis, and leprosy.
• The impact of acute adenolymphangitis in podoconiosis on caregivers.
• Neglected tropical diseases and disability-what is the link?
• Locomotor disability in bancroftian filarial lymphoedema patients.
• Neglected patients with a neglected disease?
• Neglected tropical diseases and mental health: a perspective on comorbidity.
• People are neglected, not diseases.
• Addressing Inequity: Neglected Tropical Diseases and Human Rights.
• Neglected Tropical Diseases, Conflict, and the Right To Health.

BLOOD VASCULAR SYSTEM 

• Peripheral Edema
• Phlebolymphedema
• Understanding Chronic Venous Disease: A Critical Overview of Its Pathophysiology and Medical Management
• Role of the lymphatic vasculature in cardiovascular medicine
• Communication between lymphatic and venous systems
• Phlebopathies and occupation
• Phlebopathies and workers
• Evidence of health risks associated with prolonged standing at work and intervention effectiveness
• Leg edema formation and venous blood flow velocity during a simulated long-haul flight