Questions about fibrosis

Carol, that would great if we had a travelling "learning clinic" that went all over, especially to places outside metro areas. On the other hand, I do know several gals who are attending the NLN, and maybe someone could ask about fibrosis? And using different forms of MLD? :-)




I will email my therapist next week and talk with her at my appt on Friday, but I was curious as our group knowledge.

Thank you for taking my questions with you! I had the same thought about a question list when I read your response, Binney. You may get a lot.

You are always right on top of things, Carol! I love that about you.

I saw my therapist yesterday and she answered all of my questions!! 




First of all, fibrosis is something that can be felt more than seen. It is not the same as pitting. Normal skin will be soft and immediately bounce back when touched. Fibrosis feels firm. I asked whether one could confuse with a flare, since that will often feel firm, (i.e, when my forearm swelled). She said a flare will subside with MLD, but certain locations such as the forearm are likely areas for fibrosis. I asked if fibrosis was inevitable and she said no, not if the areas of LE are kept soft, which means doing MLD and wearing compression garments (day or night).




I told my therapist how some of us have had "show and tell" with our garments and discussions about wrapping techniques. I told her I watched the Rovig DVD and noticed some differences in MLD technique from what she had taught me and wondered if I could combine techniques. I mentioned that the half circle move (Vodder technique) I usually do on my trunk is more awkward for me to do on my arm. I tried Rovig's method on my arm and had more success, but I didn't bring the fluid toward the neck as shown on DVD. When done clearing arm, I took it down to the inguinals again like I was taught. She said it is fine to combine techniques, as long as the main sequence of clearing the trunk was done first (I have to clear both sides down to the inguinals as my left side of chest has occasional swelling even though I didn't have sentinel node taken on that side). She felt as long as the trunk was clear and I followed the same path I had been using I would be fine.




I then asked about the slower more deep movement for fibrosis shown on the DVD, as I have been fearful of pressing too hard and damaging the lymphatics. She said as long as MLD has been done first to clear the whole area, then you can work a little more deeply in areas of fibrosis or areas that are more stubborn with retaining fluid, like the parts on the palm of my hand or forearm. Also told me not to spend a lot of time working on the area, just a couple of minutes and then move on.




I asked about the difference between fibrosis and scarring. She said fibrosis is extra collagen laid down irregularly. I said I understood it is the enemy and one is more likely to get cellulitis if you have. She said, yes, it creates areas that cannot receive the proper support from the immune system, which will make the arm more prone to infection. The body isn't able to protect that spot from bacteria and may develop cellulitis. 




I said when I was doing myofascial release therapy for my chest (I had implants then) the MFR therapist explained that the fascia is made of collagen. It exists like a net in several layers throughout the body, below the skin and within the fibers of the muscle, even among the internal organs. My LE therapist nodded in agreement. I said when the MFR therapist worked on my chest I often experienced a decrease in swelling in my trunk.  He worked on the scarring on my chest from the recon but also on the capsule surrounding the implants. My LE therapist then corrected my use of the term "scar" tissue, said the myofascial therapist mainly works on what are considered adhesions (oops, yes, she is right) or an area of restriction where connective tissue is stuck together. The adhesions can also affect nearby areas, so it is likely that I experienced a reduction in truncal swelling as releasing the chest restrictions allowed the lymphatics the proper space to drain. They were no longer being compressed because of tightness around the implant/breast area. 




 I asked if the collagen of fibrosis is the same as in the collagen of fascia. She said that the area of fibrosis occurs just below the skin, whereas the fascia is located a little more deeply within the layers of the skin. 




I came away from the discussion vowing to myself to be consistent with MLD (and aerobic exercise) - need to remove any garbage or stagnant fluid and keep my chest and arm functioning as well as possible. Even though my therapist says I am at the point of stability where I can experiment with not wearing compression garments, it made me think MLD will always be important. She didn't say this, but the conversation gave me a sense of how vital it will be if I want to wear compression as little as possible. When looked at this way, yes, MLD each day is a drag, however, it's preferable to the alternative. Time will tell, and I may be wrong, but armed with this info, I am on a mission to reduce my need for compression. My new mantra:  MLD each day, will keep the garments away.