lunes, 18 de marzo de 2024

WORLD PODOCONIOSIS DAY 2024 - MARCH 18TH - CHRONIC ESTABLISHED LYMPHEDEMA - Organic and Physical Impairment - Lymphatic Vascular Disease - Secondary Lymphedema - Best Practices Management Guideline - Treatment Protocol - Patient Care Pathway - Awareness Campaign


March is "World Lymphatic Vascular Disease Awareness Month" which includes Podoconiosis as a disease related to Lymphatic dysfunction. March 18th aims to raise awareness about podoconiosis, a disease that affects the Lymphatic Vascular System, and teach people that this disease is easily treatable nowadays. The majority of cases of podoconiosis that progress to the Elephantiasis Stage are due to a lack of treatment or undertreatment of lymphedema. 

The United Nations General Assembly endorsed a resolution urging countries to aim towards the goal that everyone, everywhere, should have access to quality health care, and proclaimed the Universal Health Coverage Day (UHC Day) by resolution 72/138. To this day, millions of people all over the world are suffering from nontreatment or undertreatment of Lymphedema, and are still waiting for adequate and effective health care, and many of them are already in the very severe stages (Elephantiasis). 

Lymphedema (Organic Lymphatic Vascular Disease) is a neglected disease in many countries, especially in the world's poorest communities. Like other neglected chronic diseases, inaccessibility to the treatment of lymphedema, or the implementation of low-cost alternative solutions due to the cost-saving policies of some national health systems, can lead to the progression of the disease to its most advanced degree of severity called "Elephantiasis". For patients, this means further disfigurement, disability, discrimination, loss of income, and loss of quality of life (QoL) as can be assessed with the ICF model (International Classification of Functioning, Disability, and Health). Read more about why the world is failing to treat a treatable condition like Elephantiasis HERE.

The use of footwear is very important for the prevention of Podoconiosis, but once chronic lymphatic dysfunction (lymphedema) is established, shoes alone are not enough to stop the progression of the disease. Scientific studies highlight the importance of compression therapy in controlling the progression of lymphedema. Clinical results of interventions to control lymphoedema show that simple hygiene-based measures (skin care, exercises, elevation of affected limbs, and use of footwear) are necessary, but these alone are not enough to reduce the volume and size of the extremities.

For the maintenance phase of lymphedema management, compression is the most important intervention. Compression garments (Orthotic Devices) are easy to use and achieve significant improvements in most patients without causing much discomfort. The beneficial value of applying compression stockings in the treatment of venous and lymphatic disease is supported by recommendations rated as Grade 1 evidence. 

The daily use of standard bandages for lymphedema is not practical, for they tend to loosen and slip off when undertaking work that requires continuous physical activity, and likewise, dirty bandages can also be an important source of infection.

Self-management strategies according to the chronic care model (CCM), where patients with chronic diseases should assume a leading role in their treatment to improve health status, daily functioning, and quality of life, should not be a substitute for the adequate and necessary clinical treatment that a disease requires.

Lymphedema of the limbs and genitalia should always be treated in its early stages, and not left untreated until they reach Stage III (elephantiasis), and then resorting to aggressive surgeries. Radical reductive ablative surgery (Charles Procedure), aimed to remove the diseased skin and subcutaneous tissue in the elephantiasis stage, should always be the last option for it is frequently associated with significant blood loss, morbidity, infections, permanent disfigurement, and recurrence of symptoms. Read more about the best treatment for Elephantiasis HERE.

Concerning “Dermatolymphangioadenitis” (DLA), also known as Infectious Cellulitis, studies have shown that swelling control is associated with a lower risk of cellulitis, that advanced degrees of chronic edema are a strong risk factor, and that "Compression Garments" are essential. Infectious cellulitis can lead to sepsis (Septicemia). Read more about the risk of Infectious Cellulitis for Lymphoedema HERE.

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