jueves, 31 de octubre de 2019

FOCUS ON THE TERM ELEPHANTIASIS AND ITS IMPLICATIONS FOR LYMPHEDEMA - Organic Lymphatic Vascular Disease - Pediatric & Primary Lymphoedema - Secondary Lymphoedema - Lymphatic Filariasis & Podoconiosis

Although in most cases the elephantiasis stage is the consequence of untreated or undertreated lymphedema (lymphatic dysfunction), this term is linked in many health-related texts only to filariasis, thereby putting the incidence and prevalence due to the other causes in second place.


Elephantiasis is also sometimes projected as if it were an isolated disease, or of sudden onset, and the best first-line treatment option in developing countries is basic patient self-care (washing and elevation of limbs and footwear), or surgery by radical debulking technique (Charles Procedure) if the first treatment option is unresponsive. The necessary specialized treatments and compression garments for lymphedema are not contemplated here.




This approach to elephantiasis (Stage III lymphedema) is very important, as it implies no need for health care interventions. Most lymphedema patients in developing countries do not receive specialized treatment or compression garments, and when they reach the stage of maximum severity, elephantiasis, some are operated on with radical excision surgery for volume reduction. many patients suffer severe infections such as dermatolymphangioadentitis-ADLA (Infectious Cellulitis), sepsis, or malignant complications. Read more about what is the risk of infectious cellulitis HERE.


Many health texts only mention the incidence of the population in poor countries affected by elephantiasis related to filariasis, but say nothing at the same time about the millions of people suffering from Primary Lymphedema and Secondary Lymphedema due to other causes in these same regions, who also live in dramatic conditions of under-treatment and to the extent of elephantiasis.




On a medical level, if a disease manifests with pain or serious complications, it is considered a priority healthcare issue that needs prompt and regular treatment. As for elephantiasis, if it is presented as primarily related to filariasis, this may lead to the perception that it is not a risk factor for the other causes of lymphedema. 


If elephantiasis is also presented as a disease in itself or of spontaneous onset, this may lead one to believe that there is no need to treat lymphatic dysfunction (Organic Impairment) early in its initial stages. See a video of elephantiasis treatment HERE.


There are still numerous protocols and clinical practice guidelines that also define lymphedema/elephantiasis as a non-painful condition, without serious complications, or not needing clinical treatment. This is one of the reasons why health systems in some countries are not creating Specialized Lymphedema Units, and why many patients have to self-treat for the reduction of their edema. Read more about which country has the best public healthcare coverage of lymphedema HERE.


It is very important to clearly define what is lymphedema and its symptoms,  what are the complications, what is basic daily self-care, and what are the best treatment options for lymphatic dysfunction. Read more about the signs, symptoms, and functional impairments of lymphedema HERE




IMPORTANT NOTICE 

Lymphedema is a serious chronic and progressive disease due to lymphatic dysfunction (Organic Lymphatic Vascular Disease). 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 more about what is the best treatment option for Lymphedema HERE.
  • 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.

REFERENCES

(Click on the texts to read the research articles)

SCIENTIFIC SOCIETIES

PATHOPHYSIOLOGY

CUTANEOUS COMPLICATIONS
INFECTIOUS COMPLICATIONS
CELLULITIS / DERMATOLYMPHANGIOADENITIS
TUMOURS

TREATMENT

COMPRESSION GARMENTS

DISABILITY

DISFIGUREMENT

PSYCHOSOCIAL IMPACT

PEDIATRIC LYMPHEDEMA

LYMPHATIC FILARIASIS / PODOCONIOSIS











  • WHAT KIND OF DOCTOR TREATS LYMPHEDEMA/LYMPHOEDEMA - WHICH MEDICAL SPECIALITIES ARE RELATED TO LYMPHEDEMA












LYMPHEDEMA INCIDENCE 
AND PREVALENCE
(click on the texts) 






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