jueves, 31 de octubre de 2019

FOCUS ON THE TERM ELEPHANTIASIS AND ITS IMPLICATIONS FOR LYMPHOEDEMA - Pediatric & Primary Lymphoedema - Secondary Lymphoedema - Lymphatic Filariasis & Podoconiosis - Rare Disease

Although elephantiasis is the outcome consequence of non-treatment or under-treatment of lymphedema (lymphatic dysfunction), it is perceived in many health-related texts that elephantiasis is linked only to filariasis, thereby putting the incidence and prevalence due to other causes second.

Elephantiasis is also sometimes projected as if it were an isolated disease, of sudden onset or with no apparent cause, and that the best first-line treatment option in developing counties is basic patient self-care (washing and elevation of limbs), or surgery by radical debulking technique (Charles Procedure) if the first treatment option is unresponsive. Read more about what is the best treatment option for lymphedema HERE.

This approach to medical and health care of lymphedema is very important, as it implies no need for the "Conservative Treatment" option. Most lymphedema patients in developing counties 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, and others try to survive with severe infections such as dermatolymphangioadentitis-ADLA (Infectious Cellulitis), sepsis or malignant complications. Read more about what is the risk of dermatolymphangioadenitis (Infectious Cellulitis) HERE.

Many health texts mention the incidence of the population affected by elephantiasis due to filariasis in poor countries, 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 and has 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 subjectively implies 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 also implies that there is no need to treat lymphatic dysfunction early and 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 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 structural and functional impairments of lymphedema HERE

(Pinch on the texts to read the following Research Articles)



(click on the texts) 

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