Risk Reduction from Germany: avoid neural therapy/accupuncture

kira66715 · January 2012

Doing some research and found this page, from a comprehensive German LE clinic--actually the home of the Vodder School in Austria:

http://www.lymphedema-clinic.com/navid.52/exercises-arm.htm

5 pillars of treatment

Practical tips and precautions lymphedema of the arm

Lymphoedema of the arm frequently occurs in the wake of treatment for breast cancer. Lymph nodes are removed in the course of surgery and/or radiotherapy, resulting in damage to the lymphatic system. Special recommendations have been defined for cancer patients in aftercare, which are intended to help avoid or at least delay the development of arm lymphedema.

1. At home and at work

- Avoid any injuries, overexertion, heat and cold
- Be careful using kitchen knives
- Be careful when sewing - always use a thimble
- Do not wash dishes in hot water
- Always use oven mittens when working at a hot stove or oven
- Avoid carrying heavy shopping bags
- Be careful when ironing
- Avoid using the hand of your swollen arm to hold cigarettes
- Avoid wearing a wrist watch on your swollen arm
- Always wear arm sleeves or rubber gloves when working in the household

2. Clothing

- Ensure that the straps of your bra do not cut into your shoulder or chest
- Wear the lightest possible breast prosthesis

3. Beauty treatment and body care

- Try to keep as clean as possible and care for your skin thoroughly
- When doing your fingernails, avoid cutting away the nail folds
- Be careful when filing
- Avoid pushing back or cutting away the cuticles
- Avoid using any irritating or allergenic cosmetic products
- Avoid using the sauna
- Avoid sun-bathing
- When massaging, avoid kneading the arm

4. 4. At the hairdresser

- Ensure that your shoulders and arms are protected from heat radiated by the dryer hood

5. In the garden

- Avoid injuring yourself when working in the garden (by prickles, thorns or tools)

6. With household pets

- Be sure to avoid any bites or scratches to the swollen arm

7. Sports and recreation

- Avoid overexerting yourself
- Avoid exposure to heat or cold
- Avoid injuring yourself
- While swimming is one of the activities recommended in therapy, avoid overexerting yourself when doing so

8. Food and nutrition

- Maintain your target weight
- Make sure you are getting a balanced diet (meat, vegetables and fresh fruit)
- Limit your intake of table salt as far as possible

9. During the day

- Perform your special gymnastic exercises with the arm sleeve from time to time
- Wear the arm sleeve prescribed by your doctor

10. During the night

- Prop up your swollen arm in bed

11. When planning a vacation

- Avoid destinations where insects are prevalent
- Be sure to wear compression stockings when traveling by plane

12. At the doctor's

- Avoid having your blood pressure taken on the side of your body that has been treated by surgery or is swollen
- Avoid having injections administered (to the skin, muscles, veins or joints) on the side of your body that has been treated by surgery or is swollen
- Avoid injections to the surgical scar
- Avoid having blood samples taken from the side of your body that has been treated by surgery or is swollen
- Avoid acupuncture or neural therapy to the side of your body that has been treated by surgery or is swollen

13. Immediately consult your doctor:

- If your swollen arm becomes infected (fever, reddening of the skin, shivers)

Leah_S · January 2012

Thank you, Kira!

Could you ask the mods to pin this thread?

Leah

cookiegal · January 2012

yikes!

It's like they are talking to me with the neural therapy!

kira66715 · January 2012

Cookie, it's the first time I ever saw it mentioned.

I'm not trying to second guess you, but I did think of you.

Their web site is kind of fascinating, they're in an in-patient clinic in Austria, allied with the Vodder School.

I think because there was translation involved, the risk reductions need to be clear about at risk and swollen limbs, as they use them interchangably.

I've been writing an article on diagnosis of LE, and found this when looking for photos and references--forget pubmed when you can google...

Kira

Nitocris · February 2012

Hi,

I found the same precaution regarding acunpuncture on the web site of the Royal United Hospital, Bath, UK.

