Joining forces

The interaction of experts in many fields is required for successful lymphedema treatment. Prof. Dr. Bram Balduyck, Belgian Vascular Surgeon, explained during the Lymphology Workshop which experts are needed. Of course, patients play a crucial role because their motivation for lengthy treatment and compliance makes an absolute difference.

Lymphology is a team effort. Prof. Dr. Bram Balduyck, Belgian Vascular and Thoracic Surgeon, emphasized this. In his presentation “The significance of multi-disciplinary cooperation when treating (lymph)edema patients”, he described who should be part of this lymphology team. The background for his explanations is his work at Decockliniek in Willebroek, which specializes in treating edema patients.

The first group of team members consists of physicians. But what type of physicians? Asked and answered: This would mainly be vascular surgeons, of whom there are 320 in Belgium, but just 15 with a specialization in lymphology. However, successful treatment depends entirely on the correct diagnosis, according to the speaker. Too many cases are classified as primary lymphedema. Dr. Balduyck reported that he and his colleagues have to correct this for many patients and change the diagnosis to secondary lymphedema. It is also important to get the stage right because a patient in Stage I is not the same as a patient in Stage IV.

“Successful treatment absolutely depends on a proper diagnosis. Too many cases are classified as primary lymphedema.”

Prof. Dr. Bram Balduyck

Being aware of contraindications
Physical therapists are the second group in the lymphology team. According to Dr. Balduyck, there are around 1,500 physical therapists in Belgium but only a few of these are specialized in edema treatment, and these few are hard to find. The vast majority of physical therapists uses the Vodder Method. The Leduc and Belgrado Methods are much less popular.

Dr. Balduyck named bandaging experts as the third group. When prescribed by a specialist, compression stockings from classes III and IV will be reimbursed up to 80% by the statutory health insurance fund. For patients under the age of 15, this also applies to Class II stockings. Patients can be prescribed a maximum of four pairs per year.

Reasons for poor compliance
Dr. Balduyck then got to the major group in the team – the patients. First he asked what reasons there might be for non-compliance with compression stockings, then summarized these reasons in five clusters: physical limitations (strength, age, obesity), insufficient understanding of the treatment and its duration, a lack of comfort (itching, heat, poor fit), financial aspects, as well as psycho-social reasons, such as appearance.

Shoes are often underestimated in their importance. But in addition to the difficulty of even finding shoes that fit and look reasonable, poor footwear can affect patients’ gait as well as posture and make the edema worse. Dr. Balduyck pointed out that foot arch support should definitely be considered for edema patients.

“Improper footwear can also negatively impact the patient’s gait and posture, which can worsen the edema condition. This is why foot arch supports should definitely also be considered for edema patients.”

Prof. Dr. Bram Balduyck

Specialist literature cannot quite agree on the role exercise plays in all this. What is always being discouraged is running on hard ground, rowing, sit-ups, push-ups, tennis, or basketball … But positive recommendations are not being provided. Bearing in mind that lymphedema treatment is a lengthy process, it is crucial to maintain patients’ motivation. Exercise can help with that and have a positive impact on weight management as well. He and his colleagues recommend swimming, Nordic walking, cycling, and yoga – always with the advice to ensure sufficient hydration, a proper warm-up, and not to overdo it. He asked those present whether patients should be wearing their compression stockings during exercise or not. During practice, this would depend on the individual case. There is no specific recommendation.

The future of lymphedema treatment
At the end, Dr. Bram Balduyck looked at the future of lymphedema treatment and described two perspectives. One of those focused on the multi-disciplinary cooperation in the lymphology team as described, which can also include nutritionists and psychologists – a concept with which the Decockliniek has had good experience. The second addressed current developments in Oncology, where the treatment concept for certain types of cancer often includes immune therapy. Knowledge relating to the significance of lymph nodes – which used to be removed without question – has increased. Experts now understand that removal of lymph nodes impairs the success of immune therapy because it weakens the immune response. Preserving tumor-free lymph nodes not only has a positive influence on cancer treatment but can also prevent the development of secondary lymphedema. “There is something big happening at the moment,” emphasized Dr. Balduyck.

Pictures: Andreas Wetzel, Bauerfeind AG, AdobeStock