Flexitouch Info for Users with Bilateral Involvement

Binney this is mostly directed towards you since I'm not aware of anyone else on the forums with bilateral involvement using the Flexitouch.  You had sent me a question in another post regarding concern about the Flexi potentially pushing fluid over the watershed to the contralateral side. 

Binney4 wrote: "Along that same line, I have a Flexitouch question for you. At the "top" of the cycle (the last two inflations on the chest) it seems to be directing flow to the opposite side (across the watershed) rather than up toward the cleared neck nodes. Have you noticed that? I've never had it actually create swelling on the opposite quadrant, but because it concerns me I put a folded cloth under that last section so it doesn't compress there. What's your experience?"

I happened to have a discussion with my therapist recently about this issue and she contacted our Flexitouch rep who got back with me today. The rep had obtained an indepth response from their inhouse CLT Alison Golla.  I don't think they will mind me sharing her information with you and the board.  It might be helpful for other Flexi users who also have an at risk side or active bilateral LE.

"Yes, a portion of the fluid will be directed towards the contralateral upper quadrant as the device was originally designed for the treatment of unilateral lymphedema. But the larger portion will be directed to the lymph nodes along the core of the body - along the sternum and intercostals and down past the transverse watershed so that the functioning and healthy inguinal nodes can manage the fluid.

The principles of design are to move the fluid towards the contralateral lymph node group AND ipsilaterally to the adjacent healthy truncal quadrant as in MLD. Many clinicians, however, prescribe the Flexitouch to treat bilateral lymphedema. These bilateral patients are demonstrating very positive outcomes. Treatment with the Flexitouch has a "systemic affect" so it increases fluid absorption, lymphangiomotoricity (lymph transport) and decongestion overall. In addition, because the system treats the trunk, the deeper lymphatics become stimulated via a chain reaction and fluid is "pulled" directly into the trunk by these larger central vessels.

When treating bilateral patients, it is sometimes appropriate to recommend an additional/supplemental treatment program for the trunk, U2 (trunk only) or U3 (trunk and chest) - this theoretically "squeezes the sponge" in the center of the body to allow the sponge to pull and absorb the fluid from the periphery (arm). The additional trunk program provides any necessary additional clearing and drainage. We have good anecdotal reports of the positive impact additional trunk treatments can provide for bilateral patients. So if she would like this as an option, they would run U1, followed by U2 for trunk only (15 min program), or U3 for chest and trunk (24 minute program), so it does take a bit of extra time. Alison"

I think this explanation makes sense and the fact that the Flexitouch stimulates our entire lymphatic system including the deeper lymphatics should outweigh any minimal fluid transfer to the contralateral quadrant.  I had recently been running an extra U2-Trunk treatment following my standard U1 treatment and its gratifying to get confirmation that it may be beneficial to do so. Binney, your folded cloth solution should still be appropriate for limiting movement contralaterally.  You could still add the second U2 treatment also for good measure.  Personally, since we are concerned about the chest garment moving fluid contralaterally I don't think I would run a second U3-Chest treatment unless it would further improve overall fluid movement out of the extremities and encourage deep system stimulation.  I think trialing using just an additional U2 or the U3 which includes both chest/trunk, and see if there is any noticeable difference might be worthwhile.  Just depends on how much extra time we have to devote to a Flex session! 

Hope this helps!