AVOID INFECTION AND INJURY

The skin is covered in germs and a break in the skin can let germs in. With fewer lymph nodes there is a decreased ability to fight off germs and thyis can lead to an incrased risk of developing an infection in the affected area. An infection could trigger the start of lymphoedema. So:

Wear long sleeves and gloves when gardening
Wear gloves for washing up
Take care when cutting nails
Wear insect repellent to avoid bites
Exercise care whilst shaving always use an electric shaver as razors can cut the skin
Avoid having injections or blod taken from the affected arm. For people who have had surgery to both armpits blood samples may be obtained from the feet or legs
Avoid having your blood pressure taken from the affected arm
Avoid acupuncture to the affected side
Try to avoid pet scratches

Here is the link: the text in on page 3. They only mention acupuncture. I don't know how common the use of neural therpy is in the UK. In Germany, an estimated 35% of physicians use this therapy to some extent.

http://www.ruh.nhs.uk/patients/services/breast_unit/documents/Lymphoedema_Advice.pdf

Take care

Nitocris · February 2012

Hi,

I sent an e-mail to the Wittlinger Klinik to ask some precisions and here is the answer of Dr. Susanne Schmidt. (posted with her permission):

When reading your Directives, one point particularly called my attention. No. 12 "at the doctor's " - it says to avoid acupuncture or neural therapy to the side of your body that has been treated by surgery or is swollen. So far, I have only found information recommending to avoid acupuncture to the affected arm.
So, when you say "left side", do you mean the whole upper quadrant, front and back?
Avoiding acupunture and any kind of injection at the part of your body that is affected by lymphoedema is a precaution not to risk any inflammation or infection eventually caused by injuring the "surface". Therefore the chest or back is not necessarily to be avoided in combination with the arm. If only the arm is affected the rest of the body can be treated with acupuncture .
About neural therapy: it involves the injection of Procaine (Novacain) in various but specific areas. I would like to know what is the danger of such a procedure for a lymphedema patient. Is it, again,because of the needle or is it because of the product injected? What kind of reaction does it trigger? If a patient has an injection in the lower back because of chronic pain there, can it worsen lymphedema in the arm for instance?
As I described regarding acupuncture and lymphoedema, it is the same with neural therapy: Just the injection and possible inflammation in the oedema arm is the risk to be aware of.
Kind regards
Dr. Susanne Schmidt
Medical director

Hope this helps Smile

kira66715 · February 2012

Nitocris, as this is the medical director from the primary Vodder school in Austria, I find it very troubling that she doesn't recognize the quadrants.

And from what Cookie said, neural therapy didn't involve procaine, but glucose water.

Robert Harris is the head of the Vodder School in the US, and I doubt he would agree with this answer.

Kira

Nitocris · February 2012

Kira,

When we get answers from a source which we think is a reliable one, we don't necessarily have a cautious approach. Posting on this Board not only allows us to share but also to verify information and correct it when necessary. Thank you for your input.

Take care

Binney4 · February 2012

Nitocris, how great that she took the time to answer your questions so thoroughly. She'll be a good resource for you and for your new support group moving forward. It always surprises me how these busy LE professionals will take the time to respond to patients. Maybe it's because LE is such a little backwater of the medical world! Laughing

I think there's a lot of confusion/controversy on this issue in the LE world, because there are no "Western-medical-style" studies on LE and acupuncture (though there's at least one in progress). The opinions range from "no problem!" to "no unnecessary needles anywhere on the body" since any skin puncture is a challenge to the overall lymph system. Probably the truth lies somewhere in between. A chinese doctor I talked to at the NLN conference thought any American-trained acupuncurist was a danger, but one trained rigorously in China was not!

So we wait -- again! Undecided -- for research to help us solve these sticky issues.

Thanks for sharing her responses. I hope this will be a long and mutually helpful relationship for you.

Hugs,
Binney

Risk Reduction from Germany: avoid neural therapy/accupuncture

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